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研究生:吳星皜
研究生(外文):WU, XING-HAO
論文名稱:高齡中風者其失能嚴重程度與生活品質和醫療資源利用相關聯性之探討
論文名稱(外文):A study on Health Related Quality of Life and Health Care Resource Utilization among elderly stroke patients with severity of disability
指導教授:翁世峰
指導教授(外文):WENG, SHIH-FENG
口試委員:何宗翰梁富文
口試委員(外文):HO, CHUNG-HANLIANG, FU-WEN
口試日期:2021-08-24
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2021
畢業學年度:109
語文別:中文
論文頁數:118
中文關鍵詞:高齡者中風失能生活品質醫療資源利用
外文關鍵詞:elderlystrokedisabilityquality of Lifehealth care resource utilization among
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研究目的
根據世界衛生組織(WHO)相關報導內容指出腦中風是主要造成全球人口死亡與失能的原因之一。台灣衛福部統計結果也顯示國人十大死因中腦中風為第3位,腦中風好發的年齡層為60至79歲,且腦中風容易造成失能等問題,因此本研究之研究對象為高齡者進而探討高齡者中風者其失能的嚴重程度與生活品質和醫療資源利用的相關連性,並了解高齡中風者不同失能嚴重程度之間相關因素的差異。

研究方法
本研究使用臺灣國民健康訪問調查(NHIS)資料庫並選取其2013年年齡大於65歲以上且有中風的高齡者,失能嚴重程度依照量表可區分ADL(日常生活活動評估)和IADL(工具性日常生活活動評估)兩種分類,本研究將其各自再區分為ADL無限制至輕度限制、ADL中至重度限制; IADL無限制至輕度限制、IADL中至重度限制。統計方法採用卡方檢定、獨立樣本T檢定、複迴歸及邏輯斯迴歸分析,探討高齡中風者其失能嚴重的生活品質與醫療資源利用之關聯性。

研究結果
研究樣本為65歲以上的腦中風高齡者,經排除後樣本數為156人,腦中風高齡者依相關量表將失能嚴重程度分組為:ADL程度不嚴重至輕度嚴重共125人,ADL程度中至重度嚴重共31人;IADL程度不嚴重至輕度嚴重共98人,IADL程度中至重度嚴重共58人。在生活品質(EQ-5D)方面,失能嚴重程度(ADL)(IADL)為中至重度嚴重的生活品質分數比失能程度為不嚴重至輕度嚴重分別低4.70分(95%CI:-4.95,-4.46,P<0.001)與低3.45分(95%CI:-3.60,-3.30,P<0.001);在生活品質(EQ-VAS)方面,失能嚴重程度(ADL)(IADL)為中至重度嚴重的生活品質分數比失能程度為不嚴重至輕度嚴重分別低8.78分(95%CI:-12.13,-5.42,P<0.001)與低9.90分(95%CI:-12.08,-7.71,P<0.001)。在醫療資源利用方面,與失能嚴重程度(ADL)(IADL)不嚴重至輕度嚴重的人相比,失能嚴重程度(ADL)(IADL)中至重度嚴重在過去一年內急診利用的機率分別為3.05倍(95%CI=1.92~4.86,P<0.001)與2.67倍(95%CI=1.92~4.86,P<0.001);在過去一年內住院利用的機率分別為3.89倍(95%CI=2.43~6.22,P<0.001)與3.25倍(95%CI=2.33~4.52,P<0.001);在過去一個月內西醫門診利用的機率分別為1.98倍(95%CI=1.61~2.62,P<0.05)與1.36倍(95%CI=1.01~1.85,P<0.05);在過去一個月內中醫門診利用的機率分別為1.37倍(95%CI=0.63~2.98,P=0.59)與0.82倍(95%CI=0.48~1.48,P=0.51)。

結論與建議
透過本研究結果可以得知,不同失能嚴重程度對於生活品質與醫療資源利用都有顯著性的影響,失重程度越嚴重對生活品質影響較大,會導致生活品質下降,而失重程度越嚴重對於醫療資源利用也會提高。透過此研究了解到腦中風高齡者因失能嚴重程度影響生活品質及醫療資源耗用之情形,可以將此數據提供給相關政府單位,藉此了解腦中風高齡者因不同失能嚴重程度對於生活品質與醫療資源利用的相關影響,並根據此研究結果評估預期因子,進行相關醫療衛生政策之擬定。
Purpose:
According to the World Health Organization (WHO), stroke is one of the major causes of death and disability in the global population. The Ministry of Health and Welfare of Taiwan also showed that stroke is the third leading cause of death among the ten leading causes of death in Taiwan. The study was conducted to examine the correlation between the severity of disability and quality of life and health care resource utilization among elderly stroke patients.

Methods:
This study uses the Taiwan National Health Interview Survey (NHIS) database and selects elderly people who are older than 65 years of age and have stroke in 2013. The severity of disability can be distinguished from ADL (Activities of Daily Living) and IADL (Instrumental Activities of Daily Living). In this study, each of them was subdivided into ADL unrestricted and mildly restricted, ADL moderately to severely restricted; IADL unrestricted and mildly restricted, and IADL moderately to severely restricted. The statistical method uses chi-square test, independent samples t-test, multiple regression and logistic regression analysis to explore the relationship between the severely disabled quality of life and the utilization of medical resources in elderly stroke patients.

Results:
The sample size of the study was 156 elderly people aged 65 years or older with stroke. The severity of disability of the elderly people with stroke was divided into the following groups according to the relevant scales: 125 people with less severe and mild severity of ADL, 31 people with moderate to severe severity of ADL, 98 people with less severe and mild severity of IADL, and 58 people with moderate to severe severity of IADL. In terms of quality of life (EQ-5D), those with moderate to severe ADL (IADL) were 4.70 points (95% CI: -4.95, -4.46, p<0.001) and 3.45 points (95% CI: -3.60, -3.30, p<0.001) lower than those with less severe to mildly severe ADL IADL.In terms of quality of life (EQ-VAS), quality of life scores were 8.78 points (95% CI:-12.13,-5.42, p<0.001) and 9.90 points (95% CI:-12.08,-7.71, p<0.001) lower for moderate to severe disability (IADL) than for less severe to mild disability, respectively. In terms of health care resource utilization, the difference between In terms of health care resource utilization, the odds of emergency utilization in the past year were 3.05 times (95%CI=1.92~4.86,P<0.001) and 2.67 times(95%CI=1.92~4.86,P<0.001); 3.89 times(95%CI=2.43~6.22,P<0.001) and 3.25 times (95%CI=2.33~4.52,P<0.001) for inpatient utilization in the past year; 1.98 times (95%CI=1.61~2.62,P<0.05) and 1.36 times(95%CI=1.01~1.85,P<0.05) for western medicine outpatient in the past month; the utilization rate of Chinese medicine outpatient services in the past month was 1.37 time (95%CI=0.63~2.98,P=0.59)and 0.82 time (95%CI=0.48~1.48,P=0.51).

Conclusion:
Through the results of this study, it was found that different severity of disability had significant effects on the quality of life and the utilization of health care resources utilization among. Through this study, we understand the impact of severity of disability on quality of life and health care resource utilization among elderly people with stroke, and we can provide this data to relevant government agencies to understand the impact of different severity of disability on quality of life and health care resource utilization among elderly people with stroke, and evaluate the expected factors based on the results of this study to formulate relevant health care policies.

中文摘要 I
英文摘要 III
致謝 VI
目錄 VII
圖目錄 VIII
表目錄 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 腦中風之介紹 6
第二節 失能之介紹 8
第三節 中風失能與生活品質的關係 11
第四節 中風失能與醫療資源利用的關係 18
第三章 研究方法 28
第一節 資料來源 29
第二節 研究樣本 32
第三節 研究架構 35
第四節 研究假說 37
第五節 研究變項之定義 38
第六節 統計分析 48
第四章 研究結果 49
第一節 不同失能嚴重程度的社會人口學變項、健康狀態之相關聯性 50
第二節 不同失能嚴重程度與生活品質之相關聯性 64
第三節 不同失能嚴重程度與生活品質之影響因子 68
第四節 不同失能嚴重程度與醫療資源利用之影響因子 74
第五章 討論與建議 91
第一節 高齡中風者其失能嚴重程度的社會人口學特性與健康狀態之關係 92
第二節 探討高齡中風者其失能嚴重程度的生活品質之關係 94
第三節 高齡中風者其失能嚴重程度的醫療資源利用之關係 96
第四節 研究限制 98
第五節 結論與建議 99
參考文獻 101
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