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研究生:盧承駿
研究生(外文):LU, CHENG-JYUN
論文名稱:探討失智症嚴重度、合併症與醫療資源利用之關聯性-以南部某醫學中心為例
論文名稱(外文):Exploring the Relationship between Dementia Severity, Comorbidities and Medical Resource Utilization–Example of a Medical Center in Southern Taiwan.
指導教授:李易蓁李易蓁引用關係
指導教授(外文):LEE, I-CHEN
口試委員:林育德蘇永裕許弘毅
口試委員(外文):LIN, YU-TESU, YUNG-YUSHI, HON-YI
口試日期:2022-07-14
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:2022
畢業學年度:110
語文別:中文
論文頁數:139
中文關鍵詞:失智症合併症醫療資源利用CDR
外文關鍵詞:DementiaComorbidityMedical Resource UtilizationCDR
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研究目的
  不同嚴重程度的失智症患者,若有較多合併症,醫療資源也會較多。本研究希望能瞭解並釐清不同的失智症嚴重程度、合併症、與醫療資源利用三者的關聯性,希冀研究之結果能提供政府或臨床醫療照護人員參考,進而研擬適當的失智症預防與照護相關政策。

研究方法
  本研究的樣本為南部某醫學中心失智共同照護中心之個案,研究工具為次級資料庫:失智共同照護中心個案服務管理資料庫、以及個案醫院的臨床大數據資料庫病歷紀錄檔;醫療資源利用資料係擷取個案受測CDR後一年內的利用狀況,資料回收後,使用SPSS 20.0及SAS 9.4進行資料處理及統計分析。統計方法採用描述性統計、卡方檢定、獨立樣本T檢定、皮爾森相關分析、單因子變異數分析、雙因子變異數分析及階層複迴歸分析。

研究結果
  本研究樣本共有1,923人,男性(41.6%)及女性(58.4%)各半;平均年齡為79.8歲(SD=7.93);失智症嚴重程度中,極輕度患者有305人(15.9%);輕度患者有944人(49.1%);中度患者有544人(28.3%);重度患者有130人(6.8%);共有1,805位患者罹患合併症,每人平均罹患3.8個合併症(SD=2.5)。
  根據階層複迴歸模式結果發現,各項醫療資源利用中,失智症嚴重度及合併症數量與門診費用、住院次數、住院天數、急診次數及醫療總費用有顯著相關;門診次數僅與合併症數量有顯著相關;住院費用則是皆沒有顯著相關。而中度失智症(CDR=2)與住院天數及醫療總費用具有顯著關係,原與住院次數及急診次數不具有顯著關係,後加入合併症則皆達到顯著關係;且於各項醫療資源利用的結果中,加入合併症的解釋力(R2)變化量也有明顯提升。(門診次數:0.149;門診費用:0.222;住院次數:0.138;住院天數:0.065;急診次數:0.137;醫療總費用:0.262)。
  另外,本研究發現完全無合併症的族群一年內「完全沒有」使用住院相關的醫療資源。

結論與建議
  本研究發現中、重度失智症病人若罹患愈多合併症,會有更多的醫療資源利用,沒有合併症的病人,其醫療資源利用會變少,反之,則會增加。
  由上述結果得知以下結論,失智症病人的醫療資源利用不僅會受到嚴重程度的影響,更多的是伴隨而來的多種合併症問題。建議政府或臨床人員可以透過延緩失智症惡化成中重度,早期預防可能會產生的合併症,以降低失智症患者的醫療支出。
Background
Dementia patients with different severity levels will have more medical resources if they have more comorbidities. The study hopes to understand and clarify the relationship between different severity of Dementia, comorbidities, and the utilization of medical resources. This study is aims to provide reference for government or clinical medical care staff, and then develop appropriate prevention and care related policies on Dementia.

Methods
The participants are from the cases of a Dementia integrated care center (DICC) in a medical center in the south. The data ais from the secondary databases: the case service management database of the Dementia integrated care center (DICC), and the clinical big data database of the hospital. The medical resource utilization has been collected during one year since first CDR test. After the data was recovered, SPSS 20.0 and SAS 9.4 were applied for data processing and statistical analysis.

Results
The study population consisted of 1,923 people. Males (41.6%) and females (58.4%) were evenly divided. The mean age was 79.8 years (SD=7.93).There are 1,923 people in this study sample. There are 800 males (41.6%) and 1,123 females (58.4%). The mean age was 79.8 years (SD=7.93). Among the severity of dementia, 305 people were very mild (15.9%). 944 people were mild (49.1%). 544 people were moderate (28.3%). 130 people were severe (6.8%). A total of 1,805 patients had comorbidities, with an average of 3.8 comorbidities per person (SD=2.5).
According to the results of the hierarchical regression model, it was found that among the utilization of various medical resources, the severity of dementia and the number of comorbidities were significantly correlated with outpatient expenses, hospitalization visits, hospitalization days, emergency visits, and total medical expenses. Outpatient visits was only significantly correlated with the number of comorbidities. Hospitalization expenses were not significantly related. And moderate dementia (CDR=2) had a significant relationship with the length of hospital stay and total medical expenses. Originally, there was no significant relationship with the number of hospitalizations and the number of emergency rooms, but after adding comorbidities, all of them reached a significant relationship. And in the results of the utilization of various medical resources, the explanatory power (R2) changes of adding comorbidities also increased significantly. (Outpatient visits: 0.149; Outpatient expenses: 0.222; Hospitalizations visits: 0.138; Hospitalization days: 0.065; Emergency visits: 0.137; Total medical expenses: 0.262)
In addition, this study found that the population without comorbidities had "absolutely no" use of hospital-related medical resources within one year.

Conclusion
This study found that if patients with moderate and severe dementia have more comorbidities, they will use more medical resources. For patients without comorbidities, their medical resource utilization will decrease, and vice versa, it will increase.
From the above results, the following conclusions can be drawn: the utilization of medical resources of dementia patients will not only be affected by the severity, but also by the accompanying multiple comorbidities. It is suggested that the government or clinical staff can reduce the medical expenditure of dementia patients by delaying the deterioration of dementia to moderate to severe disease and preventing possible complications at an early stage.
中文摘要  i
Abstract iii
致謝  v
目錄  vi
表目錄 vii
第一章 緒論 1
  第一節 研究背景與動機 2
  第二節 研究目的    4
  第三節 名詞解釋    4
第二章 文獻探討 6
  第一節 失智症定義、評估與現況     6
  第二節 失智症與醫療資源利用相關研究 10
  第三節 合併症與醫療資源利用之研究  12
第三章 研究方法 14
  第一節 研究架構       14
  第二節 研究假說       16
  第三節 研究對象與資料收集  17
  第四節 研究工具       19
  第五節 研究變項及操作型定義 21
  第六節 資料統計與分析方法  23
第四章 研究結果 25
  第一節 失智症嚴重度之人口學變項及合併症的分佈情形   25
  第二節 失智症嚴重度、合併症及醫療資源利用之關係    32
  第三節 失智症嚴重度、合併症與醫療資源利用之迴歸模式  47
第五章 討論 66
  第一節 失智症、合併症與醫療資源利用的現況  66
  第二節 失智症、合併症與醫療資源利用的關聯性 68
  第三節 失智症、人口學變項與醫療資源利用   69
第六章 結論與建議 71
  第一節 研究限制 72
  第二節 建議   73
參考資料 74
附錄 81
中文文獻:
中華民國人口推估(2020至2070年)。國家發展委員會。臺北市:國發會, 民109.08
財團法人臺灣失智症協會(民111.04)。台灣失智症人口推估,取自臺灣失智症協會網址http://www.tada2002.org.tw/About/IsntDementia
失智症防治照護政策綱領暨行動方案2.0(2018至2025年)。衛生福利部。臺北市:衛福部,民109.12
失智症診療手冊。衛生福利部醫事司。臺北市:衛福部醫事司, 民106.02。
衛生福利部(2021)。國際失智症日衛生福利統計通報

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