臺灣博碩士論文加值系統

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

英文文獻：
Gauthier S, Rosa-Neto P, Morais JA, & Webster C.2021. World Alzheimer Report 2021: Journey through the diagnosis of dementia. London, England: Alzheimer’s Disease International.
Leese D., Jackson M., Szczepaniak M., Verne J. Dementia: Comorbidities in patients—Data briefing. [(accessed on 1 June 2021)];Public Health Engl. 2019 Available
Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, Chen TF, Lin KN, Tang LY, Lin CC, Wang PN. Comorbidity and dementia: A nationwide survey in Taiwan. PLoS One. 2017 Apr 12;12(4):e0175475. doi: 10.1371/journal.pone.0175475. PMID: 28403222; PMCID: PMC5389824.
Park C, Fang J, Hawkins NA, Wang G. Comorbidity Status and Annual Total Medical Expenditures in U.S. Hypertensive Adults. Am J Prev Med. 2017 Dec;53(6S2):S172-S181.
Chen TB, Yiao SY, Sun Y, Lee HJ, Yang SC, Chiu MJ, Chen TF, Lin KN, Tang LY, Lin CC, Wang PN. Comorbidity and dementia: A nationwide survey in Taiwan. PLoS One. 2017 Apr 12;12(4):e0175475. doi: 10.1371/journal.pone.0175475. PMID: 28403222; PMCID: PMC5389824.
Kaczynski A, Michalowsky B, Eichler T, Thyrian JR, Wucherer D, Zwingmann I, Hoffmann W. Comorbidity in Dementia Diseases and Associated Health Care Resources Utilization and Cost. J Alzheimers Dis. 2019;68(2):635-646.
Aigbogun MS, Stellhorn R, Krasa H, Kostic D. Severity of memory impairment in the elderly: Association with health care resource use and functional limitations in the United States. Alzheimers Dement (Amst). 2017 Apr 20;8:51-59.
FLEMING, R., ZEISEL, J. & BENNETT, K. 2020. World Alzheimer Report 2020: Design Dignity Dementia: dementia-related design and the built environment Volume 1, London, England: Alzheimer’s Disease International.
Ee C, Lake J, Firth J, Hargraves F, de Manincor M, Meade T, Marx W, Sarris J. An integrative collaborative care model for people with mental illness and physical comorbidities. Int J Ment Health Syst. 2020 Nov 11;14(1):83. doi: 10.1186/s13033-020-00410-6. PMID: 33292354; PMCID: PMC7659089.
Fisher RA, Miners JS, Love S. Pathological changes within the cerebral vasculature in Alzheimer's disease: New perspectives. Brain Pathol. 2022 Mar 14:e13061. doi: 10.1111/bpa.13061. Epub ahead of print. PMID: 35289012.
Weyman-Vela Y, Simental-Mendía LE, Camacho-Luis A, Gamboa-Gómez CI, Guerrero-Romero F. The Triglycerides and Glucose Index Is Associated with Mild Cognitive Impairment in Older Adults. Endocr Res. 2022 Feb-May;47(2):89-93. doi: 10.1080/07435800.2022.2061508. Epub 2022 Apr 8. PMID: 35393913.
Wong C, Benyaminov F, Block L. Reversible dementia in the setting of multiple medical comorbidities due to B12 deficiency. BMJ Case Rep. 2022 Mar 22;15(3):e248440. doi: 10.1136/bcr-2021-248440. PMID: 35318204; PMCID: PMC8943724.
Reisberg B, Ferris SH, de Leon MJ, Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry. 1982 Sep;139(9):1136-9. doi: 10.1176/ajp.139.9.1136. PMID: 7114305.
Alzheimer’s Disease International. 2019. World Alzheimer Report 2019: Attitudes to dementia. London: Alzheimer’s Disease International.
Alzheimer’s Disease International. 2015. World Alzheimer Report 2015:The Global Impact of Dementia An analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International.
Aigbogun MS, Stellhorn R, Krasa H, Kostic D. Severity of memory impairment in the elderly: Association with health care resource use and functional limitations in the United States. Alzheimers Dement (Amst). 2017 Apr 20;8:51-59.
Nakanishi M, Igarashi A, Ueda K, Brnabic AJM, Treuer T, Sato M, Kahle-Wrobleski K, Meguro K, Yamada M, Mimura M, Arai H. Costs and Resource Use Associated with Community-Dwelling Patients with Alzheimer's Disease in Japan: Baseline Results from the Prospective Observational GERAS-J Study. J Alzheimers Dis. 2020;74(1):127-138.
Ashizawa T, Igarashi A, Sakata Y, Azuma M, Fujimoto K, Kobayashi T, Takase Y, Ikeda S. Impact of the Severity of Alzheimer's Disease on the Quality of Life, Activities of Daily Living, and Caregiving Costs for Institutionalized Patients on Anti-Alzheimer Medications in Japan. J Alzheimers Dis. 2021;81(1):367-374. doi: 10.3233/JAD-201514. PMID: 33780368; PMCID: PMC8203217.
Lenox-Smith A, Reed C, Lebrec J, Belger M, Jones RW. Resource utilisation, costs and clinical outcomes in non-institutionalised patients with Alzheimer's disease: 18-month UK results from the GERAS observational study. BMC Geriatr. 2016 Nov 25;16(1):195. doi: 10.1186/s12877-016-0371-6. PMID: 27887645; PMCID: PMC5124297.
Alzheimer’s Association, 2017, 2017 Alzheimer’s disease facts and figures, Alzheimer’s & Dementia, 13(4),325-373.
Moriyama Y, Yoshino A, Muramatsu T, Mimura M. Detailed analysis of the supermarket task included on the Japanese version of the Rapid Dementia Screening Test. Psychogeriatrics. 2017 May;17(3):170-176. doi: 10.1111/psyg.12209. Epub 2016 Jun 30. PMID: 27357056.
Liu C-C, Sun Y, Lee P-C, et al. Risk of dementia after Parkinson’s disease in Taiwan: a populationbased retrospective cohort study using National Health Insurance claims. BMJ Open 2019;9:e025274. doi:10.1136/bmjopen-2018-025274
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, Brayne C, Burns A, Cohen-Mansfield J, Cooper C, Costafreda SG, Dias A, Fox N, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Ogunniyi A, Orgeta V, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30. PMID: 32738937; PMCID: PMC7392084.
Zhu CW, Sano M. Demographic, Health, and Exposure Risks Associated With Cognitive Loss, Alzheimer's Disease and Other Dementias in US Military Veterans. Front Psychiatry. 2021 Feb 25;12:610334. doi: 10.3389/fpsyt.2021.610334. PMID: 33716816; PMCID: PMC7947283.
Villarejo-Galende A, García-Arcelay E, Piñol-Ripoll G, Del Olmo-Rodríguez A, Viñuela F, Boada M, Franco-Macías E, de la Peña AI, Riverol M, Puig-Pijoan A, Abizanda-Soler P, Arroyo R, Baquero-Toledo M, Feria-Vilar I, Balasa M, Berbel Á, Rodríguez-Rodríguez E, Vieira-Campos A, García-Ribas G, Rodrigo-Herrero S, Lleó A, Maurino J. Awareness of Diagnosis in Persons with Early-Stage Alzheimer's Disease: An Observational Study in Spain. Neurol Ther. 2022 Jun 1. doi: 10.1007/s40120-022-00367-3. Epub ahead of print. PMID: 35648383.
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012 Jul 7;380(9836):37-43. doi: 10.1016/S0140-6736(12)60240-2. Epub 2012 May 10. PMID: 22579043.
Zhu CW, Cosentino S, Ornstein KA, Gu Y, Andrews H, Stern Y. Interactive Effects of Dementia Severity and Comorbidities on Medicare Expenditures. J Alzheimers Dis. 2017;57(1):305-315. doi: 10.3233/JAD-161077. PMID: 28222520; PMCID: PMC5461168.
Zhdanava M, Kuvadia H, Joshi K, Daly E, Pilon D, Rossi C, Morrison L, Lefebvre P, Nelson C. Economic Burden of Treatment-Resistant Depression in Privately Insured U.S. Patients with Physical Conditions. J Manag Care Spec Pharm. 2020 Aug;26(8):996-1007. doi: 10.18553/jmcp.2020.20017. Epub 2020 Jun 19. PMID: 32552362.
Rice JB, White A, Lopez A, Nelson WW. High-Cost Sarcoidosis Patients in the United States: Patient Characteristics and Patterns of Health Care Resource Utilization. J Manag Care Spec Pharm. 2017 Dec;23(12):1261-1269. doi: 10.18553/jmcp.2017.17203. Epub 2017 Oct 17. PMID: 29172980.
Kaczynski A, Michalowsky B, Eichler T, Thyrian JR, Wucherer D, Zwingmann I, Hoffmann W. Comorbidity in Dementia Diseases and Associated Health Care Resources Utilization and Cost. J Alzheimers Dis. 2019;68(2):635-646. doi: 10.3233/JAD-180896. PMID: 30856111.
Wang X, Zeng F, Jin WS, Zhu C, Wang QH, Bu XL, Luo HB, Zou HQ, Pu J, Zhou ZH, Cui XP, Wang QS, Shi XQ, Han W, Wu Q, Chen HS, Lin H, Zhang LL, Zhang M, Lian Y, Xu ZQ, Zhou HD, Zhang T, Wang YJ. Comorbidity burden of patients with Parkinson's disease and Parkinsonism between 2003 and 2012: A multicentre, nationwide, retrospective study in China. Sci Rep. 2017 May 10;7(1):1671. doi: 10.1038/s41598-017-01795-0. PMID: 28490759; PMCID: PMC5431825.
O'Malley M, Parkes J, Stamou V, LaFontaine J, Oyebode J, Carter J. Young-onset dementia: scoping review of key pointers to diagnostic accuracy. BJPsych Open. 2019 Jun 4;5(3):e48. doi: 10.1192/bjo.2019.36. PMID: 31530311; PMCID: PMC6582217.
Rossor MN, Fox NC, Mummery CJ, Schott JM, Warren JD. The diagnosis of young-onset dementia. Lancet Neurol. 2010 Aug;9(8):793-806. doi: 10.1016/S1474-4422(10)70159-9. PMID: 20650401; PMCID: PMC2947856.
Crum RM, Anthony JC, Bassett SS, Folstein MF. Population-based norms for the Mini-Mental State Examination by age and educational level. JAMA. 1993 May 12;269(18):2386-91. PMID: 8479064.
Solias A, Skapinakis P, Degleris N, Pantoleon M, Katirtzoglou E, Politis A. [Mini Mental State Examination (MMSE): determination of cutoff scores according to age and educational level]. Psychiatriki. 2014 Oct-Dec;25(4):245-56. Greek, Modern. PMID: 25630544.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975, 12 (3): 189–98. PMID 1202204. doi:10.1016/0022-3956(75)90026-6
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982 Jun;140:566-72. doi: 10.1192/bjp.140.6.566. PMID: 7104545.
Lin KN,Liu HC(2003).Clinical Dementia Rating (CDR),Chinese Version.Acta Neurologica Taiwanica;12(3):154-165
Möllers T, Perna L, Ihle P, Schubert I, Bauer J, Brenner H. Factors Associated with Length of Stay in Hospital Patients with and Without Dementia. J Alzheimers Dis. 2019;67(3):1055-1065. doi: 10.3233/JAD-180593. PMID: 30776005.
Chen YH, Lai YC, Wu YC, Sasaki J, Tsai KT, Ho CH. Healthcare Utilization in Different Stages among Patients with Dementia: A Nationwide Population-Based Study. Int J Environ Res Public Health. 2021 May 26;18(11):5705. doi: 10.3390/ijerph18115705. PMID: 34073398; PMCID: PMC8199003.
Yusuf AJ, Baiyewu O, Bakari AG, Garko SB, Jibril ME, Suleiman AM, Muktar HM, Amedu MA. Low education and lack of spousal relationship are associated with dementia in older adults with diabetes mellitus in Nigeria. Psychogeriatrics. 2018 May;18(3):216-223. doi: 10.1111/psyg.12309. Epub 2018 Feb 8. PMID: 29424096.
Dauphinot V, Potashman M, Levitchi-Benea M, Su R, Rubino I, Krolak-Salmon P. Economic and caregiver impact of Alzheimer's disease across the disease spectrum: a cohort study. Alzheimers Res Ther. 2022 Feb 12;14(1):34. doi: 10.1186/s13195-022-00969-x. PMID: 35151368; PMCID: PMC8841058.
Wang CY, Wu YL, Sheu WH, Tu ST, Hsu CC, Tai TY. Accountability and utilization of diabetes care from 2005 to 2014 in Taiwan. J Formos Med Assoc. 2019 Nov;118 Suppl 2:S111-S121. doi: 10.1016/j.jfma.2019.08.010. Epub 2019 Oct 4. PMID: 31590971.
Guerrero-Fernández de Alba I, Orlando V, Monetti VM, Mucherino S, Gimeno-Miguel A, Vaccaro O, Forjaz MJ, Poblador Plou B, Prados-Torres A, Riccardi G, Menditto E. Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients. Front Pharmacol. 2020 Nov 30;11:586187. doi: 10.3389/fphar.2020.586187. PMID: 33746740; PMCID: PMC7970761.
Shaw LJ, Goyal A, Mehta C, Xie J, Phillips L, Kelkar A, Knapper J, Berman DS, Nasir K, Veledar E, Blaha MJ, Blumenthal R, Min JK, Fazel R, Wilson PWF, Budoff MJ. 10-Year Resource Utilization and Costs for Cardiovascular Care. J Am Coll Cardiol. 2018 Mar 13;71(10):1078-1089. doi: 10.1016/j.jacc.2017.12.064. PMID: 29519347; PMCID: PMC5846485.
Meyers J, Hoog M, Mody R, Yu M, Davis K. The Health Care Resource Utilization and Costs Among Patients With Type 2 Diabetes and Either Cardiovascular Disease or Cardiovascular Risk Factors An Analysis of a US Health Insurance Database. Clin Ther. 2021 Nov;43(11):1827-1842. doi: 10.1016/j.clinthera.2021.09.003. Epub 2021 Oct 6. PMID: 34625283.
Żylińska E, Kosior DA. Education, cardiovascular risk factors and blood pressure control in hypertensive outpatients. Kardiol Pol. 2018;76(11):1551-1561. doi: 10.5603/KP.a2018.0157. Epub 2018 Aug 9. PMID: 30091135.
Zwald ML, Fakhouri THI, Fryar CD, Whitfield G, Akinbami LJ. Trends in active transportation and associations with cardiovascular disease risk factors among U.S. adults, 2007-2016. Prev Med. 2018 Nov;116:150-156. doi: 10.1016/j.ypmed.2018.09.008. Epub 2018 Sep 15. PMID: 30227156; PMCID: PMC7216826.
Zou Y, Wu F, Liu Q, Deng X, Hai R, He X, Zhou X. Downregulation of miRNA‑328 promotes the angiogenesis of HUVECs by regulating the PIM1 and AKT/mTOR signaling pathway under high glucose and low serum condition. Mol Med Rep. 2020 Aug;22(2):895-905. doi: 10.3892/mmr.2020.11141. Epub 2020 May 12. PMID: 32626978; PMCID: PMC7339821.
Schwab P, Dhamane AD, Hopson SD, Moretz C, Annavarapu S, Burslem K, Renda A, Kaila S. Impact of comorbid conditions in COPD patients on health care resource utilization and costs in a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis. 2017 Feb 23;12:735-744. doi: 10.2147/COPD.S112256. PMID: 28260880; PMCID: PMC5327909.
Nair R, Haynes VS, Siadaty M, Patel NC, Fleisher AS, Van Amerongen D, Witte MM, Downing AM, Fernandez LAH, Saundankar V, Ball DE. Retrospective assessment of patient characteristics and healthcare costs prior to a diagnosis of Alzheimer's disease in an administrative claims database. BMC Geriatr. 2018 Oct 16;18(1):243. doi: 10.1186/s12877-018-0920-2. PMID: 30326851; PMCID: PMC6192320.
Yamabe K, Liebert R, Flores N, Pashos CL. Health-related quality of life outcomes, economic burden, and associated costs among diagnosed and undiagnosed depression patients in Japan. Clinicoecon Outcomes Res. 2019 Mar 12;11:233-243. doi: 10.2147/CEOR.S179901. PMID: 30881068; PMCID: PMC6419602.
Lynch FL, Dickerson JF, O'Keeffe-Rosetti M, Chow W, Pesa J. Understanding the Relationship Between Depression Symptom Severity and Health Care Costs for Patients With Treatment-Resistant Depression. J Clin Psychiatry. 2022 Feb 1;83(2):21m13976. doi: 10.4088/JCP.21m13976. PMID: 35120286.
Cahill S, Pierce M, Werner P, Darley A, Bobersky A. A systematic review of the public's knowledge and understanding of Alzheimer's disease and dementia. Alzheimer Dis Assoc Disord. 2015 Jul-Sep;29(3):255-75. doi: 10.1097/WAD.0000000000000102. PMID: 26207322.
Zhu D, Guo N, Wang J, Nicholas S, Chen L. Socioeconomic inequalities of outpatient and inpatient service utilization in China: personal and regional perspectives. Int J Equity Health. 2017 Dec 4;16(1):210. doi: 10.1186/s12939-017-0706-8. PMID: 29202843; PMCID: PMC5715559.
Nguyen KB, Read C, Wu KK, Armstrong AW. Where you live matters: Regional differences in health care resource use for psoriasis in the United States. J Am Acad Dermatol. 2020 Jun;82(6):1360-1367. doi: 10.1016/j.jaad.2019.10.014. Epub 2019 Oct 10. PMID: 31606478.
Ryan BL, Shadd J, Maddocks H, Stewart M, Thind A, Terry AL. Methods to Describe Referral Patterns in a Canadian Primary Care Electronic Medical Record Database: Modelling Multilevel Count Data. J Innov Health Inform. 2017 Nov 17;24(4):888. doi: 10.14236/jhi.v24i4.888. PMID: 29334347.
Farhadi Hassankiadeh R, Kazemnejad A, Gholami Fesharaki M, Kargar Jahromi S, Vahabi N. Assessment of length of stay in a general surgical unit using a zero-inflated generalized Poisson regression. Med J Islam Repub Iran. 2017 Dec 17;31:91. doi: 10.14196/mjiri.31.91. PMID: 29951392; PMCID: PMC6014792.