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研究生:張紘嘉
研究生(外文):Hong-Chia Chang
論文名稱:參加論質計酬方案對糖尿病COVID-19患者重症及死亡之影響
論文名稱(外文):Impact of Pay-for-Performance Program on Severe Illness and Mortality among COVID-19 Patients with Diabetes Mellitus
指導教授:董鈺琪董鈺琪引用關係
指導教授(外文):Yu-Chi Tung
口試委員:鄭守夏楊銘欽李純馥
口試委員(外文):Shou-Hsia ChengMing-Chin YangChun-Fu Lee
口試日期:2023-06-05
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:103
中文關鍵詞:論質計酬方案糖尿病COVID-19重症死亡
外文關鍵詞:pay-for-performancediabetes mellitusCOVID-19severe illnessmortality
DOI:10.6342/NTU202301005
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研究背景研究目的:
糖尿病不但顯著影響COVID-19患者的重症及死亡狀況,也增加入住加護病及使用呼吸器風險,雖多數Omicron感染者為輕症,但若患者具有糖尿病史,可能增加了患者的重症及死亡風險。本研究目的為探討參與糖尿病及初期慢性腎臟病照護整合方案,對於第一次感染COVID-19的糖尿病患者其死亡、臨床表現重症、入住加護病房、使用侵襲型呼吸器、重症結果是否有所影響。
研究方法:
透過健保資料庫蒐集2021年10月至2022年9月之間第一次確診COVID-19的糖尿病患者,依前一年度的人口學特徵、健康狀況、醫療資源使用做為影響參與論質計酬的控制變項,並使用傾向分數進行1:1配對,研究組及對照組均為122,514人,最後以羅吉斯迴歸分析各組不良健康事件發生風險。
研究結果:
參與論質計酬方案者,相對於未參加者發生不良健康事件風險可能性較低,其死亡危險對比值為0.54(95%CI:0.49-0.60)、臨床表現重症危險對比值0.55(95% CI:0.52-0.58)、入住加護病房危險對比值為0.61(95% CI:0.57-0.66)、使用侵襲性呼吸器危險對比值0.60(95% CI:0.54-0.67)、重症危險對比值為0.56(95% CI:0.53-0.59)。
結論:
糖尿病患者第一次確診COVID-19前一年度參與論質計酬方案,對於確診後30天內的重症及死亡事件,具有顯著保護效果。在未來鼓勵高風險族群參相關論質計酬方案,也建議發展不良健康事件預測模型,降低重症及死亡發生機會。
Background and Aims:
Diabetes mellitus (DM) is associated with greater risk of COVID-19 severe illness and mortality, as well as increases the risk of admission to intensive care and the use of mechanical ventilation. Most COVID-19 patients infected with Omicron variant have mild symptoms. However, it may increase the risk of severe illness and mortality for those diabetes patients with COVID-19 infection. We aimed to analyze the association between pay-for-performance(P4P) program and outcomes of diabetic patients infected COVID-19, including mortality, severe illness, admission to intensive care unit, use of invasive ventilators, and adverse health events.
Materials and Methods:
In order to construct the intervention group, we selected COVID-19 patients with diabetes mellitus cases from NHI database from October 2021 to September 2022. By using the propensity score method to construct a comparable matching group , we selected the research group (N=122,514) and the control group (N=122,514) by matching their characteristics, health status and medical resources covariates relating to the probability of their participation in the program. Subsequently, we took logistics regression to compare the likelihood of risk of adverse health events among groups.
Results:
After matching , P4P group had a lower likelihood of adverse health events risk than non-P4P group with mortality odds ratio (OR) of 0.54 (95% CI: 0.49-0.60), severe illness odds ratio (OR) of 0.55 (95% CI: 0.52-0.58),admission to intensive care unit odds ratio (OR) of 0.61 (95% CI: 0.57-0.66),use of invasive ventilators odds ratio (OR) of 0.60 (95% CI: 0.54-0.67), adverse health events odds ratio (OR) of 0.56 (95% CI: 0.53-0.59).
Conclusion:
This study provides evidence that pay-for-performance program improved the outcomes after diabetic patients infected COVID-19 in Taiwan. Policymaker shoulder considers expanding P4P for diabetic patients in the post-pandemic era. We encourage high-risk groups to engage in P4P and recommend to develop prediction models of adverse health events.
口試委員會審定書 i
誌謝 ii
中文摘要 iii
Abstract iv
目錄 v
圖目錄 vii
表目錄 viii
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、實習單位簡介 5
第二章 文獻探討 6
第一節 糖尿病及論質計酬計畫 7
第二節 嚴重特殊傳染性肺炎(COVID-19)介紹 10
第三節 糖尿病患者易發展至COVID-19重症可能原因 13
第四節 相關實證研究 15
第五節 綜合評論 21
第三章 研究方法 22
第一節 研究設計與架構 23
第二節 研究假說 25
第三節 研究對象 26
第四節 資料來源與資料處理流程 27
第五節 研究變項操作型定義 29
第六節 統計方法分析 33
第四章 研究結果 34
第一節 描述性統計 35
第二節 雙變項分析 45
第三節 多變項分析 64
第五章 討論 79
第一節 研究方法討論 80
第二節 研究結果討論 81
第三節 研究限制 90
第六章 結論與建議 91
第一節 結論 92
第二節 建議 93
參考文獻 95
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