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題名：採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用之分析
書刊名：臺灣公共衛生雜誌
作者：洪燕妮 引用關係／吳肖琪／吳義勇／柯博仁
作者(外文)：Hung, Yen-ni／Wu, Shiao-chi／Ng, Yee-yung／Ko, Po-jen
出版日期：2009
卷期：28:2
頁次：頁144-154
主題關鍵詞：血管通路；血液透析；醫療利用；住院天數；住院費用；Vascular access；Hemodialysis；Hospital utilization；Length of stay；Expenditure
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(9) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:9
  • 共同引用共同引用:1
  • 點閱點閱:66
目標：了解國內採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用情形。方法：採回溯性世代研究法，以衛生署提供之健保門住診申報資料，選取2002年新透析病人，以其第一次建置血管通路為起始點追蹤其一年內之住院醫療利用，住院主因依美國腎臟資料系統(USRDS)分為8大類，自變項為血管通路類型，控制變項為性別、年齡、共病症、血管通路建置時間，以複迴歸模式分析住院利用之相關因素。結果：研究對象計6,228人，不論住院人次、天數及費用由8大類住院主因來看，均以血管通路問題(23.92%-25.32%)及泌尿系統(22.03%-26.29%)為主；人工血管在透析後一年內的8大類住院次數、住院天數、住院費用均較自體動靜脈瘻管平均值高；控制其他變項後，血管通路類型對住院次數、住院天數、住院費用仍有顯著影響。結論：血管通路問題是住院主因，不同血管通路類型之住院利用及費用有顯著不同，採用人工血管較自體動靜脈瘻管有更高的住院利用，宜鼓勵提高自體動靜脈瘻管的建置率，另外，如何在臨床及病人自我照護方面，避免血管通路的感染及栓塞值得重視。
Objectives: To analyze the hospital utilization of end stage renal failure (ESRD) patients with different types of dialysis access in Taiwan. Methods: This analysis used claims data for all newly developed ESRD patients in 2002 from the Taiwan National Health Insurance (NHI) database provided by the Department of Health (DOH). Patients who died in the first year were excluded. We tracked all subjects for 12 months from the start of their dialysis access and reviewed data regarding the number of hospital admissions, length of stay, and expenditure. We grouped causes of admission according to the United States Renal Data System (USRDS) and used multiple regression to analyze the correlation between hospital utilization and type of vascular access by controlling other variables such as gender, age, co-morbidities, and time of access creation. Results: The leading causes of admission for 6,228 newly developed ESRD patients in 2002 were dialysis access related problems (23.92%-25.32%) and urology system related problems (22.03%-26.29%). The number of admissions, length of stay, and inpatient expenditure of ateriovenous graft (AVG) patients were significantly greater than those of arteriovenous fistula (AVF) patients during the first year post access creation. Conclusions: ESRD patients in Taiwan who accessed dialysis through AVG utilized more hospital resources than those with AVF. We encourage increasing the percentage of AVF creation rate for access. Lowering the incidence of access infection and thrombosis may also reduce medical expenditure on ESRD patients since access related problems were the leading cause of hospitalization of those patients.
期刊論文
1.吳肖琪、黃麟珠、雷秀麗、吳義勇(20041000)。從健保透析申報資料定義並分析國內慢性腎衰竭病患透析情形。臺灣公共衛生雜誌，23(5)，419-427。new window  延伸查詢new window
2.Lee H, Manns B, Taub K, et al.(2002)。Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access。Am J Kidney Dis，40，611-122。  new window
3.Romano, P. S.、Roos, L. L.、Jollis, J. G.(1993)。Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives。J. Clin. Epidemiol.，46，1075-1079。  new window
4.Feldman HI, Kobrin S, Wasserstein A(1996)。Hemodialysis vascular access morbidity。J Am Soc Nephrol，7，523-535。  new window
5.Pisoni RL, Young EW, Dykstra DM, et al.(2002)。Vascular access use in Europe and the United States: results fromthe DOPPS。Kidney Int，61，305-316。  new window
6.Nassar GM, Ayus JC.(2001)。Infectious complications of the hemodialysis access。Kidney Int，60，1-13。  new window
7.Manns B, Tonelli M, Yilmaz S, et al.(2005)。Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis。J Am Soc Nephrol，16，201-209。  new window
8.Feldman HI, Held PJ, Hutchinson JT, Stoiber E, Hartigan MF, Berlin JA.(1993)。Hemodialysis vascular access morbidity in the United States。Kidney Int，43，1091-1096。  new window
9.Ifudu O.(1998)。Care of patients undergoing hemodialysis。N Engl J Med，339，1054-1062。  new window
10.Metcalfe W, Khan IH, Prescott GJ, Simpson K,Macleod AM.(2003)。Hospitalization in the first year of renal replacement therapy for end-stage renal disease。Q J Med，96，899-909。  new window
11.Rocco MV, Soucie JM, Reboussin DM, McClellanWM.(1996)。Risk factors for hospital utilization in chronic dialysis patients。J Am Soc Nephrol，7，889-896。  new window
12.Arora P, Kausz AT, Obrador GT, et al(2000)。Hospital utilization among chronic dialysis patients.。J Am Soc Nephrol，11，740-746。  new window
13.Jones KR.(1991)。Factors associated with hospitalization in a sample of chronic hemodialysis patients。Health Serv Res，26，671-699.。  new window
14.張碧玉、黃尚志、毛莉雯(2000)。影響末期腎臟疾病患者醫療費用之風險因子探討：一、穩定型血液透析患者。台灣腎臟醫學會雜誌，14，319。  延伸查詢new window
15.鄭振廷、侯宏彬、錢慶文(2005)。影響洗腎病患定期血液透析醫療資源耗用之因素。醫務管理期刊，6，291-308。new window  延伸查詢new window
16.Hakim R, Himmelfarb J.(1998)。Hemodialysis access failure:a call to action。Kidney Int，54，1029-1040。  new window
17.Allon M.(2007)。Current management of vascular access。Clin J Am Soc Nephrol，2，786-800。  new window
18.Albers FJ.(1994)。Causes of hemodialysis access failure。Adv Ren Replace Ther，1，107-118。  new window
19.Ross EA, Alza RE, Jadeja NN.(2006)。Hospital resource utilization that occurs with, rather than because of, kidney failure in patients with end-stage renal disease。Clin J Am Soc Nephrol，1，1234-1240。  new window
20.Schon D, Blume SW, Niebauer K, Hollenbeak CS, de Lissovoy G.(2007)。Increasing the use of arteriovenous fistula in hemodialysis: economic benefits and economic barriers。Clin J Am Soc Nephrol，2，268-276。  new window
21.Ethier J, Mendelssohn DC, Elder SJ, et al.(2008)。Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study。Nephrol Dial Transplant，23，3219-3226。  new window
22.Reddan D, Klassen P, Frankenfield DL, et al(2002)。National profile of practice patterns for hemodialysis vascular access in the United States。Am Soc Nephrol，13，2117-2124。  new window
23.Saran, R.、Elder, SJ.、Goodkin, DA. et al.(2008)。Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients:results from the Dialysis Outcomes and Practice Patterns Study。Annals of Surgery，247(5)，885-891。  new window
24.De Vecchi AF, Dratwa M, Wiedemann ME.(1999)。Health caresystems and end-stage renal disease (ESRD)therapies-an international review: costs and reimbursement/funding of ESRD therapies。Nephrol Dial Transplant，14，31-41。  new window
25.Besarab A.(2002)。Preventing vascular access dysfunction:which policy to follow。Blood Purif，20，26-35。  new window
圖書
1.台灣腎臟醫學會(2004)。台灣血液透析診療指引。台北：台灣腎臟醫學會。  延伸查詢new window
2.Eggers P, Milam R.(2001)。Trends in vascular access procedures and expenditures in Medicare’s ESRD program.。Vascular Access for Hemodialysis,VII.。New York。  new window
3.United States Renal Data System(2007)。2007 Annual Data Report。Minneapolis, Minnesota。  new window
 
 
 
 
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