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題名:安寧療護使用天數對末期病人醫療資源耗用之影響
書刊名:臺灣公共衛生雜誌
作者:陳雪姝謝秋萍李幸諭蔡瓊玉李哲瑋
作者(外文):Chen, Sheue-shuHsieh, Chyou-pingLee, Hsin-yuTsai, Chiung-yuLi, Jhe-wei
出版日期:2015
卷期:34:4
頁次:頁413-423
主題關鍵詞:安寧療護資源耗用Hospice careMedical 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(4) 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:4
  • 共同引用共同引用:13
  • 點閱點閱:33
目標:以健保資料庫探討安寧天數對末期病患醫療資源耗用的影響,期以研究結果推動安寧療護觀念以減少無效醫療。方法:此為實驗對照研究,選取2013年死亡時67歲以上接受安寧之病患,依據性別、年齡、死前366天至730天醫療點數、特定疾病等變項與非安寧者進行1:1隨機配對,兩組各有7,890人。結果:兩組皆離死亡愈近資源耗用愈高,其中安寧組死前7天內之每人醫療點數較非安寧組為低,且其差值愈接近死亡愈明顯,從65點至2,325點。而安寧使用天數與死前0~10天及0~15天之每人費用成反比,安寧天數每多一天,費用減少523及598點;再與非安寧組比較,安寧天數越多點數節省越多,惟該現象於天數達9天及17天以上才顯現。結論:安寧療護可以節省資源,但安寧天數需相當或大於每人費用觀察期間的天數,才能觀察到其資源節省的效益。另精算,安寧組7,890人相較於非安寧組於死前7天內減少約6,056萬之醫療點數。
Objectives: To explore the impact of the length of hospice stay on the medical expenditure for terminally-ill patients by analysis of the database of National Health Insurance (NHI). Methods: This case-controlled study compared decedents over 67 years of age who were hospice users with non hospice decedents in 2013. After one-to-one random matching, there were 7,890 persons in each group. The variables used to create matches were age, gender, specific disease and the medical expenditure between the 366^(th) and 730^(th) days before the date of death. Results: Both hospice users and non hospice users had increased medical expenditure while approaching the date of death. In the 7 days before death, the medical expenditure per hospice users was 65 NT$ lower than that of non hospice users; the saving increased to more than 2,325 NT$ on the final day before death. The medical expenditure of within 10 days before death showed per hospice day reductions of 523 NT$. Conclusions: The longer the hospice stay, the greater the saving in medical expenditure.
期刊論文
1.羅健銘、陳素秋、賴允亮、林家瑾、陳建仁(20070800)。住院癌末病患照護型態對住院醫療費用與住院天數之影響。臺灣公共衛生雜誌,26(4),270-282。new window  延伸查詢new window
2.Tang, S. T.、Huang, E. W.、Liu, T. W.、Wang, H. M.、Rau, K. M.、Chen, J. S.(2010)。Aggressive End-of-Life Care Significantly Influenced Propensity for Hospice Enrollment Within the Last Three Days of Life for Taiwanese Cancer Decedents。Journal of Pain and Symptom Management,41(1),68-78。  new window
3.Scheffey, C.、Kestenbaum, M. G.、Wachterman, M. W.(2013)。Clinic-based outpatient palliative care before hospice is associated with longer hospice length of service。Journal of Pain and Symptom Management,48(4),532-539。  new window
4.Teno, J. M.、Casarett, D.、Spence, C.、Connor, S.(2012)。It is "too late" or is it? Bereaved family member perceptions of hospice referral when their family member was on hospice for seven days or less。Journal of Pain and Symptom Management,43(4),732-738。  new window
5.Campbell, D. E.、Lynn, J.、Louis, T. A.、Shugarman, L. R.(2004)。Medicare Program Expenditures Associated with Hospice Use。Annals of Internal Medicine,140(4),269-277。  new window
6.Taylor, D. H. Jr.、Ostermann, J.、Van Houtven, C. H.、Tulsky, J. A.、Steinhauser, K.(2007)。What length of hospice use maximizes reduction in medical expenditures near death in the US Medicare program?。Social Science & Medicine,65(7),1466-1478。  new window
7.劉嘉年、楊銘欽(20070400)。臺灣癌症病患的健保安寧療護利用情形與費用分析。臺灣公共衛生雜誌,26(2),118-127。new window  延伸查詢new window
8.Lin, Wen-yuan、Chiu, Tai-yuan、Hsu, Hua-shai、Davidson, Lance E.、Lin, Tsann、Cheng, Kao-chi、Chiu, Chang-fang、Li, Chia-ing、Chiu, Yi-wen、Lin, Cheng-chieh、Liu, Chiu-shong(20091000)。Medical Expenditure and Family Satisfaction between Hospice and General Care in Terminal Cancer Patients in Taiwan。Journal of the Formosan Medical Association,108(10),794-802。  new window
9.Lo, J. C.(2002)。The impact of hospices on health care expenditures- the case of Taiwan。Social Science & Medicine,54(6),981-991。  new window
10.Greer, D. S.、Mor, V.、Morris, J. N.、Sherwood, S.、Kidder, D.、Birnbaum, H.(1986)。An alternative in terminal care: Results of the national hospice study。Journal of Chronic Diseases,39(1),9-26。  new window
學位論文
1.林庭伃(2011)。癌症病患死亡前五天內加入安寧療護對醫療費用之比較分析(碩士論文)。國立陽明大學。  延伸查詢new window
圖書
1.羅紀琼(2002)。安寧療護住院服務試辦論論日計酬之評估--試辦效益分析。台北:衛生福利部。  延伸查詢new window
 
 
 
 
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