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題名：影響成年人預立醫療照護諮商之因素及其醫療費用探討
作者：劉嘉仁
作者(外文)：Liu, Chia-Jen
校院名稱：輔仁大學
系所名稱：商學研究所博士班
指導教授：劉志光
陳銘芷
學位類別：博士
出版日期：2021
主題關鍵詞：病人自主權利法；預立醫療照護諮商；預立醫療決定；醫療費用；安寧療護；精準健康；Patient Right to Autonomy Act；Advance Care Planning；Advance Decision；Medical Expenses；Palliative Care；Precision Health
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2019年1月6日病人自主權利法正式施行，預立醫療照護諮商(Advance Care Planning, ACP)在臺灣已執行二年，但關於接受預立醫療照護諮商意願人之特性、意願與醫療費用探討，目前尚無研究發表。本研究主要探討參與預立醫療照護意願人之基本人口學特性、醫療費用情形與其意願之相關性。本研究為次級資料分析法，採用北市聯醫2019年1月至2020年2月間參與預立醫療照護諮商之個案資料，並連結醫院病歷資料進行分析。
本研究的結果有以下六點：
1.女性不希望接受維持生命治療或人工營養及流體餵養的意願比男性高1.32-1.63倍。
2.年齡越大者，不希望接受維持生命治療或人工營養及流體餵養的意願相對越高，65歲以上組之簽署是20-49歲組的1.634-2.206倍。
3.主動來院的非臺北市立聯合醫院病人有相對較高不希望接受維持生命治療或人工營養及流體餵養的意願，是臺北市立聯合醫院病人的1.45-1.66倍。
4.沒有指定醫療委任代理人者，有相對較高的不希望接受維持生命治療或人工營養及流體餵養的意願(OR=0.295-0.357)。
5.醫療費用情形可能因只收集一家醫院的就診資料，所以並未呈現顯著差異情形。
6.個案簽署五款臨床條件表示意願，明顯發現不希望接受的意願最高者為永久植物人，其次依序為極重度失智、不可逆轉昏迷狀況、主管機關公告之疾病與末期病人。
接受預立醫療照護諮商服務之民眾不分病人或健康人，如何經過預立醫療照護諮商簽署預立醫療決定，皆可為自己的人生作最妥適的醫療決定，進而獲得善終，是創新的醫療照護思維模式；民眾的死亡教育(生命識能)的提升，亦是精準健康的一環，將影響推廣成效與簽署預立醫療決定及其醫療費用。
Since the Patient Right to Autonomy Act was enforced on January 6, 2019, Advance Care Planning (ACP) has been introduced to Taiwan for 2 years. However, there are still no studies on the characteristics, willingness and medical expenses of patients who receive advance care plan counsel.
Purpose: The study is to investigate the basic demography characteristics, medical utilization, and willingness of patients who have signed ACP.
The study is a secondary data analysis which adopted the data from cases who received advance care plan counsel during January 2019 to February 2020 in Taipei City Hospital and the data was combined with Hospital Information System (HIS).
Result: There are mainly 6 results of this study:
1.Women’s willingness of not wanting life-sustaining treatment or artificial nutrition and hydration is 1.317-1.628 higher than men.
2.The willingness of not wanting life-sustaining treatment or artificial nutrition and hydration grows with age and the ratio of signing ACP in the group of aged 65 and older is 1.634-2.206 higher than adults aged 20-49 years.
3.The willingness of not wanting life-sustaining treatment or artificial nutrition and hydration of outpatients who came to Taipei City Hospital actively for advance care plan counsel is 1.452-1.662 higher than patients of Taipei City Hospital.
4.Patients who have no health care attorney are with higher willingness of not wanting life-sustaining treatment or artificial nutrition and hydration, OR=0.295-0.357.
5.There is no significant difference of medical utilization and the reason may be that the data was collected from only one hospital.
6.By analyzing the willingness under 5 clinical conditions signed by cases, it shows obviously that the less accepted is permanent vegetative state followed by advanced dementia, irreversible coma and other disease conditions announced by the central competent authority, and terminal illness.
Not only the patients but also people in good health condition can receive advance care plan counsel, besides, signing AD after receiving advance care plan counsel, making the best health care decision and enjoying “Good Death” is an innovative thinking model of health care. The improvement of people’s death education, which is also recognized as life literacy, is a part of precision health that may have impact on the effect of promotion and signing ACP as well as NHI medical expenses.
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29.謝宛婷、王敏真、陳炳仁(2016)，「意思能力喪失之病人的醫療決策-英國意思能力法案給臺灣的啟發與省思」，醫療品質雜誌，10(5)， 52-61。

 
 
 
 
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