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題名:生命末期病人對安寧療護資源使用探討分析
作者:林慧美
作者(外文):LIN,HUI-MEI
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:2022
主題關鍵詞:安寧療護拒絕心肺復甦術善終palliative careDNR(Do-Not-Resuscitate)Good death
原始連結:連回原系統網址new window
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安寧療護是針對病人所提供的身、心、靈及社會照顧,以提升末期病人的生活品質。本研究使用醫院醫療資訊系統之病歷資料,追溯住院病人是否有DNR註記及使用安寧療護,進一步探討住院病人生命末期使用安寧療護資源相關因子及醫療費用分析,以期能提早發現有潛在有安寧療護需求病人,以減少生命末期的無效醫療,讓病人在人生最後階段能夠善終。本研究採回顧性研究,資料來自臺北市立聯合醫院醫療資訊系統,收集2018年1月1日至12月31日、年齡大於20歲2144名死亡個案,分析拒絕心肺復甦術(DNR;Do-Not-Resuscitate)註記、安寧緩和諮詢會議,及病人是否在生命末期使用安寧療護、醫療費用之間的相關性。研究結果發現DNR註記四個顯著變量分別是:安寧緩和諮詢會議、TW-PCST分數、病房類型、住院天數;而於生命末期有29.8%個案使用安寧療護資源、在醫療費用上使用安寧療護病人每天住院的平均每日醫療費用低於未使用安寧療病人,而影響使用安寧療護資源因素包含診斷、住院單位、住院天數等因素;嘗試使用安寧療護資源預測模式,其中MARS(Multivariate Adaptive Regression Spline)模型預測力達0.751最高,預測模型主要因子為院區、醫療費用、住院天數、診斷、TW-PCST分數。綜上而言,安寧緩和諮詢會議為病人、家屬及醫療團隊,提供了參與討論有關生命末期安寧療護和DNR的機會,病人臨終使用安寧緩和醫療資源仍偏低;尤其非癌症個案在推廣安寧療護上有很大的空間。透過安寧療護推動,以期讓生命末期病人能獲得善終;同時也減降低無效醫療,在醫院中有限的醫療資源能夠分配給更多有需要的病人使用。
Palliative care is the physical, mental, spiritual and social care provided to patients to improve the quality of life at end of life patients. This study uses the medical record data of the hospital medical information system to trace whether the inpatients have DNR and use palliative care, and further explores the factors related to the use of palliative care resources and the analysis of medical expenses in the end of life of inpatients, in order to detect potential palliative care needs in advance. patients, in order to reduce ineffective medical treatment at the end of life, so that patients can end well in the last stage of life.This study was a retrospective study. The data were collected from 2144 death cases aged over 20 years old from the Taipei City Hospital Health Information System (HIS) from January 1 to December 31, 2018. The purpose of this study was Exploratory related to the Do-Not-Resuscitate(DNR),family palliative care consultation utilization of palliative care at end-of-life, and medical expensen. Results: The correlation between DNR consent and family palliative care consultations was statistically significant. Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR. 29.8% inpatients utilization palliative care at end of life.Inpatients who received palliative care and the average daily medical expense of patients with cancer who received palliative care were statistically significantly lower than patients who did not receive palliative care; diagnosis, hospital, and length of stay (LOS) may affect palliative care utilization of inpatient. MARS had the most consistent results; its accuracy was 0.751, and the main predictors of palliative care utilization are hospital, medical expense, LOS, diagnosis, and TW-PCST scores.
Conclusion: Familiy palliative consultation provide patients and families with an opportunity to participate in discussions about palliative care and DNR at end-of-life, and provide patients and their families with accurate medical information about the end-of-life care decision-making process. The results reveal that palliative care utilization by inpatients remains low, and it is necessary to educate patients without cancer of the benefits and advantages of palliative care.Precisely predicting the need for palliative care may encourage patients andtheir family members to consider palliative care, which may balance both physical and mental care.Therefore, unnecessary medical care can be avoided and limited medical resources can be allocatedto more patients in need.
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