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題名：血管通路建立時機對新進入血液透析患者住院醫療費用之影響
書刊名：醫務管理期刊
作者：吳鈴珠／林明彥／謝炯昭／黃尚志
作者(外文)：Wu, Ling-chu／Lin, Ming-yen／Hsieh, Chong-chao／Hwang, Shang-jyh
出版日期：2009
卷期：10:2
頁次：頁63-75
主題關鍵詞：末期腎臟疾病；血液透析；血管通路；建立時機；住院醫療費用；End stage renal disease；Hemodialysis；Vascular access；Timing of creation；Inpatient expenses
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目的：血管通路的成熟度決定末期腎臟病患者是否可平順進入血液透析而不需緊急置放臨時導管，因此本研究主要在探討新進入血液透析之末期腎臟病患者，血管通路建立時機對其血管通路相關住院醫療費用之影響。 方法：以回溯性研究南部某醫學中心及其區域教學醫院2001年至2003年新進入血液透析治療滿三個月之患者，依其血管通路建立時機分成三組；計畫性建立組(n=70)爲透析前一個月以上建立者、延遲建立組(n=48)爲透析前一個月內建立者及緊急建立組(n=368)爲透析後建立者，比較病患進入透析前後一年住院醫療費用。 結果：符合研究定義之樣本共486位，透析前後一年期間平均住院醫療費用，緊急建立組顯著地高於計畫建立組。複迴歸分析顯示，人口學因子之年齡與工作狀態、血管通路因子之建立時機與血管通路重建與否、疾病因子之原發病因爲糖尿病及合併症個數爲透析前後一年平均住院醫療費用之影響因子。 結論：末期腎臟病患者如能在開始透析前配合醫療團隊指導，有計畫的完成血管通路建立，將能有效節省住院醫療費用。預先建立血管通路是一個可在透析前期加以推廣之重要醫療策略。
Objectives: Good preparation of vascular access (VA) for patients with advanced chronic kidney disease (CKD) is mandatory for a smooth initiation of hemodialysis. This not only influences the quality of medical care but also medical expenses. The aim of our study was to evaluate the influences of the timing of VA creation on hospitalization expenses in incident HD patients. Methods: We recruited 486 incident HD patients from 2001 to 2003 at a medical center and a district teaching hospital in southern Taiwan. Based on the timing of VA creation they were divided into the planned group with VA creation more than one month before initiation of HD, the delayed group with VA creation less than one month before initiation of HD, and the urgent group with VA creation after initiation of HD. Data on inpatient expenses during the one year period before and after initiation of HD were obtained from the two study hospitals. Results: The overall inpatient medical expenses (ME) during the period were significantly higher in the urgent goup than in the planned group. A regression model revealed that age, working status, the timing of VA creation, reconstruction of VA, diabetes as a primary disease and numbers of comorbidities were significant factors for inpatient ME. Conclusions: Incident HD patients with VA created after the initiation of HD have significantly higher inpatient expenses one year before and after initiation of HD. In pre-end stage renal disease care, VA creation before initiation of HD is recommended.
Other
1.台灣腎臟醫學會(2005)。92年度透析病患年度報告。  延伸查詢new window
期刊論文
1.Beddhu, Srinivasan、Bruns, Frank J.、Saul, Melissa、Seddon, Patricia、Zeidel, Mark L.(2000)。A simple comorbidity scale predicts clinical outcomes and costs in dialysis patients。The American Journal of Medicine，108(8)，609-613。  new window
2.Bruns, F. J.、Seddon, P.、Saul, M.、Zeidel, M. L.(1998)。The Cost of Caring for End-stage Kidney Disease Patients: An Analysis Based on Hospital Financial Transaction Records。Journal of the American Society and Nephrology，9，884-890。  new window
3.Yang, W. C.、Hwang, S. J.、Chiang, S. S.、Chen, H. F.、Tsai, S. T.(2001)。The impact of diabetes on economic costs in dialysis patients: Experiences in Taiwan。Diabetes Research and Clinical Practice，54(Suppl 1)，47-54。  new window
其他
1.行政院衛生署(2006)。死因統計結果摘要--94年全文目錄。  延伸查詢new window
2.中央健康保險局(2005)。全民健康保險統計--90年度、91年度、92年度、93年度。  延伸查詢new window
3.United States Renal Data Systems(USRDS)(2005)。2005 Annual Data Report, National Institutes of Diabetes, Digestive and Kidney Diseases。  new window
4.(2006)。NKF-DOQI Clinical practice guidelines for vascular access: Update 2006。  new window
5.Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni RL.(2006)。Haemodialysis vascular access problems in Canada: results from the dialysis outcomes and practice patterns study(DOPPS II)。  new window
6.Khosla N, Ahya SN.(2002)。Improving dialysis access management。  new window
7.Manns B, Tonelli M, Yilmaz S,(2005)。Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis。  new window
8.邱美清(2004)。末期腎臟疾病患者進入透析前之醫療服務利用及其影響探討。  延伸查詢new window
9.Rocco MV, Bleyer AJ, Burkart JM.(1996)。Utilization of inpatient and outpatient resources for the management of hemodialysis access complications。  new window
10.Merrill D, Brouwer D, Briones P.(2005)。Hemodilysis access: a guide for caregivers and patients。  new window
11.Arora P, Kausz AT, Obrador GT,(2000)。Hospital utilization among chronic dialysis patients。  new window
12.Kizilisik AT, Kim SB, Nylander WA, Shaffer D.(2004)。Improvements in dialysis access survival with increasing use of arteriovenous fistulas in a veterans administration medical center。  new window
13.Feldman HI, Joffe M, Rosas SE, Bums JE, Knauss J, Brayman K.(2003)。Predictors of successful arteriovenous fistula maturation。  new window
14.Lok CE, Oliver MJ.(2003)。Overcoming barriers to arteriovenous fistula creation and use。  new window
15.Xue JL, Dahl D, Ebben JP, Collins AJ.(2003)。The association of initial hemodialysis access type with mortality outcomes in elderly medicare ESRD patients。  new window
16.Lee H, Manns B, Taub K,(2002)。Cost analysis of ongoing care of patients with end-stage renal disease: the impact of dialysis modality and dialysis access。  new window
17.Sehgal AR, Dor A, Tsai AC.(2001)。Morbidity and cost implications of inadequate hemodialysis。  new window
18.Murphy SW, Foley RN, Barrett BJ(2000)。Comparative hospitalization of hemodialysis and peritoneal dialysis patients in Canada。  new window
19.宋玉峰、林裕峰(2000)。腎臟衰竭之血管通路。  延伸查詢new window
20.Robbins JD, Kim JJ, Zdon G, Chan WW, Jones J.(2003)。Resource use and patient care associated with chronic kidney disease in a managed care setting。  new window
21.Saran R, Dykstra DM, Pisoni RL(2004)。Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS。  new window
22.Rayner HC, Pisoni RL, Gillespie BW(2003)。Creation, cannulation and survival of arteriovenous fistula: data from the dialysis outcomes and practice patterns study。  new window
23.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。  延伸查詢new window
24.楊昌叔、張慧如、滕春祐、錢慶文(2005)。糖尿病視網膜病變醫療資源耗用影響因素之研究--以某醫學中心爲例。  延伸查詢new window
25.Mishler R, Sands JJ, Ofsthun NJ, Teng M, Schon D, Lazarus JM.(2006)。Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments。  new window
 
 
 
 
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