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題名：高危險妊娠因素與出生體重對新生兒住院醫療費用的影響
書刊名：臺灣公共衛生雜誌
作者：楊雅淑／黃偉堯 引用關係
作者(外文)：Yang, Ya-shu／Huang, Wei-yao
出版日期：2013
卷期：32:3
頁次：頁240-250
主題關鍵詞：高危險妊娠因素；出生體重；住院醫療費用；診斷關聯群；High-risk pregnancy factors；Birth weight；Inpatient expenditure；Diagnosis-related groups
原始連結：連回原系統網址new window
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目標：探討高危險妊娠因素與出生體重對新生兒住院醫療費用的影響。方法：次級資料世代研究設計，使用2008年全民健康保險資料庫中入院年齡小於或等於28天之新生兒為研究對象，以獨立樣本t、ANOVA和複迴歸分析高危險妊娠因素與出生體重對新生兒的住院醫療費用的影響。結果：複迴歸分析結果顯示，母親年齡≧35歲(β=0.078)、孕期酗酒(β=1.004)、母體糖尿病(β=0.181)、母體腎臟病(β=0.761)、母體肺臟病(β=0.599)、母體貧血(β=0.119)、三胞胎以上(β=0.323)、產程太長(β=0.176)、羊水異常(β=0.290)、羊水中有胎便(β=0.259)、臍帶脫垂(β=0.414)、剖腹產(β=0.308)、妊娠週數＜37週(β=0.354)等高危險妊娠因素，和出生體重＜1,500克(β=1.428)、出生體重1,500至2,499克(β=0.432)，會使得新生兒的住院醫療費用偏高，且達統計顯著相關(p<.05)。結論：特定的高危險妊娠因素和低出生體重使得新生兒的住院醫療費用有上升的情形。建議健保局未來修正「新生兒與其他源於周產期病態之新生兒」(MDC 15)分類架構時，可同時考量特定高危險妊娠因素和出生體重的影響。
Objectives: The aim of this study is to investigate the influence of high-risk pregnancyfactors and birth weight on newborn inpatient expenditure. Methods: The study design is that ofa secondary cohort study. The subjects are admitted patients with ages of 28 days or less from the2008 National Health Insurance Research Database. This study analyzed the influence of highriskpregnancy factors and birth weight on newborn inpatient expenditure by t-test, ANOVAand multiple regression. Results: The multiple regression results showed that a maternal ageof 35 years or more at delivery (β=0.078), alcohol consumption during pregnancy (β=1.004),diabetes mellitus (β=0.181), renal disease (β=0.761), lung disease (β=0.599), anemia (β=0.119),giving birth to three or more babies (β=0.323), undergoing prolonged labor (β=0.176), sufferingfrom oligohydramnios or polyhydramnios (β=0.290), having meconium stained amniotic fluid(β=0.259), having a prolapsed cord (β=0.414), undergoing a caesarean section (β=0.308), havinga gestational age of less than 37 weeks (β=0.354), having a birth weight of less than 1,500g(β=1.428) and having a birth weight of 1,500-2,499g (β=0.432) increases newborn inpatientexpenditure significantly (p<0.05). Conclusions: Certain risk conditions associated with highriskpregnancies as well as low birth weight increase newborn inpatient expenditure. This studysuggests that when the Bureau of National Health Insurance modifies the Taiwan Diagnosis-Related Groups classification framework of Newborns and Other Neonates with ConditionsOriginating in the Perinatal Period (MDC 15), they should take into consideration various riskconditions that are associated with high-risk pregnancy in addition to birth weight.
期刊論文
1.Sedman, A. B.、Bahl, V.、Bunting, E.(2004)。Clinical redesign using all patient refined diagnosis related groups。Pediatrics，114，965-969。  new window
2.Lichtig, L. K.、Knauf, R. A.、Parrott, R. H.、Muldoon, J.(1989)。Refining DRGs. The example of children’s diagnosis-related groups。Med Care，27，491-506。  new window
3.黃瑞美、陳琇玲、楊捷如、林富滿、林秀美、李宣緯、鄭茉莉(20040800)。發展臺灣版新生兒病例組合分類系統。健康保險雜誌，1(1)，84-102。new window  延伸查詢new window
4.陳琇玲、楊銘欽、薛亞聖、楊捷如(20051200)。健保DRGs對臺灣病例變異解釋力之初探。臺灣公共衛生雜誌，24(6)，548-560。new window  延伸查詢new window
5.Hope, P.(1995)。CRIB, son of Apgar, brother to APACHE。Arch Dis Child Fetal Neonatal Ed，72，81-83。  new window
6.Richardson, D. K.、Phibbs, C. S.、Gray, J. E.、McCormick, M. C.、Workman-Daniels, K.、Goldmann, D. A.(1993)。Birth weight and illness severity: independent predictors of neonatal mortality。Pediatrics，91，969-975。  new window
7.Hobel, C. J.、Hyvarinen, M. A.、Okada, D. M.、Oh, W.(1973)。Prenatal and intrapartum high-risk screening. I. Prediction of the high-risk neonate。Am J Obstet Gynecol，117，1-9。  new window
8.徐興國、柯瑞祥、洪正修(19870200)。高危險妊娠的產前評估及處理。臨床醫學，19(2)=110，110-123。  延伸查詢new window
9.Korvenranta, E.、Linna, M.、Hakkinen, U.(2007)。Differences in the length of initial hospital stay in very preterm infants。Acta Paediatr，96，1416-1420。  new window
10.Adams, E. K.、Miller, V. P.、Ernst, C.、Nishimura, B. K.、Melvin, C.、Merritt, R.(2002)。Neonatal health care costs related to smoking during pregnancy。Health Econ，11，193-206。  new window
11.Phibbs, C. S.、Bateman, D. A.、Schwartz, R. M.(1991)。The neonatal costs of maternal cocaine use。JAMA，266，1521-1526。  new window
12.Ross, M. G.、Downey, C. A.、Bemis-Heys, R.、Nguyen, M.、Jacques, D. L.、Stanziano, G.(1999)。Prediction by maternal risk factors of neonatal intensive care admissions: evaluation of >59,000 women in national managed care programs。Am J Obstet Gynecol，181，835-842。  new window
13.Villar, J.、Carroli, G.、Zavaleta, N.(2007)。Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study。BMJ，335，1025。  new window
14.Malkin, J. D.、Broder, M. S.、Keeler, E.(2000)。Do longer postpartum stays reduce newborn readmissions? Analysis using instrumental variables。Health Serv Res，35(5 Pt 2)，1071-1091。  new window
15.Wang, M. L.、Dorer, D. J.、Fleming, M. P.、Catlin, E. A.(2004)。Clinical outcomes of near-term infants。Pediatrics，114，372-376。  new window
16.Powell, P. J.、Powell, C. V.、Hollis, S.、Robinson, M. J.(1992)。When will my baby go home?。Arch Dis Child，67，1214-1216。  new window
17.Russell, R. B.、Green, N. S.、Steiner, C. A.(2007)。Cost of hospitalization for preterm and low birth weight infants in the United States。Pediatrics，120，1-9。  new window
18.Lichtig, Leo K.、Knauf, Robert A.、Bartoletti, Albert、Wozniak, Lynn-Marie、Gregg, Robert H.、Muldoon, John、Ellis, William C.(1989)。Revising Diagnosis-related Groups for Neonates。Pediatrics，84(1)，49-61。  new window
19.Muldoon, John H.(1999)。Structure and Performance of Different DRG Classification Systems for Neonatal Medicine。Pediatrics，103(1 Suppl E)，302-318。  new window
20.Gilbert, W. M.、Nesbitt, T. S.、Danielson, B.(2003)。The cost of prematurity: Quantification by gestational age and birth weight。Obstetrics and Gynecology，102(3)，488-492。  new window
21.Schmitt, S. K.、Sneed, L.、Phibbs, C. S.(2006)。Costs of newborn care in California: A population-based study。Pediatrics，117(1)，154-160。  new window
會議論文
1.楊雅淑、黃偉堯(2011)。高危險新生兒的生命指數與醫療資源耗用的影響因素分析。台灣健康保險學會第三屆第二次會員大會暨全民健康保險與長期照護保險發展趨勢研討會。臺北：國立台灣大學公衛學院。60-74。  延伸查詢new window
圖書
1.Lee, K. G.(2008)。Identifying the high-risk newborn and evaluating gestational age, prematurity, postmaturity, large-for-gestational-age, and small-for-gestationalage infants。Manual of Neonatal Care。Philadelphia：Wolters Kluwer Health：Lippincott Williams & Wilkins。  new window
2.許振東、湯美萍、吳恩婷(2003)。圖解小兒科學。臺北：藝軒。  延伸查詢new window
3.洪漢陽(2006)。高危險兒的辨認與低體重兒的分類及罹患疾病。臨床新生兒科學。臺北：嘉洲。  延伸查詢new window
4.顏兆熊(2009)。高危險妊娠。金名。  延伸查詢new window
5.陳月枝、廖珍娟、高碧霞(1998)。小兒科護理學（上）。臺北：華杏。  延伸查詢new window
6.Fetter, R. B.(1991)。Background。DRGs: Their Design and Development。Michigan：Health Administration Press。  new window
 
 
 
 
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