中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/25073
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    题名: 比較都市與偏遠地區民眾在可避免住院照護、透析治療及癌症治療之成效
    Comparing the Effectiveness of Health Care for Preventable Hospitalizations, Hemodialysis, and Cancers in Urban and Rural Residents
    作者: 蔡文正
    贡献者: 中國醫藥大學醫務管理學系
    关键词: 都市地區;偏遠地區;可避免住院;血液透析;癌症;Urban;Rural areas;Preventable hospitalization;Hemodialysis;Cancer
    日期: 2010-07
    上传时间: 2010-06-29 14:42:37 (UTC+8)
    摘要: 近年來由於健保政策的改善，政府越來越重視都市與偏遠地區間醫療資源分布的均衡性，陸續推行巡迴醫療、鼓勵醫師至偏遠地區執業以及山地離島地區醫療給付效益提升計畫(IDS)等措施，雖然過去研究發現台灣過半數偏遠地區居民表示就醫不會不方便，甚至其平均西醫門診次數高於全國平均。但是甚少研究比較都市與偏遠地區醫療資源差異是否影響醫療照護，進而導致兩地居民在健康預防照護或疾病存活情形之差異。因此，本研究以比較都市及偏遠地區民眾醫療利用與疾病照護成效之差異為主軸，分三年期進行探討，第一年主要探討都市與偏遠地區其可避免住院疾病之盛行率與醫療利用趨勢之差異和其影響因素；第二年主要討論都市與偏遠地區血液透析病患其醫療利用趨勢以及存活情形之差異和相關影響因素；第三年則探討都市與偏遠地區其六大癌症病患其醫療利用及存活情形之差異。本計畫三年之研究方法分述如下：第一年主要利用2006 年美國健康照護研究及品質局(AHRQ)所定義之「可避免住院疾病」之病患為本研究對象，以1997～2007 年之健保資料庫為資料來源，進一步篩選出位於都市及偏遠地區者為本研究對象。以變異數分析比較都市及偏遠地區其可避免住院疾病門、急、住診之醫療利用上的差異。最後利用羅吉斯迴歸分析探討1997 年、2002 年、2007 年三個年度影響可避免住院之疾病是否住院之相關因素及其差異。第二年則以1998 年～2008 年之健保資料庫中之都市及偏遠地區初次進行血液透析治療病患為本研究對象。除基本描述性分析外，本研究欲利用多年期資料探討血液透析病患3 年、5 年及7 年存活率之差異，並利用存活分析比較都市及偏遠地區血液透析病患存活時間之差異和其可能影響的相關因素。第三年則以1998 年～2009 年之健保資料庫中之都市及偏遠地區之新罹患六大癌症病患為研究對象，以趨勢分析檢驗都市與偏遠地區六大癌症罹患率及醫療利用趨勢變化，並比較六大癌症新罹癌病患3 年、5 年及7 年存活率以及平均存活時間。並利用KM Curves 及Log-Rank test 比較都市及偏遠地區六大癌症病患於1998-2009 各年間的存活情形差異。最後以Cox Regression Model 探討影響六大癌症病患存活情形之相關因素。依據本研究結果，希望可提供政府單位促進醫療資源分布或擬定偏遠地區相關衛生政策之參考依據。

    Since the improvement of health insurance policy, Taiwan government has paid much attention to balancing health care resources between urban and rural areas. These policies included encouraging physicians to practice in rural area, providing mobile care, and implementing the integrative delivery system (IDS) program. More than half of the rural area residents did not complain the inconvenience when they sought for medical care, and the average number of outpatient visits per person in rural areas was higher than that of the whole nation. There were very few researches to examine whether the difference of health care resources between urban and rural areas influences health care and causes the difference in health prevention and disease survival status between these two areas’ residents. This study is a three-year research and will compare the differences in health care utilizations and effectiveness of illness care between urban and rural areas. In the first year, this study will investigate the prevalence of preventable-hospitalization diseases and the differences of health care utilization, as well as the associated factors between these two areas. In the second year, this study will explore the differences in health care utilizations and survival status of hemodialysis patients as well as the relative factors between these two areas. In the third year, this study will examine the differences in heath care utilizations and survival status of six leading cancers patients in these two areas. The research methods are the following: this study will apply national health insurance (NHI) dataset from 1997 to 2007 in the first year. The study population is the patients who live in urban or rural areas with preventable-hospitalization diseases that were defined by Agency for Healthcare Research and Quality (AHRQ). One way ANOVA will be used to test the differences in health care utilizations such as outpatient services, emergency service, and inpatients services in preventable- hospitalization diseases in these two areas. Logistic regression will be applied to investigate the relative factors that influence hospitalization of preventable-hospitalization diseases in 1997, 2002, and 2007, respectively The second-year research will apply the hemodialysis-related data from the NHI claim dataset for the residents in urban and rural areas in 1998-2008. The residents with hemodialysis care will be the study population. Besides the description statistics, this study will examine the difference in 3-year, 5-year, and 7-year survival rate for hemodialysis patients living in urban and rural areas. Moreover, this study will use survival analysis to compare the difference in survival times for the hemodialysis patients living in urban and rural areas and investigate the associated factors. The third-year research will also use the six leading cancers patients-related data from the NHI claim dataset for the residents in urban and rural areas in 1998-2009. The six leading cancers patients will be the study population. The trend analysis will be conducted to explore the changes in prevalence rate and medical utilization of cancer patients. The 3-year, 5-year, and 7-year survival rate as well as average survival time will be analyzed. In addition, KM curves and Long-rank test will be performed to compare the difference in survival time between urban and rural areas’ cancer patients. Cox regression model will be used to examine the factors associated with cancer patients’ survival time. The results of this study will be the reference to enhance the distribution of health care resources or to set the relative health care policy for the rural areas.
    显示于类别:[醫務管理學系暨碩士班] 研究計畫

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