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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=Timing of Vascular Access Creation Influences Hospitalization Expenses in Incident Hemodialysis Patients |
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作 者 | 吳鈴珠; 林明彥; 謝炯昭; 黃尚志; | 書刊名 | 醫務管理期刊 |
卷 期 | 10:2 2009.06[民98.06] |
頁 次 | 頁63-75 |
分類號 | 419.44 |
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; |
語 文 | 中文(Chinese) |
中文摘要 | 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。 |
英文摘要 | 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. |
本系統中英文摘要資訊取自各篇刊載內容。