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題名 | 中醫臨床標準作業程序及療效評估:以氣喘、腦中風、腦性麻痺為例=Clinical Pathways and Cost-Benefit Appraisals of the Traditional Chinese Medicine : The Cases of Asthma, Stroke, and Cerebral Palsy |
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作 者 | 孫茂峰; | 書刊名 | 中醫藥年報 |
卷期 | 28:3 2010.09[民99.09] |
頁次 | 頁23-68 |
專輯 | 中醫醫療品質之研究(二) |
分類號 | 413.2 |
關鍵詞 | 臨床標準作業程序; 療效評估; 氣喘; 腦中風; 腦性麻痺; Clinical pathways; Cost-benefit; Asthma; Stroke; Cerebral palsy; |
語文 | 中文(Chinese);中文(Chinese) |
中文摘要 | 研究目的:本研究針對長庚紀念醫院中醫醫院之「腦性麻痺患者中醫優質門診」,「氣喘患者中醫優質門診」,以及腦中風住院患者,評估相關疾病在臨床標 準作業程序下的效益與成本。 研究方法:病患分為實驗組與對照組,以問卷方式收集病患、家屬的基本資料,腦性麻痺、氣喘、腦中風患者實驗組基期樣本分別有33、40、41位,對照組 各有28、65、26位;後續追蹤期實驗組樣本分別有24、24、23位,對照組有 16、33、12位。在效益方面,我們以特定慢性病患的臨床療效評估、生活品 質指標、以及EQ5D評量的效用等工具評估病患效益,並利用主要照護者生 活品質量表和EQ5D評量的效用考慮照護者生活品質的效益;在成本方面,我們考慮治療的健保支出和病患自付的費用,評估在中醫臨床標準作業程序下接受治療的病患的成本與療效之成本效益比。 結果與討論:腦性麻痺、氣喘、腦中風患者基期基本特性沒有明顯差異,唯一的例外 是腦性麻痺實驗組年齡顯著低於對照組,但氣喘實驗組自評健康狀況明顯低 於對照組。在一般就醫習慣方面,腦性麻痺、氣喘、腦中風患者的急診、住院費用都高於對照組。主要照護者實驗組基期基本特性與健康都與對照組沒有明顯差異。 實驗組接受中醫治療約3個月後,腦性麻痺患者在粗動作功能評量上有 顯著優於對照組的進步,但在學齡前兒童發展量表的表現卻不如對照組;氣喘患者在氣喘控制測驗的表現與對照組近似;腦中風患者基期的狀況多不如 對照組,治療後在巴氏量表和中風衝擊量表的表現多有進步,且有明顯優於對照組的項目。各類病患與主要照護者自評健康都有進步、不變和退步互見的情形,但實驗組病患的平均效用增加,腦性麻痺、氣喘照護者的平均效用卻下降。治療後實驗組的一般急診、住院利用多較對照組低。我們設算成本效益比值,以作為臨床照護和政策的參考。 |
英文摘要 | Aim: This study aims to appraise the costs and benefits of the traditional Chinese medicine treatments for patients of asthma, stroke and cerebral palsy under the standard procedures developed by the Chang Gung Memorial Hospital. Method: Patients are stratified into experiment and controlled groups. There are 33, 40, and 41 samples for cerebral palsy (cp), asthma, and stroke in the experiment group at base line. The control group consists of 28, 65, and 26 sample, respectively. There are 24,24,23 samples in the follow-up experiment group, and 16, 33, 12 samples in the controlled group. On the benefit side, we take into account the clinical effectiveness, quality of life, opportunity costs saved and so forth. Care-givers’ quality of life is also considered. On the costs side, we consider the treatment costs for the health insurance, out-of-pocket expenditures and so forth. Information of the participating patients, care-givers is collected regularly through questionnaires designed by the investigators. Cost utility ratios are estimated for patients of the specific diseases. Results and Discussion: There are no significant age and gender difference between the experiment and controlled group. The only exception is that cp experiment patients are significantly younger than the controlled group. The self-assessed health of asthma experiment group is lower than that of the controlled group. Patients of the experiment group have higher emergency and inpatient utilization than the controlled group. There is no significant differences between the care-givers. After receiving Chinese medicine treatment for 3 months, cp patients have shown improvement better than that of the controlled group in GMFM tests. Nonetheless, they did not performed as well in the CCDI tests. Asthma patients show improvement that is similar to the controlled group. While stroke patients have inferior health at baseline, they have shown some greater improvement measured by Bathel index and stroke impact scale. After being treated for about 3-months, patients and care-givers have shown improvement, some remain unchanged, while the others have regressed in self-assessed health measured by EQ5D. Nonetheless, all experiment group experience increase in average utility, while experiment group care-givers of cp and asthma experience decrease in average utility. Emergency and inpatient utilization of the experiment group have mostly been lowered than that of the controlled group. Cost utility ratios are estimated separately for each group. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。