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| 題 名 | 用ACG風險校正系統篩選臺灣地區高風險血液透析治療病人=Using the Adjusted Clinical Groups System to Identify High-risk Hemodialysis Patients in Taiwan |
|---|---|
| 作 者 | 孫嘉敏; 莊書琳; 李偉強; | 書刊名 | 醫務管理期刊 |
| 卷 期 | 11:4 2010.12[民99.12] |
| 頁 次 | 頁311-326 |
| 分類號 | 415.816 |
| 關鍵詞 | 末期腎臟疾病; 血液透析治療; 疾病負荷; 校正臨床群; 死亡率; End-stage renal disease; Hemodialysis; Morbidity burden; Adjusted clinical groups; Mortality; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 目的：台灣血液透析病人及費用快速成長，本研究將量化並且分析血液透析病人疾病負荷與死亡風險的關聯性，希望能採用適當的工具篩選高風險病人。 方法：由全民健保門住診透析資料擷取2006年連續透析四個月以上，只使用血液透析治療的病人，且這群病人在2005年亦採血液透析治療。導入Adjusted Clinical Groups (ACGs)系統，按病人年齡、性別及門、住診診斷，計算個人的疾病負荷，並以Major Aggregated Diagnosis Groups (Major ADG)的數目多寡，分成五組：非常輕(0~1)、輕(2)、中等(3)、較重(4)與重(5~8)。用Kaplan-Meier curves比較不同疾病負荷病人之累積死亡風險，並分析與病人死亡的關聯性。 結果：共有32，944位病人合乎條件，疾病負荷程度經ACGs系統評量，61.9%有1-2個，19.4%有3個，18.7%有4個或以上的Major ADGs。病人的疾病負荷程度，為影響其死亡風險的主要因素。與非常輕的病人相比，校正後疾病負荷「輕」病人的相對死亡風險高出90%，中等疾病負荷者高出4.7倍，而較重與重度疾病負荷者，其危險性更高出近10倍。 結論：應用ACG系統可以有效量化病人的疾病負荷，可以及早發現高風險的血液透析病人，並納入更有效的疾病管理。 |
| 英文摘要 | Objectives: There has been an increasing number of patients with end-stage renal disease and rising costs for hemodialysis in Taiwan. The objective of this study was to quantify patients' morbidity burdens and to examine the association between these morbidity burdens and mortality. Methods: Claims data for patients who received regular hemodialysis in 2005 and for at least four months in 2006 were used. The Adjusted Clinical Groups (ACGs) system was used to quantify an individual's morbidity burden based on age, gender, and ambulatory and inpatient diagnoses. Patients were classified into five morbidity groups based on an individual's number of Major Aggregated Diagnosis Groups (Major ADGs): very mild (0-1), mild (2), middle (3), severe (4), and very severe (5-8). Kaplan-Meier curves were used to present the cumulative mortality rates for patients with varying morbidity burdens, and the Cox proportional hazard model was used to evaluate the association between morbidity burden and mortality. Results: Claims data for 32, 944 patients were analyzed. Of these, 61.9% of the patients had 1-2, 19.4% had 3, and 18.7% had 4 or more Major ADGs. A patient’s morbidity burden was significantly associated with his or her likelihood of mortality. When compared to patients with 0-1 Major ADG, the adjusted hazard ratio was 1.90 for those with 2 Major ADGs, 5.71 for those with 3 Major ADGs, 9.60 for those with 3 Major ADGs, and 10.5 for those with 4 or more ADGs. Conclusions: The ACG case-mix adjustment tool quantified a patient's morbidity burdens and this was significantly associated with mortality risk. Application of the ACG system can screen high-risk patients for disease management programs in order to improve quality of care. |
本系統中英文摘要資訊取自各篇刊載內容。