乳癌病人疾病管理與治療結果之分析 - 以論質計酬試辦計畫
參與醫院為例
研究目的:比較「全民健康保險乳癌醫療給付改善方案試辦計劃」試辦醫院的收案病人
,在醫療資源的利用、治療方式和醫療品質等情形是否有顯著差異。
研究方法:擷取試辦醫院於 2003 年 4 月至 2004 年 12 月開始治療、無復發狀況且完治
的個案共 2033 人,觀察上述個案自治療日起 1 年內全國西醫醫院及基層診所的門、住
診醫療費用申報資料,並經由勾稽全民健康保險之保險對象承保資料檔、全民健康保險
重大傷病檔、治療完成個案醫療明細檔( B 表),以分別取得投保、死亡、重大傷病
及復發等資料。以百分比及平均數(標準差)來描述病人與醫院的特質;以卡方檢定、
平均值 t 檢定及 F 檢定來了解病人及醫院的特質,在醫療利用、治療方式和醫療品質等
情形是否有顯著差異;以線性複迴歸分析及羅吉斯複迴歸分析來評值醫療利用、治療方
式和醫療品質等方面,在醫院間是否有顯著差異。
研究結果: B 、 C 、 E 、 F 醫院病人的平均總就醫次數顯著偏高。 B 醫院之病人急診
情形顯著偏高。各醫院間收案病人之跨院就醫次數沒有顯著差異。除第 0 期病人外,醫
院間對相同期別的病人存在著不同的治療方式。 B 及 C 醫院之第 0 及 1 期手術病人執
行乳房保留手術情形顯著偏低。 C 醫院病人治療開始一年內之復發情形顯著偏高。 E
醫院病人治療開始一年內之死亡情形顯著較低。
結論:試辦醫院在疾病管理與治療結果上有顯著的差異,中央健康保險局應繼續監測各
醫院的治療及品質狀況。
Disease Management and Outcome Evaluation of Breast
Cancer Patients
Objectives: To compare the health care utilization, treatment modality and clinical outcome among patients enrolled in the “National Health Insurance Breast Cancer Disease Management Program”.
Methods: A total 2,033 newly diagnosis breast cancer patients participated in this program during April 20 03 and December 2004 were identified from Enrollment list ( Table A ) and Closed case list ( Table B ) . The National Health Insurance ( NHI ) claims data related medical uses were traced for one year f rom the date of principal treatment. Information on patients’ treatment modality and clinical outcome was r etrieved from Table B and Death file.
Percentage and mean ( standard deviation ) were used to describe patient’s characteristics and institutio n’s factors. χ2 test, t test and F test were used to test whether health care use, treatment modality and clinic al outcome were significantly different among patient’s characteristics and institution’s factors. Multiple L ogistic regression was employed to assess whether health care use, treatment modality and clinical outcom e were significantly different among hospitals.
Results: Compared with patients treated in Hospital A, patients treated in Hospital B 、 C 、 E and F have higher number of visits. Compared with patients treated in Hospital A, patients treated in Hospital B have h igher number of emergency visits. There was no significant difference in number of irregular visits. Except for non- invasive patients treatment modalities were significantly different among hospitals. Compared wit h patients treated in Hospital A, patients treated in Hospital B and C were significantly less likely to under go breast conserving surgery. Compared with patients treated in Hospital A, patients treated in Hospital C was significantly more likely to recurrent within one year. Compared with patients treated in Hospital A, p atients treated in Hospital E was significantly less likely to die within one year.
Conclusions: There were significant differences exist in disease management and outcome between hospita
ls participated in this program. The NHI should keep monitoring on treatment and quality of the hospitals.