探討術前合拼症指標與醫療利用及手術相關結果之關聯性-以全股(髖)關節置換健保申報資料為例

Using the Comorbidity Index to Evaluate the Medical Utilization and Outcomes of Total Hip Replacement through Analyzing National Insurance Claimed Data

10.6288/TJPH2004-23-02-04

吳肖琪(Shiao-Chi Wu)；簡麗年(Li-Nien Chien)；吳義勇(Yee-Yung Ng)

合拼症嚴重度指標(CCI) ； 死亡率 ； 申報資料 ； 全股(髖)關節置換術 ； Charlson comorbidity index ； mortality rate ； claimed data ； total hip replacement

台灣公共衛生雜誌

23卷2期（2004 / 04 / 01）

121 - 129

繁體中文

目標：應用察爾森合拼症嚴重度指標(Charlson comorbidity index，以下簡稱CCI)，探討全股(髖)關節置換術病患之手術前合拼症嚴重度與術後醫療利用及手術結果之關聯性。方法：利用全國健保申報次級資料，以民國89年1至12月進行單側全股(髖)關節置換手術者為研究對象，控制病患特質（年齡、性別、手術原因）、醫院特質（地區別、公私立與評鑑等級別）與住院期間復健次數與住院期間拼發症等，評估以當次住院及當次拼前一年住院診斷，計算合拼症嚴重度之CCI值大小與住院日、住院費用，出院後３０日及一年內死亡與再住院之關聯性。結果：以當次住院診斷計算CCI值，發現CCI值「2」分以上之病患住院日、費用、出院後３０日及一年內之死亡與再住院顯著高於「0」分的病患（住院日分別為11.9日與9.4日，費用為14.9萬與12.5萬，３０日內死亡率為2.8%與0.4%，30日再住院率為31.4%與7.2%，一年內死亡率為15.3%與1.8%，一年內再住院率為147.5%與40.0%）；控制其他干擾因子後，CCI值高低仍顯著影響住院日、費用，出院後30日及一年內死亡及再住院。當次拼前一年住院診斷之CCI值也顯著影響病患醫療利用與手術結果，但以當次住院CCI值校正合拼症嚴重度較具便利性。結論：術前合拼症嚴重度CCI值的高低與病患之住院期間醫療利用與出院後手術結果有關，除非計算一年內住院，否則以當次住院診斷計算CCI值即可。建議未來研究者可利用CCI值校正病患術前合併症嚴重度，健保局可進一步利用CCI值評估支付金額之合理性，醫院管理者可利用CCI值追蹤病患的預後。

Objective: To evaluate the correlation between the pre-operative Charlson comorbidity index (CCI) and post-operative medical utilization and quality for patients who underwent a total hip replacement (THR). Methods: The claimed data from the National Health Insurance for patients who underwent elective primary THR in 2000 was used in this study. The correlation between CCI and the parameters including length of stay, medical fee rate of mortality, and readmission within thirty days and one year were analyzed after adjustment of patients’ characters (age, gender, major diagnosis), characters of hospitals (area, owner and size), times of in hospital rehabilitations and complications. Result: The THR patients with a present pre-operative CCI score of more than 2 had a higher medical fee (NT $14,900 versus NT $12,500), thirty-day mortality (2.8% versus 0.4%), thirty-day readmission rate (31.4% versus 7.2%), one-year mortality (15.3% versus 1.8%), one-year readmission rate (147.5% versus 40.0%) and longer length of stay (11.9 days versus 9.4 days) than those with a zero score. After adjustment of the confounding factors, the pre-operative CCI score was still significantly positively related to the above parameters. Even the CCI score within one year was also positively related to the above parameters. The present score CCI was more efficient than the CCI score within one year for the response to the medical utilization and quality. Conclusion: The CCI score was highly correlated with the utilization of medical care during hospitalization and medical quality after discharge. The present CCI was more efficient than the CCI within one year, except for in respect to the one-year readmission rate. The CCI score could be used for the correction of severity of THR patients. NHI could use CCI to evaluate the rationality of reimbursements. The CCI score could also be applied to the hospital for prediction of the prognosis of THR.

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