採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用之分析

Analysis on Hospital Utilization in Hemodialysis Patients with Different Types of Access

10.6288/TJPH2009-28-02-07

洪燕妮(Yen-Ni Hung)；吳肖琪(Shiao-Chi Wu)；吳義勇(Yee-Yung Ng)；柯博仁(Po-Jen Ko)

血管通路 ； 血液透析 ； 醫療利用 ； 住院天數 ； 住院費用 ； vascular access ； hemodialysis ； hospital utilization ； length of stay ； expenditure

台灣公共衛生雜誌

28卷2期（2009 / 04 / 01）

144 - 154

繁體中文

目標：了解國內採用動靜脈瘻管或人工血管之血液透析病人住院醫療利用情形。方法：採回溯性世代研究法，以衛生署提供之健保門住診申報資料，選取2002年新透析病人，以其第一次建置血管通路為起始點追蹤其一年內之住院醫療利用，住院主因依美國腎臟資料系統(USRDS)分為8大類，自變項為血管通路類型，控制變項為性別、年齡、共病症、血管通路建置時間，以複迴歸模式分析住院利用之相關因素。結果：研究對象計6,228人，不論住院人次、天數及費用由8大類住院主因來看，均以血管通路問題(23.92%-25.32%)及泌尿系統(22.03%-26.29%)為主；人工血管在透析後一年內的8大類住院次數、住院天數、住院費用均較自體動靜脈瘻管平均值高；控制其他變項後，血管通路類型對住院次數、住院天數、住院費用仍有顯著影響。結論：血管通路問題是住院主因，不同血管通路類型之住院利用及費用有顯著不同，採用人工血管較自體動靜脈瘻管有更高的住院利用，宜鼓勵提高自體動靜脈瘻管的建置率，另外，如何在臨床及病人自我照護方面，避免血管通路的感染及栓塞值得重視。

Objectives: To analyze the hospital utilization of end stage renal failure (ESRD) patients with different types of dialysis access in Taiwan. Methods: This analysis used claims data for all newly developed ESRD patients in 2002 from the Taiwan National Health Insurance (NHI) database provided by the Department of Health (DOH). Patients who died in the first year were excluded. We tracked all subjects for 12 months from the start of their dialysis access and reviewed data regarding the number of hospital admissions, length of stay, and expenditure. We grouped causes of admission according to the United States Renal Data System (USRDS) and used multiple regression to analyze the correlation between hospital utilization and type of vascular access by controlling other variables such as gender, age, co-morbidities, and time of access creation. Results: The leading causes of admission for 6,228 newly developed ESRD patients in 2002 were dialysis access related problems (23.92%-25.32%) and urology system related problems (22.03%-26.29%). The number of admissions, length of stay, and inpatient expenditure of ateriovenous graft (AVG) patients were significantly greater than those of arteriovenous fistula (AVF) patients during the first year post access creation. Conclusions: ESRD patients in Taiwan who accessed dialysis through AVG utilized more hospital resources than those with AVF. We encourage increasing the percentage of AVF creation rate for access. Lowering the incidence of access infection and thrombosis may also reduce medical expenditure on ESRD patients since access related problems were the leading cause of hospitalization of those patients.

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