外傷性脊髓損傷者使用健保資源秏用率及復健之介入初探

The Health Insurance Resources Utilization and Rehabilitation Intervention in Patients with Traumatic Spinal Cord Injury: A Pilot Study

10.6315/TJPMR.202112_49(2).0004

黃寶(Pao Huang)；王仁宏(Jen-Hung Wang)；樊志成(Chih-Cheng Fan)；陳柏廷(Po-Ting Chen)；梁忠詔(Chung-Chao Liang)

脊髓損傷（spinal cord injury） ； 復健治療（rehabilitation） ； 健保資料庫（national health insurance research database） ； spinal cord injury ； rehabilitation ； national health insurance research database

台灣復健醫學雜誌

49卷2期（2021 / 12 / 01）

173 - 182

繁體中文

脊髓損傷是一種對病患本身及健保醫療造成長期醫療負擔的疾病。隨著醫療技術進步，脊髓損傷患者死亡率降低，且因為台灣人口平均餘命延長，伴隨失能存活的脊髓損傷患者，需要長期復健治療及應付各種後續併發症，長期照護需求的費用也可預期地將會再增加。本研究的目的在分析外傷性脊髓損傷病患在住院時及出院後追蹤三年健保醫療費用的影響因子，以期望能更有效的運用醫療資源。本研究收集分析健保資料庫的百萬歸人檔，於2000年到2009年並持續追蹤三年到2012年，計有5652位外傷性脊髓損傷，符合ICD-9分類碼806.XX及952.XX者。病患的基本資料包括年齡、性別、受傷原因、住院天數、是否合併六大外傷、復健使用次數、再次入院次數及天數等醫療費用相關的因子皆被納入，再以複迴歸分析各變項之影響。分析結果顯示，平均住院費用為96246 ± 142451元，平均住院天數則為10.4 ± 25.3天。而與健保醫療耗用相關的顯著因子，包含：（1）年齡、（2）性別、（3）受傷部位、（4）是否合併外傷及（5）三年內再次住院次數。本研究顯示下列幾項數據，年紀越大，因意外發生造成的TSCI比率逐漸提高，尤其女性在超過60歲之後，發生比率相對顯著。患者若合併六大外傷，以頭部創傷達14.9%佔最大宗。而在住院時有接受復健治療的只佔17.9%，而其中職能治療介入更少，只有5.6%。為減少失能且預防併發症的發生，能及早接受復健治療的介入，可以衛教家屬減少關節攣縮、褥瘡的發生或其他併發症所造成照護上的困擾。

Spinal cord injury is associated with a substantial and long-term economic burden on both the patients and the national health insurance. Due to the advancements in medical techniques, the mortality rate of patients with spinal cord injury has decreased. Moreover, as the life expectancy has increased in Taiwan, patients with spinal cord injury may need long-term rehabilitation to restore their functions of daily living and prevent further complications. Nonetheless, long-term rehabilitation would increase the economic burden on the long-term care facilities, as expected. This study aimed to analyze the impact (from admission to 3-year follow-up after discharge) of medical expenses on patients with traumatic spinal cord injury, with a focus on using the medical resources more efficiently. In this study, data from the National Health Insurance Research Database was analyzed and 5,625 patients with traumatic spinal cord injury (ICD-9 classification cord 806.XX and 952.XX) between 2000 and 2009 (follow-up to 2012) were finally included. The extracted data included age, gender, cause of injury, duration of inpatient hospital stay, presence of other traumatic injuries, duration of rehabilitation, total number and duration of readmissions, and other variables that might have an impact on the medical expenses. Multiple regression analysis was performed to ascertain the effects of the variables. The results showed that the average hospitalization expenses were 96,246 ± 142,451 dollars, and the average duration of the inpatient hospital stay was 10.4 ± 25.3 days. In addition, the variables, that had a significant impact on the utilization of the health insurance included age, gender, site of injury, presence of other traumatic injuries, and the number of readmissions during the 3-year follow-up period. The results showed that patients using more health insurance and economic resources had some specific characteristics, including male aging from 40 to 60, cervical spinal cord injury, and receiving rehabilitation. Female aging more than 60 were more likely to suffer from traumatic spinal cord injury (TSCI) causing by accidents. Moreover, head injury was the commonest traumatic injuries combining with TSCI (14.9%). Only 17.1% and 5.6% patients with TSCI received inpatient rehabilitation and occupational therapy, respectively.

1. 張勝閔、曾聖維：慢性脊髓損傷患者神經性膀胱併發症發生率之回溯性研究。台灣復健醫學雜誌2019；47：125-32。
   連結：
2. Wan FJ, Chien WC., Chung CH, et al. Association between traumatic spinal cord injury and affective and other psychiatric disorders-A nationwide cohort study and effects of rehabilitation therapies. Journal of affective disorders 2020 265, 381-88.
   連結：
3. Lim SW, Shiue YL, Ho CH, et al. Anxiety and Depression in Patients with Traumatic Spinal Cord Injury: A Nationwide Population-Based Cohort Study. PLOS one, 12:e0169623.
   連結：
4. 張清棊、楊喻婷、游舒涵等：脊髓損傷患者創傷後壓力症候群之盛行率及相關因子研究。台灣復健醫學雜誌2014；42：111-20。
   連結：
5. Chu D, Lee YH, Lin CH, et al. Prevalence of associated injuries of spinal trauma and their effect on medical utilization among hospitalized adult subjects--a nationwide data-based study. BMC health services research 2009;9:137.
   連結：
6. Granger CV, Karmarkar AM, Graham JE, et al. The uniform data system for medical rehabilitation: report of patients with traumatic spinal cord injury discharged from rehabilitation programs in 2002-2010. American journal of physical medicine & rehabilitation 2012;91:289-99.
   連結：
7. Wu JC, Chen YC, Liu L, et al. Effects of age, gender, and socio-economic status on the incidence of spinal cord injury: an assessment using the eleven-year comprehensive nationwide database of Taiwan. Journal of neurotrauma 2012;29:89-97.
   連結：
8. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of clinical epidemiology 1992;45:613-19.
   連結：
9. Chan BCF, Cadarette SM, Wodchis WP, et al. The lifetime cost of spinal cord injury in Ontario, Canada: a population-based study from the perspective of the public health care payer. The journal of spinal cord medicine 2019;42:184-93.
   連結：
10. Russell HF, Richardson EJ, Bombardier CH, et al. Professional standards of practice for psychologists, social workers, and counselors in SCI rehabilitation. The journal of spinal cord medicine 2016;39:127-45.
    連結：
11. 徐子雯、林彣芷、何宗翰等：台灣老年髖骨骨折病患特色分析以及術後住院期間復健治療之使用狀況。台灣復健醫學雜誌2014；42：63-68。
    連結：
12. 蔡宗棋、曾櫻枝；步態訓練對社區重覆跌倒老人往前及往後步態之成效探討。新臺北護理期刊。2019；21：53-63。
    連結：
13. Gao F, Chu H, Chen L, et al. Factors associated with in-hospital outcomes of traumatic spinal cord injury: 10-year analysis of the US national inpatient sample. JAAOS-Journal of the American Academy of Orthopaedic Surgeons 2020;28:707-16.
    連結：
14. Chu D, Lee YH, Lin CH, et al. Prevalence of associated injuries of spinal trauma and their effect on medical utilization among hospitalized adult subjects-a nationwide data-based study. BMC health services research 2009;9:137.
    連結：
15. 胡嘉桂、林佩昭：脊髓損傷者之持續性照護。領導護理2020；21：24-35。
    連結：
16. Lam, C. S. K., Chen, P. L., Kang, J. H., Cheng, K. F., Hung, K. S., & Chen, R. J. (2018). Risk factors for 14-day rehospitalization following trauma with new traumatic spinal cord injury diagnosis.
    連結：
17. 朱育增、吳肖琪：回顧與探討次級資料適用之共病測量方法。台灣公共衛生雜誌29：8-21。
    連結：
18. 許嘉麟、陳妙旼、陳智光：中風病患在慢性復健科病房住院醫療費用預測因子之探討。台灣復健醫學雜誌2010；47：145-53。
    連結：
19. 連賢明：如何使用健保資料進行經濟研究。經濟論文叢刊2008；36：115-43。
    連結：
20. Devivo M, & Chen Y. Epidemiology of traumatic spinal cord injury. In: Kirshblum L, & Campagnolo DI, editor. Spinal cord medicine, 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2011. p.72-84.
21. Somers MF. 脊髓損傷。林光華譯：脊髓損傷的功能性復健(物理治療的理論與實務指引)。第三版。新北市：臺灣培生教育出版：2014。p.27-33。
22. 張一岑。人因危害。張一岑著：人因工程學。3版。新北市：揚智文化事業股份有限公司：2016年。p.455-73。
23. Indira S. Lanig, I. & Theresa M. Lester M, Kathy L. Aspen. A practical guide to health promotion after spinal cord injury. Aspen.；1996 .p.137-57.
24. Lien, W. C., Kuan, T. S., Lin, Y. C., Liang, F. W., Hsieh, P. C., & Li, C. Y. (2016). Patients With Neurogenic Lower Urinary Tract Dysfunction Following Spinal Cord Injury Are at Increased Risk of Developing Type 2 Diabetes Mellitus: A Population-Based Cohort Study. Medicine;95:e2518.
25. 桃園縣脊髓損傷潛能發展中心（2012）：〈中心簡介〉。線上檢索於2012 年3 月21 日，取自：http://www.scsrc.org.tw