| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 94 === 英文摘要
Background and Objective: Cardiac transplantation has been chosen as one of the feasible methods to treat terminally ill patients suffering from severe cardiac illness. It aims to help patients get away from hospitalization as well as dependence on inotropic agent injection. The health service at early stage was proposed to extend patient’s life, nowadays, it emphasizes on the improvement of health care quality and utilization of health service. Starting from the year 1995, National Health Insurance covers the expenditure of kidney and cardiac transplantation in order to upgrade the quality of health care and to prolong patients’ lives. Today, most domestic medical centers have established organ transplantation centers so as to provide the pre-transplant evaluation, resources coordination, treatment of rejection post operation as well as life accommodation. The cardiac transplantation services being offered have met the standards of developed countries. There is hardly any research paper on the utilization of health services post cardiac transplantation, this research is therefore aimed to study various factors affecting the utilization of health services with an expectation to enhance the health services. The writer is inspired to investigate into the utilization of cardiac transplantation services since there has never been any documentation on this aspect.
Methods: For the research, retrospective analysis on secondary data is adopted. It is based on the data of heart failure patients underwent cardiac transplantation from 1996 to 2003 in Taiwan to study the utilization of health service during hospitalization and subsequently a long-term follow-up on the quality of health care. The focal points are to analyze how the patient characteristics and hospital characteristics have affected the utilization of health services and quality of health care post transplantation surgery. The patient characteristics include age, gender, comorbidity, death, etc. The hospital characteristics involve hospital ownership, hospital level, hospital cardiac transplantation volume, physician cardiac transplantation volume and hospital area. The quality of health service relates to in-hospital mortality. The surgery utilization of health service includes the surgery hospital expenditure and length of stay. The quality of long-term health service refers to 1-year mortality and 3-year mortality.
Results: In terms of surgery utilization of health service, the research reveals that the average length of stay for surgery hospitalization is 41.59 days, and the average cardiac transplantation hospital expenditure is NT$870,600. Post operation, the significant factor extending the length of stay is renal disease, while the significant factor increasing the hospital expenditure is peripheral vascular disease. As regard to surgery utilization of health service, the in-hospital mortality takes 17.81%, 9.89% for 1-year mortality and 23.53% for 3-year mortality. Peripheral vascular disease, renal disease, legal hospital as well as low volume hospital are all significant factors for in-hospital mortality. However, as regard to long-term health service quality, it has no correlation with patient characteristics, disease characteristics or hospital characteristics.
Discussion and Suggestion: As for surgery hospitalization, neither age nor gender is the significant factor affecting the length of stay. In terms of cormobidity, it is found that renal disease is a significant factor to extend the length of stay for patients having surgery. In terms of hospital characteristics, none can be regarded as the significant factor to extend the length of stay, no matter hospital ownership, hospital level, hospital cardiac transplantation volume, physician cardiac transplantation volume, or hospital area. As regard to cardiac transplantation hospital expenditure, a special finding in this research is that neither age nor gender of the patients has anything to do with it. The research shows that peripheral vascular disease is a significant factor to increase the hospital expenditure for patients having transplantation. Generally speaking, renal disease, peripheral vascular disease as well as low volume hospital are all significant factors affecting the quality of surgery health service, while the hospital level has no connection with it.
It is found that long-term health service quality has no connection with the disease characteristics for patients receiving cardiac transplantation. It is expected that the successor may study the changes of disease characteristics through the long-term follow-up clinic research to discover the real causes affecting the long-term health service quality.
This research reveals that patients with renal disease or peripheral vascular disease have more utilization of health service, whereas, with lesser service quality. It reminds us to enhance the health care of patients suffering from these two diseases so as to reduce the risk of chronic disease. According to this research, high volume hospitals tend to offer better postoperative health service quality. However, most hospitals performing operation are located at northern part of Taiwan, for patients residing at southern part of Taiwan and suffering from heart failure, they are not equally accessible to considerate health services. It is therefore recommended that a systematic development of cardiac transplantation should be proposed as a priority in southern medical organizations in order to upgaade the health service quality for patients in southern Taiwan.
Keyword: cardiac transplantation, quality of heath care, utilization of health service
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