| Summary: | 碩士 === 國立成功大學 === 護理學系碩博士班 === 94 === Background: Hospitalization is an important indicator to evaluate the morbidity in chronic dialysis patients. The majority of hospitalization is for complications and comorbidities which can be attenuated in advance. Few studies have discussed related factors of hospitalization among chronic dialysis patients under a National database. It also lacked such researches in Taiwan, where showed the greatest incident rate of ESRD around the world. Moreover, the long term effects of demographic factors, CKD-related complication factors, and hospital characteristic factors on hospitalization were also under investigation.
Objectives: The purposes of this study were to (a) explore the characteristics of hospitalization within the three years following the initial dialysis therapy from 1997 to 2001 among chronic dialysis patients in Taiwan, and (b) examine the hospitalization in associated with demographic factors, CKD-related complication factors, and hospital characteristic factors.
Method: This research was a retrospective cohort study with a secondary data analysis method by evaluating the research databank from the National Health Insurance (NHI) program in Taiwan. Data were retrieved for all patients starting chronic dialysis therapy from December 31, 1997 to September 30, 2001. The study period for each patient was three years after three months following the initial dialysis therapy. A two-part model was used to analyze the utilization of inpatient care. The process of inpatient utilization was separated into two parts: the contact analysis and the frequency analysis.
Results: The study cohort was composed of 26,837 patients with a mean age of 59 years and over half of the cohort were females (55%). A total of 17,330 (65%) patients had experienced at least one hospital episode during the follow-up period. Overall, they had an average of two admissions and spent about 11 to 12 days each admission. The mean inpatient expenditure per admission was increased as the episodes of hospitalization increased. Circulatory events were the most frequent reason (20%) for admission, followed by dialysis access-related events (13% - 17%) and digestive diseases-related events (13% - 14%). Age (b = 0.01, p < .001), comorbidity (b = 1.41, p < .001), diabetic nephropathy (b = -0.61, p < .001), male (b = -0.12, p < .001), hypertension (b = 1.75, p < .001), anemia (b = 1.00, p < .001), renal osteodystrophy (b = -4.10, p < .001), and neuropathy (b = 1.17, p < .001) were associated with probability of hospitalization. Age (b = 0.003, p < .001), comorbidity (b = 0.05, p < .001), and male (b = -0.05, p < .001) were associated with the number of admissions. Age (b = 0.008, p < .001), comorbidity (b = 0.08, p < .001), diabetic nephropathy (b = 0.21, p < .001), hypertension (b = -0.03, p < .05), malnutrition (b = 0.32, p < .01), anemia (b = -0.08 in the third year, p < .05), neuropathy (b = 0.15, p < .01), academic medical centers (b = 0.46, p < .001), metropolitan hospitals (b = 0.21, p < .001), and private hospitals (b = 0.11, p < .001) were associated with the number of hospital days. The factors associated with hospital days were similar to those associated with inpatient expenditures. The difference mainly came from the influences of the peritoneal dialysis modality (b = -0.6, p < .05) and the hospital global budget (b = 0.12, p < .01) on expenditures.
Conclusions: Early intervention may improve the morbidity of chronic dialysis patients. The characteristics of high-risk patients for hospitalization are advanced age, with greater comorbidity, female, and with CKD-related complications. Timely identifying and referring high-risk patients to the nephrology team is a better way to properly provide coordinated care for recognized patients.
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