| Summary: | 碩士 === 國立中山大學 === 醫務管理研究所 === 97 === Abstract
Research Objectives：The chronic diseases of the elderly not only influence their life quality but also become a great burden of the society on the health care costs. International studies focused on the utilization of medical care resources for diabetes mellitus patients of comorbidity, such as cardiovascular disease、cerebrovascular disease、renal disease and hypertensive. However, systemic analyses on the medical care utilization of the diabetes patients with comorbidity have not been well-studied in Taiwan. The purposes of the study are to quantitatively analyze the relationships between the number of comorbidity and the utilization of medical are resources, and to further discuss the interference on the utilization of medical care resources among individual diseases of the comorbidity. The research questions are: What is the effect of comorbidity on the type and volume of the utilization of medical care resources? Which comorbidity pattern has the highest effect?
Methods：Based on the databases established by the Bureau of National Health Insurance during the period of 2005 to 2006, the diabetes patients with aged 65 or older have been analyzed. The data analyses have been carried out by Chi-square test, T-test, Pearson’s correlation, and Multiple Regression and Logistic regression.
Result：Our results showed that the clinic-visiting frequencies of outpatients with a comorbidity score of 0, 1, 2 and 3 are 52, 69 , 70 and 86 times, respectively, and their expenses are NT dollars 50,505, 97,347, 83,006 and 146,954, respectively. The hospital admission frequency of inpatients with a comorbidity score of 0, 1, 2 and 3 are 2 , 3, 3 and 5 times, respectively; the length of stay are 24, 29, 27 and 60 days, respectively; and the inpatient expense are NT dollars 118,079, 174,727, 147,639 and 271,725 respectively. In addition, the logistic regression model showed that ORs for the probability of hospitalization for the patients with comorbidity scores of 1, 2 and 3 were higher than those with the comorbidity score of 0（OR=1.689, OR=1.597, OR=3.319）respectively.
Conclusion：A clear gradient was observed between the number of comorbidities and the increased health care utilizations. Moreover, comorbidity among diabetes patients is associated with considerable consequences of health care and related costs. In addition, current single-disease approach of diabetes care should be extended to the integrated care modules, which must be generic and include comorbidity disease in order to meet the complex health care demands of diabetes patients in the future.
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