| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === Background:
Some domestic and foreign academic researches indicate that although the changes of medical expenses regime have decreased the average medical expenses by making the patients discharged from hospital earlier, the subsequently increasing rate of re-hospitalization have enlarged the consumption of medical resources（Enrico Brizioli et al., 1996）.
Goal :
The goal was to understand the number of times of re-hospitalization, the duration of re-hospitalization and the reasons of re-hospitalization of the patients who had undergone pancreatectomy within one year and to analyze the factors related to such re-hospitalization in order to improve the care quality after pancreatectomy.
Methods:
This is a retrospective study. The data source was from the National Health Insurance academic research database from 2004 to 2005. This study focused on the patients who had undergone pancreatectomy and integrated and analyzed their medical files. The goal was to investigate the frequency and reasons of re-hospitalization of the patients through their hospitalization records within 14 days, within from 15 to 30 days, within from 31 to 90 days, within from 91 to 180 days, within from 181 days to one year, within 90 days, within from 90 days to one year, including the state of health, surgical factors, medical resources, to assess the relationship between different factors and re-hospitalization, quantify the risk of the above-mentioned factors with respect to the re-hospitalization and compare the reasons and risk factors of the re-hospitalization at different times. Furthermore, the re-hospitalization within 90 days of a patient was defined early re-hospitalization and the re-hospitalization within from 90 days to one year was defined late re-hospitalization; and, this study assessed the impact of early and late re-hospitalization on the risk factors.
Discussions:
This study was conducted on the basis of a total of 1,317 samples. With respect to the impact of the re-hospitalization at different times, this study used Logistic Regression to analyze the relevant factors to identify the risk factors. The analysis result showed that there were obvious differences with respect to gender, Charlson Co-morbidity Index, amount of physician services, level of the hospital which performed such surgery, complication caused by such surgery, and such disease identified as pancreatic cancer. As to the impact of the re-hospitalization within one year after the surgery, this study used Poisson Regression to analyze the relevant factors to identify the risk factors. The analysis result showed that there were obvious differences with respect to gender, Charlson Co-morbidity Index, number of days of such hospitalization, amount of physician services, level of the hospital which performed such surgery, complication caused by such surgery, and such disease identified as pancreatic cancer. As for the impact of the re-hospitalization at different times after the surgery and the early and late re-hospitalization due to various diseases, this study used Logistic Regression to analyze the relevant factors. Because there were only a small number of cases of re-hospitalization at different times due to surgery-related complications (please see Table 4-1), the relevant risk factors were not discussed here. Besides, because the numbers of cases of re-hospitalization at different times were different, all the relevant factors were put into the model to use stepwise regression method to select significant risk factors (α=0.2). The result of the statistical analysis will be described in detail in this study report.
Conclusions:
The study result indicates that: (1) There were less cases of re-hospitalization due to pancreatic disease within 90 days after the surgery (early re-hospitalization) when a patient was one year younger. (2) The result of care was better when there was a larger amount of physician services. (3) Where such disease was identified as pancreatic cancer, the number of cases of re-hospitalization within 30 days after the surgery of such disease was larger than the one that was not identified as pancreatic cancer. (4) Where a patient’s Charlson Co-morbidity Index before the surgery was larger, there were a larger number of cases of re-hospitalization within 90 days after the surgery (early re-hospitalization) and a larger number of cases of re-hospitalization due to metastatic disease of cancer. (5) Compared to the patients who had undergone pancreatic tail resection, the patients who had undergone Whipple Procedure (Whipple pancreaticoduodenectomy) had a larger number of cases of re-hospitalization within 90 days after the surgery (early re-hospitalization) due to metastatic disease of cancer but had a larger number of cases of re-hospitalization within from 91 days to one year after the surgery (late re-hospitalization) due to pancreatic cancer.
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