| Summary: | 碩士 === 中國醫藥大學 === 醫務管理學系碩士在職專班 === 101 === Objective: The utilization of medical technology is one of the main reasons for the medical expenditure increasing. According to the domestic data, among the high-tech medical instruments, Computed Tomography (CT) was the most frequent utilized one. In recent years, there is a rising trend for the utilization of computer tomography. There are also many researches for the utilization of computed tomography, but rare researches focus on the utilization of CT scan in emergency department and the related factors. This study is designed to investigate the utilization of CT scan in the emergency department and the related factors, which can be used for reference in formulating relevant policies.
Methods: Adult patients who visited emergency department during the period 1998–2010 were identified from claims data obtained from Taiwan’s National Health Insurance program. This study analyzed patient''s age, gender, comorbidity, severity of illness, disease patterns, insured salary, medical institute degree, the degree of urbanization of the medical institute, specialist of physician, seniority of physician, the annual patient volume of physician and the CT scan utilization. Then the chi-square test (χ2-Test) conducted bivariate analysis. Otherwise, logistic regression analysis was performed to analyze the influence of the associated factors with the CT utilizations of the adult patient who visited emergency department.
Result: In emergency department, the utilization of CT scan increased year by year, from 2.83% in 1998 to 8.01% in 2010. During the 13 years, the average annual growth rate is 14.39%. The top three disease patterns of which the patients had more CT examinations were "Injury and poisoning", "Illness with unspecific symptoms, signs and diagnosis" and "Circulatory system diseases". The disease pattern of which patient had highest average annual growth rate in CT scan utilization was the "Illness with unspecific symptoms, signs and diagnosis", and its rate is 23.17%. After controlling for other variables , the result of analysis of logistic regression showed that male patients , the aged patients , patients with higher severity of illness, the emergency medicine boarded attending physicians, physicians with higher seniority, physicians with higher annual patient volume, the higher medical institute degree were associated with higher probability of computed tomography utility. On the contrary, the high income patients and patients with >5 score of CCI have significantly lower chance for CT utilization. For disease patterns, "nervous system disorders", "circulatory system diseases" and "injury and poisoning" have significant higher chance for CT utilization.
Conclusion and suggestion: The reasonable growth of health care costs is currently an important issue. In Taiwan, the patient numbers of emergency department rose rapidly year by year, and the computed tomography utilization also increased rapidly. It is worth to survey how to adequately control the CT utilization in population with high probability of CT use. In this study, seniority of attending physician and the emergency medicine boarded attending physician are associated with significant high chance of computed tomography utilization. Is it related to the training process of emergency medicine boarded physicians, or the busy medical condition in emergency department, or defensive medicine due to high medical litigation rate in Taiwan? It is worth for further survey. Besides, the disease pattern of which patient had highest average annual growth rate in CT scan utilization was the "Illness with unspecific symptoms, signs and diagnosis". It is worth to survey if there is overuse of CT in this population. Otherwise, the benefit of increasing CT utilization in emergency department is also an important issue for further survey.
|
|---|
