Medical resource utilization and mortality among hospitalized hospice patients

• Main Authors: Ching-Hsin Chien, 錢靜馨
• Other Authors: Hon-Yi Shi
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/32082186459881491399

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 101 === Purposes Objective one: To investigate the prevalence of hospitalized hospice patients and related factors. Objective two: To investigate the hospitalized hospice patient medical resource utilization and related factors. Objective three: To investigate the hospitalized hospice patient mortality and related factors. Methods All hospitalized hospice patients were included into this retrospective population-based study from September 2009 to December 2010. Total sample size was 480 people. The SPSS 19.0 statistical software package was used for data integration analysis. The chi-square test (χ2-test), independent sample t-test (T-test), single-factor analysis of variance (One-way ANOVA), multiple regression analysis, and Cox survival analysis for were employed for inferential statistical analysis. Results The prevalence of hospitalized hospice cancer patients decreased significantly from 10.51/105 in 2009 to 2.86/105 in 2010. According to the trend analysis, patients with lung cancer, hospitalized hospice patients in T4 was significantly 1.92 times than in T1 (95% CI: [1.01, 3.63]). The significant impact factors of hospitalization were age, mode of treatment (radiation therapy, tube feeding diet, hemodialysis, rehabilitation), and liver cancer (P <0.05). Treatment modalities (radiation therapy, tube feeding diet, hemodialysis, rehabilitation) are statistically significant associated with total hospital treatment cost (P <0.001). According to the duration from receiving hospitalized hospice to death ≦ 30 days, there is no risk of liver cancer liver cancer death 1.56 times (P = 0.002), the number of hospital days per additional day mortality rate decreased by 0.2-fold (P <0.001). According to the duration from receiving hospitalized hospice to death ≦ 180 days, results have liver cancer with no liver cancer 1.41-fold (P = 0.006), with breast cancer is no breast cancer 1.59-fold (P = 0.038), length of hospital stay for each additional one day mortality decreased 0.38-fold (P <0.001). After adjusting for hospitalized hospice patient demographic characteristics, clinical characteristics, hospital characteristics and dying place, the results showed that patients with radiation therapy dying place (hospital death / dying automatically discharged) was 1.9 times than those without radiation therapy there is no radiation therapy (P = 0.023), patients with rehabilitation dying place was 0.15 times than those without rehabilitation (P = 0.009), patients treated at regional hospitals dying place was 0.36 than those treated at district hospitals (P <0.001), and patients treated by high-volume physician was 0.87 than those treated by low-volume physician (P = 0.002). Conclusions and recommendations The decreased trend of this nationwide hospitalized hospice cancer patients may be due to the policy of the Department of Health Bureau of Health. Since 2007 the Government promoted hospitalized hospice shared care Pilot Project. At the beginning (2007), there are five hospitals to join, 2008 increased to 38, but in 2009, it has increased to 42, of which only 26% of hospice shared care patients go to the hospitalized hospice and gradually increased the number of hospitalized hospice shared care patients, making the utilization of inpatient hospice reduced, and leaving live hospice prevalence downward trend. Overall, medical utilization of hospitalized hospice (plus hospice shared care and inpatient hospice and home care) increased annually, 19.6% in 2009, from July 2000 to December 2001 increased to 22.4%. However, payment for health care for terminally illness patients, health care is still valid in the majority, but how to effectively promote the terminally illness hospice use is a priority. Additionally, increased in lung cancer deaths may also increase the number of hospitalizations and its final relative hospitalized hospice patients.