| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 101 === Background
According to the data of 2012 USRDS, the highest incidence and second prevalence of end-stage renal disease (ESRD), next to America, in the world is Taiwan. Several past studies had been reported that many factors influencing medical cost before or after dialysis. However, little is known about the medical cost in chronic kidney disease (CKD). Accordingly, the present study is to analysis the outpatient and inpatient charge of CKD patients at outpatient department and the outcome of dialysis and mortality.
Methods
The data source was from secondary data from CKD patients of outpatient and inpatient medical records in one regional hospital of Southern Taiwan from January 1, 2006 to December 31, 2010. After exclusion of age younger than 17 years old, a total of 1160 patients were enrolled. Statistical analysis was performed using SPSS 19.0 for Windows (SPSS Inc. Chicago, USA) and STATA 10.
Results
Generalized Estimating Equation (GEE) model showed decrease in outpatient medical cost, decrease in inpatient medical cost, decrease in total medical cost, decrease in clinic visits, and decrease in hospitalization days (P < 0.001). Male, a history of acute myocardial infarction, diabetes mellitus, hypertension, cardiovascular disease and receiving dialysis were associated with increased outpatient medical cost. Old age, a history of acute myocardial infarction, hypertension, cardiovascular disease, low estimated glomerular filtration rate (eGFR) and receiving CKD care were associated with increased clinic visits. A history of diabetes and hypertension were associated with increased hospitalization days. Besides, a history of hypertension and low eGFR were associated with increased total medical cost.
Patients with older age, lower eGFR, more advanced CKD stages, a higher prevalence of a history of diabetes mellitus, hypertension, cardiovascular disease and chronic obstructive pulmonary disease and receiving hemodialysis showed a lower survival rate. Compared with patients without hemodialysis, patients with hemodialysis were having lower eGFR, more advance CKD stages, a higher prevalence of a history of diabetes mellitus and hypertension and receiving CKD care. Compared patients without CKD care, patients with CKD care were found to have lower eGFR, more advanced CKD stages, a higher prevalence of a history of diabetes mellitus, hypertension, dyslipidemia cardiovascular disease and receiving hemodialysis.
Conclusions.
Our findings showed a decreasing trend in outpatient medical cost, inpatient medical cost, total medical cost and clinical visits over time. The possible explanation was that patients had doctor shopping habit while initial symptoms happened, and then resulted in the increase in the outpatient doctor seeing times and hospitalization days. The generalization ability of the results is limited because the study subjects were in one regional hospital in southern Taiwan. However, from our study, we hope CKD program intervention could lower the medical cost of CKD and the CKD patient educational program should be strengthened and propagated.
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