| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 102 === Purpose
While the problem of aging is growing over time, the number of total hip replacement (THR) has been increasing year by year. This treatment is regarded as the most beneficial operation due to the advance of medicine and technology. However, because of the increase in the prevalence of THR, the health unit classified THR as high usage and high expense. Therefore, it is important to consider how to maintain health care quality while saving health resources under the system of DRG, to create a three-way win for the patients, health providers, and health unit of the government. This study will explore the long term trend of initial THR for the last 15 years, and the major factors which affected the use of health resources and survival.
Methods
1. This was a retrospective longitudinal study on secondary data using National Health Insurance Research Database (NHIRD), aiming at the patients with initial THR (ICD-9-CM code 8151) in a total of 15 years, from 1996 to 2010. The sample size was a total of 74452 patients.
2. We carried out statistical analysis using SPSS version 20.0 for windows, and classified into descriptive analysis including mean, standard deviation, secondary distribution and percentage, and inferential analysis including Chi-square test, multiple regression, logistic regression, K-M and Cox survival analysis.
Results
1. There was an increase in the prevalence of initial THR year by year, from 3309 cases in 1996 to 6205 cases in 2010. However, the duration of stay and the total medical expenses decreased year by year, from 13.7 days to 7.4 days, and 168790 dollars to 113520 dollars, respectively.
2. The factors which affected the use of health resources for THR during hospital stay included sex, age, severity of the disease, diagnosis, the number of operations in the hospital, the number of operations for the doctor, and the level of the hospital. Among these, the duration of hospital stay and the total medical expenditure was higher in male, patients over 65 years old, those with a CCI index of 2 or above, with a diagnosis different from ordinary degenerative osteoarthritis such as traumatic fracture or chronic osteomyelitis, with a lower number of cases for the doctor or for the hospital, or those in the regional hospital.
3. The factors that affected the re-admission rate 30 and 90 days after being discharged from initial THR included sex, the severity of the disease, diagnosis and the number of cases for the doctor. Is was found that the re-admission rate was higher in female, and those with a CCI index of 2 and above, with traumatic fracture, with a diagnosis different from ordinary degenerative osteoarthritis such as osteomyelitis, and those with a lower number of cases for the doctor or for the hospital.
4. The average duration of survival after the initial THR was 141.23±0.27 months. It was higher in female than in male, and was higher in patients with the age of 64 and under than in those with the age of 65 and above. The survival rate was 97.1% in the first year, 91.7% in the third year, 86.1% in the fifth year, and 71.2% in the tenth year.
Conclusion and suggestion
The prevalence of initial THR has been increasing year by year, and the proportion of the its health resources usage accounted for the total NHI medical expenditure in the country has also been increased. Facing this remarkable phenomenon, it is a major consideration for the health authority how to control the increasing fees for NHI due to the increasing health expenditure. In addition, the health policy and the pattern of medical consumption has changed, and so we suggested that the following studies could take items of self expense, patient’s health condition, and information about drug usage into account. Furthermore, since the whole nature of medicine has also changed, there was a huge change in the management and survival for hospitals in different levels. This is highly related to the right for people to seek doctors, as well as the whole health care quality. This is also a topic worth deep thinking in the future.
Keywords: Total hip replacement, prevalence , usage of health resources, medical efficacy.
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