The Medical Effectiveness and the Use of Long-term care in Hip Fracture Patients with Neurological disease

• Main Authors: Chen-Yang Hsiao, 蕭振陽
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/70754556452530812497

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 105 === Purpose In recent years, the incidence of hip fractures in Taiwan has continued to rise, and the number of elderly patients is increasing. Therefore, hip fractures is one of the most important public health issues in the near future.Very fewer studies have examined the impact of preexisting comorbitidy neurologic disease (stroke, dementia with Alzheimer''s disease and Parkinson''s disease), psychiatric disease (depression, anxiety and any other psychiatric disease) and physical diseases(Charlson Comorbidity Index, CCI), on long-term care and medical effectiveness of hip fracture patients . The aim of this study was first to investigate the use of long-term care in hip fracture patients and to evaluation the preexist neurologic disease on the medical effectiveness. Methods This study used longitudinal retrospective study . Data sources were derived from the Taiwan Longitudinal Health Insurance Research Database . The study sample was patients diagnosed with hip fracture (ICD-9-CM code 820.0~820.19, 820.2~820.32, 820.8 and 820.9) and received surgery (ICD-9-CM code 79.15, 79.35 and 81.52) between 2005 and 2010. After exclusion, totally 4,079 patients were included at the study. The dependent variable are the use outcome of long-term, medium long medical. The statistical analysis use SPSS20.0 version of statistical software, methods include chi-square, independent sample T-test, logistic regression , multiple linear regression, and Cox regression. Results Hip fracture patients with preexist stroke (OR = 1.49, P = 0.001), dementia (OR = 1.34, P = 0.041), and Parkinson''s disease (OR = 1.89, P = <0.001) appear to use higher probability to home care.Patients with preexist stroke (OR = 1.41, P = 0.007), dementia (OR = 1.33, P = 0.049), PD (OR = 1.71, P = 0.002) the use of long-term care rates are higher. Patients with preexist dementia (OR = 1.81, P = 0.010), PD (OR = 2.08, P = 0.004) had higher one year orthopedic-related readmission. Patients with preexist dementia (HR = 1.46, P = 0.013) appered higher the risk of death one year after discharge. Patients with preexist dementia (HR= 1.30，P= 0.008) the risk of death is higher within three year after discharge. Conclusions The study found that patients with preexist stroke, dementia, Parkinson''s disease after the use of home care, long-term care are higher rates. Patients with preexist dementia within one year readmission, one year of death, death within three years and the overall survival are high risk factors. Hip fractures patients with dementia and Alzheimer''s disease are an important risk factor for death. Hope the government will be able to provide further postoperative care or services for the provision of care services for patients with dementia and Alzheimer''s disease, so that patients can be improved after the care and reduce the incidence of mortality.