Analysis of medical utilization and survival in patients with parkinson’s disease

• Main Authors: Guan-Lun Su, 蘇冠倫
• Other Authors: 李亞欣
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/626n73

碩士 === 中山醫學大學 === 醫療產業科技管理學系碩士班 === 106 === Objectives: Parkinson''s disease belongs to a neurodegenerative chronic disease that occurs in the elderly population. The economic burden on patients and their families will increase as the disease stages later. The population structure of Taiwan is gradually aging, indicating that the number of people suffering from Parkinson''s disease will grow in the future. It will have a far-reaching impact on the health of the people of Taiwan and the cost of health care. This study will use the two million samples of the Health and Welfare Data Science Center. To understanding the differences in medical utilization, survival days, and cost-effectiveness of patients with Parkinson''s disease under different personal backgrounds, health status, and medical factors. Methods: The source of the research data was taken from the 2 million sample of the Health and Welfare Data Science Center. Taking the new case of Parkinson''s disease in 2008 as the research object (ICD-9-CM Code:332.0). Patients who had been diagnosed in the previous year were removed and tracked until 2015. This study use SAS 9.4 to do descriptive statistics and inferential statistics. Using Binary Logistic regression analysis to understanding factors related to patient''s interruption of treatment and cross-region doctoring. Using Multiple regression analysis to understanding factors related to the number of medical treatments, medical costs and cost-effectiveness of patients. And use Cox Proportional Hazards Model to do survival analysis, and calculate the Hazard Ratio. Learn more about the factors related to the survival of patients with Parkinson''s disease. Results: A total of 856 research samples. Among the results tracked from 2008 to 2015, male patients (50.70%) were mostly, aged between 71 and 80 (42.64%), and the insurance coverage was mainly from NT 1 to 28,000 (57.70%). The majority of patients living in moderately urbanized towns (28.57%), and the marital status was mostly married (71.50%). The education level was the highest among the primary schools (including illiterate) (67.80%). Most of the patients go to the regional hospitals (36.68%) for medical treatment. Mainly medical department, the majority of neurology (69.98%). The degree of comorbidity was mostly no-comorbid (35.05%), and most patients did not have interruption of treatment (74.77%). By the end of the study, patients without confirmed death (50.23%) had a little more, and patients with no cross-region doctoring (50.88%) for the majority. The overall average number of medical treatments was 219.9 times, the average medical cost was NT 734,020, the average number of days of survival was 2,024.9 days, and the average cost-effectiveness was 582 (cost/day). In the Chi-square test, there was a significant between the amount of insurance coverage, the level of major medical institutions, the main medical department and the cross-region doctoring, and the interruption of treatment. There was a significant between age, degree of urbanization, major medical institutions, and main medical department and cross-region doctoring. In Cox Proportional Hazards Model results, both age and comorbidity were factors that significantly affect the survival of patients with Parkinson''s disease. Conclusion: This study found that female patients survived more days than male patients, and the cost-effectiveness was lower. Age is a key factor for patients, the older the age, the higher their risk of death. The higher the insurance coverage, the more the number of days of survival, and the lower the risk of death. The number of medical treatments in remote districts was higher than that in urbanized areas. Marital status and education level were not significantly with medical utilization, survival days, and cost-effectiveness. Patients who visit the medical center can be found to have higher medical treatments and survival days. Parkinson''s disease is a neurodegenerative disease. Most patients went to the neurology department for a lower risk of death. Comorbidity had reached very significant in terms of medical utilization, survival days and cost-effectiveness. If the comorbidity was more serious, the risk of death was higher. Patients who interruption of treatment had higher survival days than patients who did not interruption of treatment. Patients confirmed death were more cost-effective than patients without confirmed death. Patients with cross-region doctoring had more medical costs and survival days. If the patients with Parkinson''s disease were older and the comorbidity was more serious, the impact on survival was large. Patients who interruption of treatment risk were those with low socioeconomic status, major medical institutions in medical centers, no-comorbid and cross-region doctoring. The risk of cross-region doctoring was the major medical institutions in medical centers, and the mainly medical department was other subjects, and patients with interruption of treatment.