| 摘要: | 目的：比較不同合併症指標，Deyo, Romano, D’Hoore, 2008 Charlson與Elixhauser等合併症指標之氣喘病人住院費用之預測表現，並探索表現較佳的預測指標。方法：為回溯性健保2007~2008年次級資料之研究設計。擷取2008年主診斷為氣喘(ICD-9-CM代碼49300~49392)之住院案件，刪除住院醫療費用極端值後，住院案件有14,287件，共計12,259位病人。合併症指標疾病為經比對次診斷ICD-9-CM代碼確認之，以多元階層迴歸分析比較各合併症指標之醫療費用預測表現。結果：合併症指標以類別方式較以權重加總方式對於住院當次或年度醫療費用之預測表現佳，以Elixhauser’s合併症指標(類別)可以解釋年度住院醫療費用變異量的4.9%為最高，本研究發現「使用呼吸器」對於當次住院之醫療費用可以解釋14.1%的變異量；年度住院醫療費用變異量可以解釋11.2%。結論：「使用呼吸器」與否比本研究合併症指標對於氣喘病人醫療費用有較佳的預測表現。
Objectives: This study aimed to compare the performance of the Deyo, Romano, D’Hoore, Elixhauser and 2008 Charlson comorbidity indices and to explore a comorbidity index that out-performs the indices mentioned above. Methods: A retrospective observational study was performed using health insurance claims spanning from 2007 to 2008 (index admission). Subjects were the asthma episodes with ICD-9-CM codes 49300-49392 on the principal diagnosis. There were 14,287 admissions, 12,259 patients with the corresponding 95% central range (2.5th to 97.5th percentile). The conditions of comorbidity indices were identified at index admission and in 1 year prior index admission. The performances were compared using the change in R2 derived from multiple hierarchical regression models included age, gender, and hospital level but total yearly expenditures. Outcomes measures were healthcare expenditures. Results: All the comorbidity indices were significant predictors of healthcare expenditures regardless of whether the admission episode or total yearly healthcare expenditures (p<0.001). Based on the change in R2, model using the Elixhauser comorbid diseases being as a categorical predictor variable was the best for the total yearly expenditures. However, Elixhauser comorbidity index was still a poor predictor of the healthcare expenditures, only explaining a maximum 4.9% of the variance of total yearly healthcare expenditures. In contrast, the study found the presence or absence of mechanical ventilation explained 14.1 and 11.2% of the variance of admission episode and total yearly healthcare expenditures, respectively. Conclusions: The use of the mechanical ventilation appears to be a better predictor of healthcare expenditures for inpatients with asthma than the comorbidity indices adopted in this study. |
