運用決策樹分析論病例計酬白內障住院病患手術方式ECCE/PHACO之影響因素

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Title:	運用決策樹分析論病例計酬白內障住院病患手術方式ECCE/PHACO之影響因素 Using Decision Tree Mining Factors Affecting Cataract Inpatients’ECCE/PHACO Adoption among Cases of Case Payment
Authors:	古金艷 Chin-Yen Ku
Contributors:	楊美雪嘉南藥理科技大學：醫療資訊管理研究所
Keywords:	白內障囊外晶體摘除術超音波晶體乳化術資料探勘決策樹 ECCE Cataract PHACO data mining decision tree
Date:	2008
Issue Date:	2010-06-01 09:21:32 (UTC+8)
Abstract:	目的：國內外研究指出PHACO具有切口小、併發症低之好處，本研究旨在分析論病例計酬白內障摘除術ECCE及PHACO之利用情形及其影響因素。方法：採回溯性研究，研究對象為2005年全民健保研究資料庫之論病例計酬白內障摘除術住院案件共7,898例。以資料探勘中C5.0決策樹演算法建立白內障手術方式預測模式。結果：本研究資料，以PHACO手術方式居多，PHACO使用率為75.7%，ECCE使用率為24.3%。在PHACO手術中，男性及女性佔率分別為55.5%及44.5%，主要診斷以老年期白內障為主。PHACO個案之平均住院天數顯著地比ECCE個案短(p < 0.001)。PHACO平均每件醫療費用顯著低於ECCE 280.42元。PHACO個案的醫師平均年齡42.27 ± 6.46比ECCE個案之醫師平均年齡46.04 ± 7.45少，達統計上顯著差異。然而PHACO個案的醫師平均處置數90.57 ± 68.61顯著多於ECCE個案的醫師平均處置數80.01 ± 56.21。決策樹分析結果，顯示影響白內障手術方式最主要之因素為醫師年齡，其次為醫師處置數。結論：本研究醫師年齡不到50歲且手術量較高者，於白內障摘除術傾向採用PHACO手術方式，PHACO之醫療資源耗用比ECCE稍低。本研究結果可提供醫院推動PHACO手術之參考。 Objective: It has been suggested that phacoemulsification (PHACO) has resulted in decreasing postoperative complications. The aim of this study was to develop a model for prediction of PHACO / ECCE cataract surgeries. Methods: A C5.0 decision tree induction algorithm was used to retrospectively examine cataract inpatients of case-payment in 2005 Taiwan NHI database. A total of 7,898 cases were included in this study. Results: PHACO has been performed more than 75% cataract surgeries; most (55.5 %) were male, and the major principal diagnosis was senile cataract. PHACO surgeries were significantly with a shorter average length of stay and less average medical expenses than those of ECCE surgeries. PHACO cases’ ophthalmologists were younger, had higher cataract surgery volume than those performing ECCE. The decision tree analysis demonstrated ophthalmologist’s age, which appeared at the root node, was the most important predictor for cataract surgeries. When ophthalmologist’s age </= 49 years had a higher priority than that of age > 49 years in the carrying out of PHACO surgery. The ophthalmologist’s cataract surgery volume was the node shown in the second level, the higher volume (>142 surgeries) ophthalmologists appeared to be more likely to using PHACO even their age > 49 years. Conclusions: These findings will be a useful reference to hospitals for facilitating ophthalmologists adopting PHACO surgery.
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