| 摘要: | 背景與目的：癌症為全球人類死亡原因之首位，並預計在未來的20年，全球範圍內將面臨著癌症大爆發，罹患人數還會再持續上升，其中肺癌與乳癌的人數增長最快。再加上現代醫學發達，癌症被治癒機率上升，癌症存活率增加，但背後卻代表著病患接受其醫療科技所花費的醫療費用也持續增加，故本研究以肺癌、乳癌為例，探討癌症個案管理師的介入後其留治狀態、存活狀態及醫療費用之相關因素影響。研究方法：本研究屬於回溯性長期資料庫分析的研究，資料來源為嘉義某區域教學醫院癌症管理系統資料及醫院申報系統，以西元2004-2014年區間診斷為乳癌及肺癌之新發個案為本研究對象，以癌症個管師介入前後分為兩組進行比較差異分析，乳癌病患為682例、肺癌病患為402例。資料分析包括描述性統計、卡方、獨立t檢定及單因子變異數分析(one-way-ANOVA)檢定等推論性統計分析。研究結果：本研究發現乳癌、肺癌個案管理師入前(2004-2006)、後(2009-2011)兩組各兩年對治療成效評估-留治狀態及存活狀態均具有顯著影響，乳癌、肺癌個案管理師入前(2004-2008)、後(2009-2014)兩組各五年對治療成效評估-留治狀態及存活狀態均具有顯著影響，腫瘤個案管理模式介入對乳癌肺癌病患能有效的增加存活率及延長存活期間；乳癌病患人口特徵之年齡、個案分類、癌症分期及復發狀態對個管師介入前(2004-2006)、後(2009-2011)各兩年及介入前(2004-2008)、後(2009-2014)各五年對門診費用、住院費用及總醫療費用全部皆有顯著影響，肺癌病患人口特徵之癌症期別、復發狀態皆對個案管理師介入前(2004-2006)、後(2009-2011)各兩年及介入前(2004-2008)、後(2009-2014)各五年對醫療費用門診費用、住院費用及總醫療費用有顯著影響；乳癌個管師介入前(2004-2006)、後(2009-2011)各兩年及介入前(2004-2008)、後(2009-2014)各五年對門診費用、住院費用及總醫療費用則均皆無顯著影響，肺癌個管師介入前(2004-2006)、後(2009-2011)各兩年對門診費用、住院費用、總醫療費用均皆有顯著影響，且費用呈現上漲趨勢，肺癌個案管理介入前(2004-2008)、後(2009-2014)各五年對醫療費用則均皆無顯著影響。結論與建議：本研究以乳癌、肺癌個案管理師為例，運用個案管理師模式介入乳癌、肺癌病患之診療照護過程，經本研究結果顯示：一、癌症個案管理模式介入乳癌、肺癌病患照護過程中對乳癌、肺癌病患留治狀態及存活狀態均具有顯著提升影響，確實落實個案管理師成效及延長其病患存活率。二、乳癌個案管理師介入前、後各兩年及各五年對醫療費用皆無顯著影響，肺癌個案管理師介入前、後各兩年對醫療費用均皆顯著影響，費用增漲，肺癌對介入前、後五年則無顯著影響。所以本研究證實個案管理師對癌症治療成效具有顯著影響，可提昇雲嘉地區肝癌病患醫療照護品質及延長癌症患者之無病存活期，而費用部分證實癌症的醫療照護品質及降低病患生活品質是需要支出龐大的醫療費用，本研究建議未來再針對降低癌症醫療費用方面更需要考慮多方面因素。
AbstracPurpose：Many people died in cancer, and more people will die in cancers in next two decade, especially in Lung cancer and Breast cancer. The survival rate is raise because of medical technology improved, but the expenditures will increase more than before. So we want to exam if the case managers intervention will increase the survival rate and control the cost of treatment, and prove the positive effectiveness.Methods: This study is a long-term retrospective study to analyze the database, and the database is from a cancer center of a regional hospital in Chiayi County and the hospital information management system reporting systems. The study objects are interval diagnosis of new-onset cases of breast cancer and lung cancer during AD 2004 to 2014. Objects are divided into two groups, before and after intervention of differences analysis, which included 682 cases of breast cancer patients, 402 cases of lung cancer patients. Data analysis included descriptive statistics, chi-square, independent t-test and one-way analysis of variance inferential statistical analysis.Results: The study found that there are significant influence on breast cancer and lung cancer treatment effectiveness evaluation, stay rule status and survival status before and after the case managers’ intervention each two years and each five years; There are significant impact on the cost of outpatient medical expenses and total medical costs of breast cancer patients’ demographic characteristics before and after the intervention each two and five years.Demographic characteristics of patients with lung cancer of other former state of relapse intervention tubes division, after each two years each year there is significant impact on the cost of outpatient medical expenses and total medical costs; former breast cancer case management intervention, after all the years and all five have no significant impact on health care costs, before lung cancer case management intervention, after each two years outpatient costs, hospital costs, total medical expenses have significant impact on lung cancer before the case management intervention, then after each five-year there are no significant impact on health care costs.Conclusion: In this study, we took breast cancer and lung cancer case management division for example, the use of case management division mode to intervenes the diagnosis, treatment and care process of patients with breast cancer, lung cancer. The results of this study show: a case management model involved in breast cancer, lung cancer patients’ care process would have significant positive effects on survival and left state government state, and successfully show the effectiveness of the implementation of case management division and raise its patients’ survival rate. Second, before the case management intervention of breast cancer division, after each two years and all five are no significant impact on health care costs; before lung cancer case management division intervention, after the two years they are all significantly affect the health care costs, increase the cost; no significant impact on lung cancer five years after or before the intervention. |
