| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 97 === Background and Objective:
Recently, because of the improvement of standards of living and the diet preference’s westernization, cardio Vascular Disease (CVD) has become the risk factor of death of Taiwan’s citizens and it also contributes to the rise of the payment rates of Percutaneous Transluminal Coronary Angioplasty (PTCA). According to the researches before, the patients who suffer CVD will bring out some complications, such as infection, even death. So understanding the patients’ health status before operations becomes the important topic in the Health Care Industry. This study examines the factors associated with outcomes of Percutaneous Transluminal Coronary Angioplasty in order to give physicians the notices before operations, giving the Bureau of National Health Insurance (NHI) examination basis of PTCA for the sake of decreasing the unnecessary use of medication.
Method:
38,386 PTCA cases (ICD-9-CM code 36.01, 36.02 and 36.05) were conducted from National Health Insurance Research Database (CD and DD) of the National Health Research Institute in Taiwan during 2004 through 2005. This study tracks back and follows up the patients’ health status for one year and uses “die or not after PTCA”, “take CABG or not after PTCA”, “infect or not after PTCA” and “neither” to definite patients’ situations after PTCA. Using the SAS statistic software 9.1.3 edition to analyze, with chi-square and logistic regression to find out the factors associated with outcomes of Percutaneous Transluminal Coronary Angioplasty and generalized linear models (GLM) to examine whether the operations’ volumes will make difference of the patients’ expense in one year after PTCA or not.
Results:
After adjusting the patients’ sex and age, Cardiac Arrhythmia (OR=1.564,P<.0001)、Peripheral Vascular Disorders (OR=2.003,P<.0001)、Hypertension Uncomplicated (OR=0.636,P<.0001)、Hypertension Complicated (OR=0.632,P<.0001)、Paralysis (OR=1.776,P=0.002)、Other Neurological Disorders (OR=1.523,P=0.001)、Diabetes Uncomplicated (OR=1.274,P=0.0015)、Renal Failure (OR=1.965,P<.0001)、Peptic Ulcer Disease excluding bleeding (OR=0.708,P<.0001)、Metastatic Cancer (OR=2.263,P=0.009)、Coagulopathy (OR=2.12,P=0.006)、cholesterol (OR=0.411,P<.0001)、physicians’ operation volumes(OR=0.55,P<.0001),will affect patients’ situations whether they die or not after PTCA; Paralysis (OR=0.32,P=0.05)、Other Neurological Disorders (OR=0.542,P=0.030)、Diabetes Uncomplicated (OR=1.186,P=0.0412)、Diabetes Complicated (OR=1.224,P=0.037), will affect patients’ situations whether they take CABG or not after PTCA; Cardiac Arrhythmia (OR=0.615,P=0.028)、Hypertension Complicated (OR=0.698,P=0.037)、Rheumatoid Arthritis/collagen (OR=1.984,P=0.024)、cholesterol (OR=0.6,P=0.002) , will affect patients’ situations whether they infect or not after PTCA.
Conclusion:
This study use logistic regression to indicate the chronic diseases’ influence while patients take PTCA and some of these chronic diseases may cause the patients be the high-risk group of adverse outcome after taking PTCA, noticing what the physicians should take account of before operations. Cardiac Arrhythmia, Peripheral Vascular Disorders, Hypertension, Paralysis, Other Neurological Disorders, Diabetes, Renal Failure, Peptic Ulcer Disease excluding bleeding, Metastatic Cancer, Rheumatoid Arthritis/collagen, Coagulopathy and Hyperlipidemia are the risk factors of adverse outcome of PTCA. The physicians should assess whether the patients have the complications this study shows before operations in order to improve the rehabilitation quality. Besides, the hospitals’ administrators should build a series of follow-up systems, assessing the long-term utilization after PTCA and doing disease management for high-risk groups, so that the patients can have better outcomes after PTCA.
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