Impact of Diabetes Mellitus on the Health-Care Utilization of Patients with Stroke

• Main Authors: Li, Yi-Min, 李怡旻
• Other Authors: Chen, Chu-Chieh, Ph. D.
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/96734586507736187797

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 101 === Background: Cerebrovascular diseases (CVA) and diabetes mellitus (DM) are two of the top five causes of death in Taiwan. The death toll as well as the mortality rate of CVA have been increasing over the past five years. Witnessing the annual death toll from strokes exceed 11,000 in 2012 and the discovery of the association between DM and the elevation of cardiovascular risks, we decided to explore the impact of DM on the use of medical resources and clinical outcome in patients with first onset of stroke. Objectives: This study aims to explore the impact of DM on the use of medical resources in different types of first onset strokes. Method: The data used for this study was collected from "Longitudinal Health Insurance Database (LHID) 2005" published by the National Health Research Institute (NHRI). The data from 2000-2008 was collected, which included "Inpatient expenditures by admissions (DD)", "Details of ambulatory care orders (CD)" and "Registry for contracted medical facilities (HOSB)". A total of 6,815 subjects were obtained by including stroke patients with a chief diagnostic code of 430 - 434 in the hospitalization files of 2005-2007, while excluding patients that were hospitalized due to stroke, diagnosed with cancer, admitted and discharged on the same day due to first onset stroke and in-hospital death in 2000-2004. 1,840 of them had a history of DM. Descriptive statistics, chi square test, regression and logistic regression were used to explore the impact of DM on the use of medical resources in stroke patients. Result: The length and cost of hospitalization due to first onset stroke as well as cost of repeated hospitalization within a year after discharge in patients with hemorrhagic stroke is 19.53 days, NTD 156,258 and NTD 199,589, respectively, where it is 12.16 days, NTD 65,066 and NTD 142,166, respectively, for ischemic stroke. This study discovered that DM is associated with a higher risk of repeated hospitalization within a year after discharge in patients with hemorrhagic, ischemic and all types of stroke as well as higher cost of repeated hospitalization within a year after discharge in patients with ischemic and all types of stroke. But the length and cost of hospital stays for first onset strokes as well as the risks of repeated hospitalization within a year after discharge associated with recurrent strokes in patients with hemorrhagic, ischemic and all types of stroke were not affected. Conclusion: DM is associated with a higher risk of repeated hospitalization within a year after discharge in patients with hemorrhagic, ischemic and all types of strokes, as well as higher cost of repeated hospitalization within a year after discharge in patients with ischemic and all types of strokes. Keywords: diabetes mellitus; hemorrhagic stroke; ischemic stroke, medical resource use