| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士班 === 103 === Purpose:
Although hip fracture is an important topic in today’s society, very few empirical studies on the effectiveness and resource utilization in hip fracture patients comorbid with dementia or Parkinson’s disease. Previous researches indicated that high volume physician tend better outcomes and lower resource utilization. Therefore, the thesis investigated the short-term and midterm medical outcomes and resource utilization in surgical hip fracture patients and explored the relationship between physician volume and outcomes.
Methods:
This study adopted retrospective study design. The data source was derived from Taiwan National Health Insurance Research Database. The study sample was patents diagnosed with hip fracture (ICD-9-CM code 820.0~820.19, 820.2~820.32, 820.8 and 820.9) and received operation (ICD-9-CM code 79.15, 79.35 and 81.52) between 1996 and 2009. The dementia was patients with ICD-9-CM code 820.0~820.19, 820.2~820.32, 820.8 and 820.9. Whereas, Parkinson’s disease was patients with code ICD-9-CM code 332.0 and 332.1. After exclusion, totally 183,059 hip fracture patients were included at the study. Physician volume was divided into three groups by the 33 and 67 percentile every year: classified as low, middle and high volume. The computer software 20.0 was used to conduct descriptive and theoretical comparison and analysis.
Results:
Hip fracture patients with dementia had greater likelihood to have complications OR=1.35, 95%CI: 1.25~1.46 and prolong length of stay OR=1.19, 95%CI: 1.10~1.36. Hip fracture patients with Parkinson’s disease also tended to have higher probability of having complications (OR=1.28, 95%CI: 1.18~1.38) and prolong stay (OR=1.15, 95%CI: 1.07~1.25). Patients with dementia had lower risk of orthopedics readmission (OR=1.88, 95%CI: 0.79~0.99) 1 year after discharged, on the other hand, compared to with patients without PD, patients with PD had higher risk of orthopedics-related readmission 1 year (OR=1.11, 95%CI: 1.02~1.21) after discharges. Compared with low volume physician, high volume physician had lower risk of complication, prolong stay and index-hospital death.
Hip fracture patients had average length of hospital stay 10.7 (±6.44) days; the average hospitalization cost was 80,074 (±50,165) NTD. Hip fracture patients with dementia increased 0.47 days of hospital stay (P<0.001), and patient with PD stayed extra 0.49 days (P<0.001). No statistically significant was found in index hospital cost for patients comorbid with PD or dementia.. High volume physician compare to low volume physician, to have shorter hospital stay and lower hospitalization cost.
Conclusions:
Hip fracture patients with dementia and PD had poorer clinical outcome but had longer hospital stay. Physician experience also affect the outcome and efficient care .The study suggested that clinical team need to pay extra attention for patients with different comorbidities to improve quality of care and enhance service efficiency.
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