Analysis of Causes of Readmission in Tuberculosis Patients

• Main Authors: SHIH, CHIH-HUNG, 施志宏
• Other Authors: LEE, MEI-WEN
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/dn5whz

碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 105 === Purpose: Tuberculosis (TB) is the most prevalent and the leading cause of death of mandatory communicable disease in Taiwan. The admission policy varies according to the resources and health policies of different countries or regions. Taiwan launched the policy to accomplish the goal that halving the TB incident cases within ten years from 2006, and high contagious cases were admitted for isolation care since then. Various factors had the impact on admission of TB cases, but no study focused on the population of readmission. Our study was to analyze the percentage of readmission rate of TB patients after initial admission for isolation care, the disease distribution represented by secondary diagnosis codes with the principal diagnosis code with TB, the disease distribution represented by principal diagnosis codes with the secondary diagnosis code with TB, and the risk factors associated with readmission. Method: From claims data of National Health Insurance Research Database of Taiwan, we identified total 7,115 TB inpatients from 2007 to 2009. To investigate the readmission after initial isolation care of these patients within one year; described the demographic characteristics, medical characteristics, characteristics of medical access, and distribution of disease diagnoses with principal or secondary diagnosis of TB; and use logistic regression to analyze the associated factors of readmission within one year. Results: The readmission rate within one year was 17.2%. Used the ICD-9 code system and extracted the first three codes of diagnosis for analysis. If the principal diagnosis was TB, the main secondary diagnosis were diabetes mellitus, pneumonia, and hypertension in order; if the secondary diagnosis was TB, the main principal diagnosis were pneumonia, other diseases of lung, and unspecified procedures and aftercare in order. When used ICD-9 five codes of diagnosis, with the secondary diagnosis of TB, the main principal diagnosis were acute, or infectious, or severe diseases after excluding V code diagnosis; these diagnoses were pneumonia, acute respiratory failure, urinary tract infection, sepsis, and acute exacerbation of chronic obstructive pulmonary disease in order. Logistic regression showed patients with male sex, older age, beneficiary category Ⅴ, chronic obstructive pulmonary disease (COPD), and liver cirrhosis had higher odds ratio of readmission; patients with beneficiary category Ⅰ, geographic location of health care institution from Taipei Division, Northern Division, Kao-ping Division, and cancer had lower odds ratio of readmission. Conclusion: The readmission rate of TB patients was not low. Diabetes mellitus, pneumonia and hypertension were the most important diagnoses when patients readmitted primarily for TB. Infectious or severe and acute diseases, such as pneumonia, acute respiratory failure, and urinary tract infection were the most important diagnoses when patients readmitted not primarily for TB with the exclusion of V code and chronic disease, and should be treated properly. Demographic characteristics, beneficiary categories, location of health care institution and certain comorbidities were important factors influencing the readmission of tuberculosis patients. We should focus on the group of older age, male sex, low income households, eastern residents, and certain comorbidities with COPD and liver cirrhosis; and spend more efforts on prevention of readmission and improving quality of medical care.