生命末期病人使用安寧療護對照護利用及費用的影響

Abstract

背景：我國人口快速高齡化，預估安寧療護需求快速增加中，自2009年臺灣將八大類非癌症末期疾病患者納入安寧療護給付範圍之中，使得安寧療護的照護層面更為妥善，過往不論是在臨床應用或學術研究，安寧療護討論的對象多以癌症末期病人為主，本研究補齊此缺口，探討癌症與八大非癌患者使用安寧療護對照護利用及費用的影響。 方法：本研究採用百萬承保抽樣歸人檔，研究對象為2012年死亡之罹患癌症與八大非癌末期成年患者共5,062人，使用多元邏輯斯迴歸和線性迴歸分析，檢測安寧療護使用對於生命末期積極照護利用及整體醫療費用之影響。 結果：生命末期病人使用安寧療護，可使死亡前30天接受較少的侵入性治療，在死亡前30天下降的指標包含：降低急性加護病房的使用、降低插管的使用、降低呼吸器的使用、降低心肺復甦術的使用，以及降低死亡時是在醫院。在醫療費用上，使用安寧療護可以減少死亡前1個月的總醫療費用。 結論：整體而言，生命末期病人使用安寧療護，在死亡前積極照護率呈現下降，顯示在生命末期有使用安寧療護的患者，在照護品質上較佳、醫療利用較少；在醫療費用發現，使用安寧療護可以使死亡前1個月總醫療費用下降。

Background: The aging population in Taiwan is rising quickly, hence the demand for hospice care is increasing. Since 2009, eight categories of non-cancer terminal diseases have been included in health insurance payment, which has made hospice care accessible to more people. In the past, the discussion of hospice care only focused on patients with end-of-life cancer. This study fills up the gap and explores the impact of hospice care expenses and utilization on both cancer and non-cancer patients. Methods: The data obtained from the Million People File was a study on 5062 adult patients who died of cancer or one of the eight-category non-cancers in 2012. Using multivariate logistic regression and linear regression verifies the use of hospice care for end-of-life aggressive care utilization and overall medical expenses. Results: End-of-life patients with hospice treatment can receive fewer aggressive treatments 30 days prior to death. Declining indicators include reducing the use of acute intensive care units, intubation, mechanical ventilation, cardiopulmonary resuscitation, and death in a hospital. In medical expenses, use hospice care can reduce total medical expenses of the final month before the patients' death. Conclusion: In general, the rate of aggressive care before death for end-of-life patients using hospice care shows a decline. End-of-life patients who treated with hospice care show better care quality and less medical utilization, and the total medical expenses on hospice care dropped at the final month prior to death.