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  1. NTU Theses and Dissertations Repository
  2. 公共衛生學院
  3. 健康政策與管理研究所
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/94964
完整後設資料紀錄
DC 欄位值語言
dc.contributor.advisor鄭守夏zh_TW
dc.contributor.advisorShou-Hsia Chengen
dc.contributor.author黃文助zh_TW
dc.contributor.authorWen-Chu Huangen
dc.date.accessioned2024-08-21T16:56:57Z-
dc.date.available2024-08-22-
dc.date.copyright2024-08-21-
dc.date.issued2024-
dc.date.submitted2024-07-29-
dc.identifier.citation中文部分
江宛霖、江東亮:台灣全民健康保險的減貧效果。台灣衛誌2016;35(2):164-171。
英文部分
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dc.identifier.urihttp://tdr.lib.ntu.edu.tw/jspui/handle/123456789/94964-
dc.description.abstract背景: 孕產婦的健康一直是全球各國所重視的重要議題,針對嚴重孕產婦疾病做監測與分析,除可檢視孕產期照護品質外,亦可適時進行介入措施加以改善,著實有助於提升孕產婦的安全及促進新生兒的健康。
目的: 本研究主要以孕產婦為研究對象,首先是要了解台灣嚴重孕產婦疾病的發生率、趨勢及常見的疾病種類,進一步探討其生產住院相關醫療資源耗用與照護結果並分析可能的影響因子。接著,分析不同嚴重程度共病症的孕產婦對生產住院之醫療耗用需求差異。最後,了解不同層級別醫療院所對於嚴重孕產婦疾病案例的照護能力與結果,並探討影響照護結果的相關因子。
方法: 本研究使用衛生福利部衛生福利資料科學中心之台灣全民健康保險資料庫申報檔,進行次級資料回溯性分析比較研究。選取2011年至2021年間生產住院案例,針對嚴重孕產婦疾病的發生率、趨勢及醫療費用做測量,並以3日內非預期門急診利用及42日內再住院,做為照護結果之指標進行研究,進一步使用廣義線性迴歸模型與羅吉斯迴歸模型進行分析。
結果: 研究期間共納入2,054,010個生產案例,其中有6,961個為不含輸血之嚴重孕產婦疾病案例,估算台灣嚴重孕產婦疾病的發生率平均為3.4‰,若含輸血指標則平均達26.7‰ (53,481個案例),且有逐年顯著上升的趨勢。高齡生產、剖腹生產及具有產科共病症等,為重要之個人風險因子。嚴重孕產婦疾病案例之生產住院醫療費用顯著較一般案例為多,且3日內非預期門急診利用與42日內再住院的風險均明顯增高。生產住院之醫療費用隨產科共病症指數上升而增加。地區醫院與基層診所對於嚴重孕產婦疾病案例的照護結果較差。提早出院雖不會導致嚴重孕產婦疾病案例之3日內非預期門急診利用上升,但卻會明顯增加再住院風險。
結論:在台灣嚴重孕產婦疾病發生率逐年上升的趨勢下,減少高齡生產及避免非醫療必要之剖腹生產將有助於降低產科相關併發症。不同層級別醫療院所對於嚴重孕產婦疾病案例的照護結果確實存在差異,至合宜之院所進行相關醫療照護,可減低到達適切醫療照護機構延遲的情形,有利於產科急重症案例照護品質的提升。再者,避免嚴重孕產婦疾病相關案例提早出院,亦有助於減少產後再住院機率。持續對嚴重孕產婦疾病進行監測與分析,將有助於降低孕產婦併發症,增進母嬰之安全與健康,為台灣日後之重要課題。
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dc.description.abstractBackground: Maternal health is still a major health concern worldwide nowadays. Surveillance of severe maternal morbidity(SMM) can not only investigate the quality of obstetric care but also improve maternal and neonatal safety by adequate medical intervention.
Objective: The purpose of the study aimed to investigate the prevalence, trend and most common diseases among patients with severe maternal morbidity in Taiwan. The second purpose was to evaluate the medical expense, outcome of care and associated factors of SMM. Thirdly, we also analyzed the medical expense of delivery hospitalizations in women with different obstetric comorbidity index (OCI). Finally, the outcomes of obstetric care among different levels of institutions were compared as well.
Methods: A population-based secondary analysis using administrative datasets released by Ministry of Health and Welfare of Taiwan from 2011 to 2021 was carried out. Women who had childbirths and delivery hospitalizations were enrolled in the study. The prevalence and trend of severe maternal morbidity were investigated. The medical expense during delivery hospitalizations was measured. The outcomes of obstetric care such as outpatient or emergency department visit within 3 days, and readmission within 42 days after discharge were also evaluated. The analysis models used in the study included generalize estimating equation model and logistic regression model.
Results: A total of 2,054,010 delivery hospitalization records were identified during the study period. 6,961 subjects met the SMM indicators excluding blood transfusion, yielding an average SMM rate of 3.4 per thousand deliveries. The overall SMM rate including transfusion reached 26.7 per thousand deliveries. The trend of SMM including and excluding transfusion demonstrated significantly increasing during the study period. Advanced maternal age, cesarean delivery and obstetric comorbidity were main factors associated with SMM. The medical expense of delivery hospitalization in women with SMM was higher than non-SMM ones. The likelihood of outpatient and emergency department visit within 3 days and readmission within 42 days after discharge also increased in those with SMM. The medical expense of delivery hospitalization was positively related with the maternal OCI. The outcome of SMM care was poorer in district hospitals and maternity clinics. Finally, early discharge of SMM cases increased the risk of readmission.
Conclusion: Our findings demonstrated the steadily increasing trend of SMM in the past decade from nationwide records in Taiwan. Health policies should focus on encouraging early childbearing and avoidance of unnecessary cesarean delivery to reduce maternal complications. Delivery hospitalization in adequate level of maternal institutions may reduce the delay of adequate obstetric care which may improve medical care outcomes. Avoidance of early discharge in cases with SMM also reduces the risk of readmission. Continuous surveillance of SMM is an imperative task in Taiwan in the future.
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dc.description.tableofcontents口試委員會審定書 I
謝辭 II
中文摘要 III
英文摘要 V
目次 VII
圖次 X
表次 XI
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究重要性 4
第二章 文獻回顧 5
第一節 嚴重孕產婦疾病的定義、歷史沿革與發生率 5
一、 嚴重孕產婦疾病的定義 5
二、 嚴重孕產婦疾病的歷史沿革與確認方法 6
三、 嚴重孕產婦疾病的重要性 16
四、 孕產婦死亡率與嚴重孕產婦疾病發生率 20
第二節 嚴重孕產婦疾病的相關影響因子 28
一、 年齡 28
二、 生產方式 29
三、 共病症 30
四、 保險制度 34
五、 種族 34
六、 醫院與居住地 35
七、 肥胖 36
八、 其他 36
第三節 嚴重孕產婦疾病生產相關醫療資源耗用與結果 38
一、 孕期與生產相關醫療資源耗用 38
二、 住院日數 40
三、 生產相關的住院診斷關聯群支付制度 41
第四節 嚴重孕產婦疾病相關的照護結果 44
一、 急診利用 44
二、 產後再次住院 44
三、 服務量與預後間的關係 47
四、 片段式住院照護 50
第五節 知識缺口 55
第三章 研究方法 57
第一節 研究設計 57
第二節 研究假說 58
第三節 研究架構 59
第四節 研究材料與研究對象 64
一、 資料來源 64
二、 研究對象 64
第五節 研究變項定義 70
一、 自變項 70
二、 依變項 72
三、 控制變項 73
第六節 統計分析方法 79
第四章 研究結果 81
第一節 嚴重孕產婦疾病的發生率與趨勢 82
一、 研究對象基本特性 82
二、 各項嚴重孕產婦疾病指標之個案數及發生率 83
三、 嚴重孕產婦疾病發生率及趨勢 83
四、 嚴重孕產婦疾病相關因子之迴歸模型 84
第二節 重孕產婦疾病與非嚴重孕產婦疾病的醫療資源耗用與照護結果 93
一、陰道生產 93
二、剖腹生產 97
第三節 不同共病症之醫療耗用及其與現行生產DRG給付之比較 117
一、陰道生產 117
二、剖腹生產 119
第四節 嚴重孕產婦疾病的照護品質分析 134
一、不同層級別院所對嚴重孕產婦疾病案例醫療照護結果 134
二、嚴重孕產婦疾病案例住院天數對醫療照護結果的影響 135
第五章 研究討論 148
第一節 研究方法討論 148
第二節 研究結果討論與研究假說驗證 150
第三節 研究限制 160
第六章 結論與建議 162
第一節 結論 162
第二節 建議 164
參考文獻
中文部分 165
英文部分 166
附錄 191
-
dc.language.isozh_TW-
dc.title台灣嚴重孕產婦疾病的照護結果及影響因子分析zh_TW
dc.titleThe analysis of outcomes of care and related factors on severe maternal morbidity in Taiwanen
dc.typeThesis-
dc.date.schoolyear112-2-
dc.description.degree博士-
dc.contributor.oralexamcommittee董鈺琪;何弘能;呂宗學;陳進典zh_TW
dc.contributor.oralexamcommitteeYu-Chi Tung;Hong-Nerng Ho;Tsung-Hsueh Lu;Gin-Den Chenen
dc.subject.keyword嚴重孕產婦疾病,孕產婦瀕死,產科共病症,趨勢,醫療費用,zh_TW
dc.subject.keywordsevere maternal morbidity,maternal near miss,obstetric comorbidity,trend,medical expense,en
dc.relation.page215-
dc.identifier.doi10.6342/NTU202401926-
dc.rights.note同意授權(全球公開)-
dc.date.accepted2024-07-30-
dc.contributor.author-college公共衛生學院-
dc.contributor.author-dept健康政策與管理研究所-
顯示於系所單位:健康政策與管理研究所

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