Investigation of Associated Factors and Resource Utilization of Delayed Hemodialysis in End-Stage Renal Disease Patients
| Autor: | Hsiu-Chin Mai, 麥秀琴 |
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| Rok vydání: | 2016 |
| Druh dokumentu: | 學位論文 ; thesis |
| Popis: | 104 Aims: The purpose of this study is to explore the characteristics, clinical features, and log-tern trend of characteristics of hospitals in end-stage renal disease (ESRD) patients, who delay into the hemodialysis (HD). The study further assesses the related factors of their consumption of medical resources and medical efficacy. Methods: This study uses retrospective longitudinal study using the 1997-2012 National Health Insurance database, medical institutions stalls and stalls death, major injuries and other medical resources secondary database analysis to discuss the main diagnostic ICD-9 codes ( 585, 586, etc.) of patients with chronic kidney disease receiving delay HD treatment. A total of follow-up period is 15 years. We use descriptive statistics and inferential statistics (chi-square test, independent samples t test, multiple regression analysis, Kaplan - Meier survival analysis, Cox Analysis), to explore long-term trends of delay HD treatment in ESRD patients, and assess demographic factors, comorbidity factors, the hospital level, characteristics of time for medical resources and medical efficacy influence. Results: 1. Descriptive statistics of delay HD patients characteristics: There are 410 people in T2 (2002-2007), most during the period of 1997-2012. There are more women than men, and focus on aged 45-64 years, comorbidity index (CCI) of 2 scores, and the medical center patients. 2. Total cost of medical care increased during 2nd and 3rd year (vs. 1st year) in delay HD patients. Total cost of medical care does not increase in 2nd year, but increased in 3rd year (vs. 1st year, p < 0.001) in non-delay HD patients. Besides, total cost decreased during 4th and 5th year, which may be due to stability of patient’s condition in non-delay HD patients. The number of outpatient visits increased during 2nd year, and decreased in 4th and 5th years in delay HD patients (vs. 1st year, p < 0.001), whereas no significant change in non-delay HD patients. 3. Old age (per 1 year, HR: 1.07, p < 0.001), male (vs. female, HR: 1.41, p < 0.001) are associated with increased overall mortality in delay HD patients. Conclusions and suggestions: This is the first study to explore long-terms trend (1997-2012) of delay HD in ESRD patients, which provide the related factors influencing medical resource consumption and mortality. Through statistical analysis of different properties, this study may act as a reference although limited health-care database factors. |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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