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系統識別號 U0026-2901201715125300
論文名稱(中文) 腦性麻痺盛行率, 醫療照護以及復健治療使用率之探討
論文名稱(英文) Prevalence, healthcare and rehabilitation services utilization in individuals with cerebral palsy
校院名稱 成功大學
系所名稱(中) 健康照護科學研究所
系所名稱(英) Institute of Allied Health Sciences
學年度 105
學期 1
出版年 106
研究生(中文) 張明瑞
研究生(英文) Ming-Juei Chang
學號 ta8981102
學位類別 博士
語文別 英文
論文頁數 90頁
口試委員 指導教授-馬慧英
口試委員-呂宗學
口試委員-顏妙芬
召集委員-林巾凱
口試委員-黃昱瞳
中文關鍵字 腦性麻痺  盛行率  醫療服務使用  復健治療服務使用 
英文關鍵字 cerebral palsy  prevalence  health service utilization  rehabilitation 
學科別分類
中文摘要 腦性麻痺是常見導致兒童動作失能的疾病之一。盛行率的相關資訊,對於計劃以及提供腦性麻痺患者及家屬在醫療、教育以及社會相關服務是非常重要的。隨著醫療技術的進步,越來越多的腦性麻痺兒童能存活至成年。隨著終身的失能,腦性麻痺患者有複雜的健康議題,而且相當依賴醫療照護系統。如何能夠找出不同年齡階段的醫療需求以及提供合適的介入方案是非常重要的。然而,我們對於不同年齡層的腦性麻痺患者醫療使用情形卻所知甚少。復健治療對於腦性麻痺患者的重要性已經廣泛的被認同。經由協調運作良好的復健專業團隊 (物理治療、職能治療以及語言治療) 提供服務可以減低因為失能而導致的不良後果。但是,腦性麻痺患者使用復健治療服務的情形以及影響使用的相關因素仍鮮為人知。此博士論文針對腦性麻痺族群進行三篇研究,目的在調查台灣腦性麻痺盛行率、醫療服務以及復健治療服務使用相關情形。
第一篇研究利用不同的腦性麻痺個案定義,從全民健保資料庫承保抽樣百萬歸人檔中擷取相關資料並推估台灣腦性麻痺的盛行率。隨著個案定義的不同,推估的腦性麻痺盛行率由4.1至1.3 (每1000位新生兒) 不等。個案定義越嚴格或是腦性麻痺確診年齡越大,盛行率越小。與其他國家相比,台灣腦性麻痺盛行率較高。未來研究可針對盛行率較高的情形作相關探討。
第二篇研究調查不同年齡層的腦性麻痺患者醫療服務的使用情形。醫療服務使用資料從全民健保資料庫承保抽樣百萬歸人檔中擷取。參與個案須經由小兒科或復健科醫師開立腦性麻痺診斷後始得加入。所有參加者之醫療服務使用相關資料擷取至2003年底。腦性麻痺兒童的平均每千人口年度門診就醫率為3,1680;青少年為1,6492;成人為2,8617。醫院門診提供的門診服務占了50%以上。兒童與青少年腦性麻痺患者相對於成人腦性麻痺患者接受較多的專科醫師服務。呼吸系統的疾病是兒童與青少年腦性麻痺患者接受門診服務的主要原因,而成人則是因為循環系統的疾病接受門診服務。
第三篇研究探討腦性麻痺患者使用復健治療服務的情形以及影響使用服務的相關因素。腦性麻痺患者復健治療服務使用的相關資料由全民健保資料庫承保抽樣百萬歸人檔中擷取。所有參加者之復健治療服務使用相關資料擷取2004年底。首先利用邏輯斯迴歸 (logistic regression) 去分析使用復健治療服務的相關因素。接著利用變異數分析 (ANOVA) 去找出與使用次數相關的因素。百分之四十的參加者 (1178位)在2000-2004年間至少使用過一種復健治療服務 (物理治療、職能治療以及語言治療)。年齡、部分負擔給付以及併發症是影響使用復健治療服務以及治療次數的相關因素。未來應針對腦性麻痺嚴重度以及其他相關因素(如社經地位或教育程度)進行復健治療服務使用的研究。 
英文摘要 Cerebral palsy (CP) is the most common cause of motor disability in children. The information of prevalence of CP is essential in order to plan medical, educational and social services to children and their family. With advanced medical care, the majority of children with CP can survive into adulthood. With lifelong disability, people with CP have complex health issues and rely heavily on the healthcare system. It is important to recognize the healthcare needs and plan age-appropriate intervention programs. However, little is known about healthcare service used by people with CP across the lifespan. The importance of rehabilitation therapy service for children with CP is widely understood. The consequences of disability can be reduced through well-coordinated rehabilitation therapy (physical therapy, PT; occupational therapy, OT; and speech and language pathology, SLP) services. However, little is known about the service utilization patterns of individuals with CP and the factors associated with rehabilitation therapy service use. Therefore, this dissertation includes three studies on the individuals with CP, aimed to investigate the prevalence, healthcare and rehabilitation therapy service utilization of individuals with CP in Taiwan.
The first study estimated the prevalence of CP using different case definitions from the representative sample of one million patients covered by Taiwan’s National Health Insurance (NHI). The estimated prevalence of CP (cases per 1000 live births) varied from 4.1 to 1.3 for different case definitions. The older the minimum age at diagnosis and the stricter the case definition used, the smaller was the estimated prevalence of CP. Using a case definition compatible with those used in most other studies, the estimated prevalence of CP in Taiwan is higher than in other countries. Additional studies are needed to determine the reasons of higher prevalence.
The second study examined the utilization patterns of people with CP across lifespan in Taiwan. Data for this study was obtained from the NHI Research Database (NHIRD) sample dataset registry of beneficiaries. Participants with pediatrician- or physical and rehabilitative medicine physician-diagnosed CP recorded in Taiwan’s NHI claims database were recruited. CP cases included in this study were followed-up until the end of 2003. Annual rates of outpatient physician visits were 31,680 for children, 16,492 for youth, and 28,617 for adults with CP (per 1000 persons). Patients received over half of their outpatient care from hospitals. More children than youth and adults used specialist physician services. Respiratory diseases were the primary reason for visits by children and youth; circulatory diseases were the primary reason for adults.
The third study examined the pattern of rehabilitation therapy service use of individuals with CP and identified factors associated with use. Data for this study was obtained from the one-million sample set of registry of beneficiaries from NHIRD. Cases were identified by the presence of the International Classification of Disease Clinical Modification, ninth revision (ICD-9-CM) code 343 from 1997 to 2000. Individuals included in this study were followed up until the end of 2004. Logistic regression was used to analyze the factors related to utilization of rehabilitation therapy service. In addition, ANOVA was used to analyze the factors correlated to the frequency of rehabilitation therapy service among the CP cases. Among 1178 participants, over 40% received at least one rehabilitation therapy (PT, OT, SLP) services during 2000-2004. Age, copayment status and comorbidity were associated with rehabilitation therapy service utilization. The mean annual rehabilitation therapy visits were different among age group, copayment status and comorbidity. Additional studies are needed to identify the severity and other factors which related to the use of rehabilitation therapy service of individuals with CP.

論文目次 Table of Contents
Abstract…………………………………………………………………………………..i
Acknowledgement…………………………………………………………………….....v
Table of Contents……………………………………………………………………......vi
List of Tables……………………………………………………………………………..ix
List of Figures……………………………………………………………………………x
Chapter 1 Introduction…………………………………………………………………...1
1.1 Statement of the issue………….………………………………………………….....1
1.2 What is cerebral palsy?...………………………………………………………….....2
1.2.1 Description……………………………………………………………………..2
1.2.2 Classification…………………………………………………………………...2
1.2.3 Associated impairments………………………………………………………...3
1.3 The prevalence of cerebral palsy…………………….…………………………….....5
1.4 Healthcare services utilization of individuals with CP………………………………7
1.5 Rehabilitation therapy services utilization of individuals with CP.……………….....9
1.6 The purpose of this dissertation………………………………………………...........11
1.7 Research questions…………………………………………………………………...12
Chapter 2 Estimating the prevalence of cerebral palsy in Taiwan: A comparison of different case definitions…………………………………………………………………..13
2.1 Abstract……………..……………………………………………………………….....13
2.2 Introduction…………………………………………………………………………....14
2.3 Methods………………………………………………………………………………..15
2.3.1 Data source…………………………………………………………………….15
2.3.2 Case definition……………………………………………………………..…..16
2.3.3 Data analysis…………………………………………………………………..17
2.4 Results………………………………………………………………………………...18
2.5 Discussion…………………………………………………………………………….19
2.6 Conclusion……………………………………………………………………………22
2.7 References……………………………………………………………………………23
Chapter 3 Ambulatory Care Utilization of Individuals with Cerebral Palsy in Taiwan- A Country with Universal Coverage and No Gatekeeper Regulation…………..…………..34
3.1 Abstract……………………………………………………………………………...34
3.2 Introduction………………………………………………………………………….35
3.3 Methods………………………………………………………………………….......37
3.3.1 Data source………………………………………………………………….....37
3.3.2 Participants…………………………………………………………………….37
3.3.3 Data analysis ………………………………………………………………......38
3.4 Results……………………………………………………………………………......39
3.4.1 General information of the cohort…………………………………………......39
3.4.2 How often did individuals with CP visit a physician office or hospital outpatient
department?........................................................................................................39
3.4.3 What types of services were used?.....................................................................39
3.4.4 How many physicians provided services?.........................................................40
3.5 Discussion……………………………………………………………………….......41
3.6 Conclusion…………………………………………………………………………..43
3.7 References……………………………………………………………………….......44
Chapter 4 Rehabilitation service utilization of individuals with CP………………..........52
4.1 Abstract……………………………………………………………………………....52
4.2 Introduction……………………………………………………………………..........53
4.3 Methods………………………………………………………………………………56
4.3.1 Data source………………………………………………………………….....56
4.3.2 Participants……………………………………………………………………56
4.3.3 Data analysis…………………………………………………………………..57
4.4 Results……………………………………………………………………………….58
4.5 Discussion……………………………………………………………………...........60
4.6 Conclusion…………………………………………………………………………..63
4.7 References…………………………………………………………………………...64
Chapter 5 General discussion and future research……………………………………….74
5.1 Overview and main findings…………………………………………………….......74
5.2 Estimating the prevalence of cerebral palsy using different case definitions……….76
5.3 Investigating the healthcare services utilization pattern across life span…………...77
5.4 Investigating the utilization pattern and determinants of rehabilitation therapy
services………………………………………………………………………………….78
5.5 Implication for future research………………………………………………….......79
5.5.1 Development of CP registry system……………………………………….......79
5.5.2 Fulfilling the unmet healthcare needs of individuals with CP……………......79
5.6 Conclusion………………………………………………………………………….81
References……………………………………………………………………………….82
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