進階搜尋


   電子論文尚未授權公開,紙本請查館藏目錄
(※如查詢不到或館藏狀況顯示「閉架不公開」,表示該本論文不在書庫,無法取用。)
系統識別號 U0026-3006201415295600
論文名稱(中文) 以健保資料庫探討全膝關節置換手術之決策過程
論文名稱(英文) Decision-making of Total Knee Replacement Based on National Health Insurance Research Database
校院名稱 成功大學
系所名稱(中) 企業管理學系
系所名稱(英) Department of Business Administration
學年度 102
學期 2
出版年 103
研究生(中文) 徐培嘉
研究生(英文) Pei-Chia Hsu
學號 R46011060
學位類別 碩士
語文別 中文
論文頁數 87頁
口試委員 指導教授-黃瀞瑩
口試委員-方世杰
口試委員-周信輝
中文關鍵字 退化性膝關節炎  全膝關節置換術  集群分析  決策分析 
英文關鍵字 Osteoarthritis  Total Knee Replacement  Cluster Analysis  Decision-making 
學科別分類
中文摘要 本研究目的在探討臺灣地區接受全膝關節置換術之病患其決策路徑及治療過程之研究。研究方法係透過全民健康保險資料庫之次級資料進行回溯性研究,並從中篩選出於2012年初次接受全膝關節置換手術之病患共321人為研究對象;利用集群分析進行探索性研究,將321位病患分群,並透過決策分析建構分群病患過去15年之治療決策路徑圖。研究結果顯示在接受全膝關節置換手術的病患中共可分為六群,因此共有六種決策路徑,接著以病患退化性膝關節炎確診至手術的時間和病患年齡歸納為兩大類。本研究之結果可提供臺灣地區患有退化性膝關節炎的病患以及主治醫生在治療過程中之參考。
英文摘要 This study aims to construct the decision-making of the patients who suffering the Osteoarthritis (OA) and finally have a Total Knee Replacement operation. A Cluster Analysis was employed. Data collected from the National Health Insurance Research Database (NHIRD) which is secondary data. The patients who have an operation at 2012 were be selected as samples. And this study is a retrospective study. Results indicated that there are two categories which are long decision-making times and short one. Moreover, there are three groups in each category which are age-sixty, age-seventy, and age-eighty. So, there are total six types of decision-making patterns. Practical implications and decision-making suggestions from the research findings for those who suffer the OA and the doctors were discussed.
論文目次 中文摘要 II
SUMMARY III
表目錄 X
圖目錄 XI
第一章 緒論 1
第一節 背景與動機 1
第二節 研究目的與研究問題 3
第三節 健保資料庫及資料簡介 4
第四節 研究範圍與限制 6
第五節 研究架構 7
第二章 文獻探討 9
第一節 退化性關節炎及治療方法 9
第二節 全膝關節置換術及趨勢 14
第三節 全膝關節置換術之成本 17
第四節 決策分析 21
第五節 人口老化及健保給付 25
第三章 研究方法 28
第一節 概念化研究模式 28
第二節 研究資料之限制 29
第三節 研究資料 30
第四節 研究方法 42
第四章 研究結果 45
第一節 44萬人之敘述性統計與代表性分析 45
第二節 目標樣本之敘述性統計 49
第三節 目標樣本之集群分析 51
第四節 決策樹之建構 55
第五節 簡單成本分析 64
第六節 小結 66
第五章 結論與建議 67
第一節 研究結果與文獻結果比較 67
第二節 管理意涵與政策性意涵 72
第三節 研究限制與建議 77
參考文獻 78
參考文獻 英文部分
Arden, G. (1973). Total knee replacement. Clin Orthop Relat Res, 94, 92-103.
Arden, N., & Nevitt, M. C. (2006). Osteoarthritis: epidemiology. Best Practice & Research Clinical Rheumatology, 20(1), 3-25.
Arya, R., & Jain, V. (2013). Osteoarthritis of the knee joint: An overview. Journal, Indian Academy of Clinical Medicine, 14(2), 155.
Attar, F. G., Khaw, F.-M., Kirk, L. M., & Gregg, P. (2008). Survivorship analysis at 15 years of cemented press-fit condylar total knee arthroplasty. J Arthroplasty, 23(3), 344-349.
Ballantyne, P. J., Gignac, M. A., & Hawker, G. A. (2007). A patient‐centered perspective on surgery avoidance for hip or knee arthritis: Lessons for the future. Arthritis Care & Research, 57(1), 27-34.
Basilico, F. C., Sweeney, G., Losina, E., Gaydos, J., Skoniecki, D., Wright, E. A., & Katz, J. N. (2008). Risk factors for cardiovascular complications following total joint replacement surgery. Arthritis Rheum, 58(7), 1915-1920. doi: 10.1002/art.23607
Bennell, K. L., & Hinman, R. S. (2011). A review of the clinical evidence for exercise in osteoarthritis of the hip and knee. Journal of Science and Medicine in Sport, 14(1), 4-9.
Bourne, R. B., Chesworth, B., Davis, A., Mahomed, N., & Charron, K. (2010). Comparing patient outcomes after THA and TKA: is there a difference? Clin Orthop Relat Res, 468(2), 542-546. doi: 10.1007/s11999-009-1046-9
Brander V A, M. S., Jet J, Heinemann A W, Stulberg S D. (1997). Outcome of hip and knee arthroplasty in persons aged 80 years and older. Clin Orthop Relat Res, 345, 67-78.
Brosseau, L., & MacLeay, L. (2003). Intensity of exercise for the treatment of osteoarthritis.
Card, D., Dobkin, C., & Maestas, N. (2004). The impact of nearly universal insurance coverage on health care utilization and health: evidence from Medicare: National Bureau of Economic Research.
Carr, A. J., Robertsson, O., Graves, S., Price, A. J., Arden, N. K., Judge, A., & Beard, D. J. (2012). Knee replacement. The Lancet, 379(9823), 1331-1340.
Coulter, A., & Jenkinson, C. (2005). European patients' views on the responsiveness of health systems and healthcare providers. The European Journal of Public Health, 15(4), 355-360.
Culliford, D., Maskell, J., Beard, D., Murray, D., Price, A., & Arden, N. K. (2010). Temporal trends in hip and knee replacement in the United Kingdom 1991 TO 2006. Journal of Bone & Joint Surgery, British Volume, 92(1), 130-135.
Demierre, M., Castelao, E., & Piot-Ziegler, C. (2011). The long and painful path towards arthroplasty: A qualitative study. Journal of health psychology, 16(4), 549-560.
Di Cesare, P. E., Abramson, S. B., & Samuels, J. (2005). Pathogenesis of osteoarthritis. Kelley's textbook of rheumatology, 7, 1493-1513.
Dieppe, P. (2011). Who should have a joint replacement? A plea for more 'phronesis'. Osteoarthritis Cartilage, 19(2), 145-146. doi: 10.1016/j.joca.2010.08.018
Dunlop, D. D., Song, J., Manheim, L. M., & Chang, R. W. (2003). Racial disparities in joint replacement use among older adults. Medical care, 41(2), 288-298.
Ethgen, O., Bruyere, O., Richy, F., Dardennes, C., & Reginster, J.-Y. (2004). Health-related quality of life in total hip and total knee arthroplastyA qualitative and systematic review of the literature. The Journal of Bone & Joint Surgery, 86(5), 963-974.
Fatima de Pina, M., Ribeiro, A. I., & Santos, C. (2011). Epidemiology and Variability of Orthopaedic Procedures Worldwide. European Instructional Lectures, 11, 9-19. doi: 10.1007/978-3-642-18321-8_2
Filardo, G., Kon, E., Buda, R., Timoncini, A., Di Martino, A., Cenacchi, A., . . . Marcacci, M. (2011). Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surgery, Sports Traumatology, Arthroscopy, 19(4), 528-535.
George, L. K., Ruiz, D., & Sloan, F. A. (2008). The effects of total hip arthroplasty on physical functioning in the older population. Journal of the American Geriatrics Society, 56(6), 1057-1062.
Hadorn, D. C., & Holmes, A. C. (1997). The New Zealand priority criteria project. Part 2: Coronary artery bypass graft surgery. BMJ: British Medical Journal, 314(7074), 135.
Hamel, M. B., Toth, M., Legedza, A., & Rosen, M. P. (2008). Joint replacement surgery in elderly patients with severe osteoarthritis of the hip or knee: decision making, postoperative recovery, and clinical outcomes. Archives of internal medicine, 168(13), 1430.
Hanchate, A. D., Zhang, Y., Felson, D. T., & Ash, A. S. (2008). Exploring the determinants of racial and ethnic disparities in total knee arthroplasty: health insurance, income, and assets. Medical care, 46(5), 481.
Hawker, G. A., Guan, J., Croxford, R., Coyte, P. C., Glazier, R. H., Harvey, B. J., . . . Badley, E. M. (2006). A prospective population‐based study of the predictors of undergoing total joint arthroplasty. Arthritis & Rheumatism, 54(10), 3212-3220.
Healy, W. L., Della Valle, C. J., Iorio, R., Berend, K. R., Cushner, F. D., Dalury, D. F., & Lonner, J. H. (2013). Complications of total knee arthroplasty: standardized list and definitions of the knee society. Clinical Orthopaedics and Related Research®, 471(1), 215-220.
Jamsen, E., Puolakka, T., Eskelinen, A., Jantti, P., Kalliovalkama, J., Nieminen, J., & Valvanne, J. (2013). Predictors of mortality following primary hip and knee replacement in the aged. A single-center analysis of 1,998 primary hip and knee replacements for primary osteoarthritis. Acta Orthop, 84(1), 44-53. doi: 10.3109/17453674.2012.752691
Jayadev, C., Khan, T., Coulter, A., Beard, D. J., & Price, A. J. (2012). Patient decision aids in knee replacement surgery. Knee, 19(6), 746-750.
Jenkins, P., Clement, N., Hamilton, D., Gaston, P., Patton, J., & Howie, C. (2013). Predicting the cost-effectiveness of total hip and knee replacement A health economic analysis. Bone & joint journal, 95(1), 115-121.
Jones, C. A., Voaklander, D. C., Johnston, D. W. C., & Suarez-Almazor, M. E. (2001). The effect of age on pain, function, and quality of life after total hip and knee arthroplasty. Archives of internal medicine, 161(3), 454.
Judge, A., Welton, N. J., Sandhu, J., & Ben-Shlomo, Y. (2010). Equity in access to total joint replacement of the hip and knee in England: cross sectional study. BMJ: British Medical Journal, 341.
Kon, E., Mandelbaum, B., Buda, R., Filardo, G., Delcogliano, M., Timoncini, A., . . . Marcacci, M. (2011). Platelet-rich plasma intra-articular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 27(11), 1490-1501.
Kurtz, S., Ong, K., Lau, E., Mowat, F., & Halpern, M. (2007). Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am, 89(4), 780-785. doi: 10.2106/JBJS.F.00222
Kurtz, S. M., Ong, K. L., Schmier, J., Mowat, F., Saleh, K., Dybvik, E., . . . Lau, E. (2007). Future clinical and economic impact of revision total hip and knee arthroplasty. J Bone Joint Surg Am, 89 Suppl 3, 144-151. doi: 10.2106/JBJS.G.00587
Lee, T. H., Marcantonio, E. R., Mangione, C. M., Thomas, E. J., Polanczyk, C. A., Cook, E. F., . . . Goldman, L. (1999). Derivation and Prospective Validation of a Simple Index for Prediction of Cardiac Risk of Major Noncardiac Surgery. Circulation, 100(10), 1043-1049. doi: 10.1161/01.cir.100.10.1043
Lievense, A. M., Koes, B. W., Verhaar, J. A., Bohnen, A. M., & Bierma‐Zeinstra, S. (2007). Prognosis of hip pain in general practice: a prospective followup study. Arthritis Care & Research, 57(8), 1368-1374.
Lin, C.-C., Lai, M.-S., Syu, C.-Y., Chang, S.-C., & Tseng, F.-Y. (2005). Accuracy of diabetes diagnosis in health insurance claims data in Taiwan. Journal of the Formosan Medical Association= Taiwan yi zhi, 104(3), 157-163.
Lin, K.-C., Lin, H.-Y., & Chou, P. (2000). Community based epidemiological study on hyperuricemia and gout in Kin-Hu, Kinmen. The Journal of rheumatology, 27(4), 1045-1050.
Losina, E., Walensky, R. P., Kessler, C. L., Emrani, P. S., Reichmann, W. M., Wright, E. A., . . . Paltiel, A. D. (2009). Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Archives of internal medicine, 169(12), 1113.
Mandl, L. A. (2013). Determining who should be referred for total hip and knee replacements. Nat Rev Rheumatol, 9(6), 351-357. doi: 10.1038/nrrheum.2013.27
Manheimer, E., Cheng, K., Linde, K., Lao, L., Yoo, J., Wieland, S., . . . Bouter, L. M. (2010). Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev, 1.
Mota, R. E., Tarricone, R., Ciani, O., Bridges, J. F., & Drummond, M. (2012). Determinants of demand for total hip and knee arthroplasty: a systematic literature review. BMC health services research, 12(1), 225.
Merrill, C., & Elixhauser, A. (2007). Hospital stays involving musculoskeletal procedures, 1997–2005.
Nuesch, E., Dieppe, P., Reichenbach, S., Williams, S., Iff, S., & Juni, P. (2011). All cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort study. BMJ, 342, d1165. doi: 10.1136/bmj.d1165
Osiri, M., Welch, V., Brosseau, L., Shea, B., McGowan, J., Tugwell, P., & Wells, G. (2009). Transcutaneous electrical nerve stimulation for knee osteoarthritis (Review).
Registry, A. O. A. N. J. R. (2010). Hipand Knee Arthroplasty Annual Report 2010.
Registry, T. N. A. (2010). Norwegian Annual Report 2010.
Ringdahl, E., & Pandit, S. (2011). Treatment of knee osteoarthritis. American family physician, 83(11).
Rodriguez-Merchan, E. C. (2013). Intra-articular Injections of Hyaluronic Acid and Other Drugs in the Knee Joint. HSS Journal®, 9(2), 180-182.
Rutjes, A., Nüesch, E., Sterchi, R., & Jüni, P. (2010). Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev, 1(1).
Sinusas, K. (2012). Osteoarthritis: diagnosis and treatment. American family physician, 85(1).
Song, J., Chang, R. W., & Dunlop, D. D. (2006). Population impact of arthritis on disability in older adults. Arthritis Rheum, 55(2), 248-255. doi: 10.1002/art.21842
Spiers, N. A., Matthews, R. J., Jagger, C., Matthews, F. E., Boult, C., Robinson, T. G., & Brayne, C. (2005). Diseases and impairments as risk factors for onset of disability in the older population in England and Wales: findings from the Medical Research Council Cognitive Function and Ageing Study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 60(2), 248-254.
Suarez-Almazor, M. E., Richardson, M., Kroll, T. L., & Sharf, B. F. (2010). A qualitative analysis of decision-making for total knee replacement in patients with osteoarthritis. Journal of clinical rheumatology: practical reports on rheumatic & musculoskeletal diseases, 16(4), 158.
Toye, F. M., Barlow, J., Wright, C., & Lamb, S. E. (2006). Personal meanings in the construction of need for total knee replacement surgery. Social science & medicine, 63(1), 43-53.
Wandel, S., Jüni, P., Tendal, B., Nüesch, E., Villiger, P. M., Welton, N. J., . . . Trelle, S. (2010). Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis. BMJ: British Medical Journal, 341.
Welch, V., Brosseau, L., Peterson, J., Shea, B., Tugwell, P., & Wells, G. (2009). Therapeutic ultrasound for osteoarthritis of the knee (Review).
Zeni, J. A., Axe, M. J., & Snyder-Mackler, L. (2010). Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis. BMC musculoskeletal disorders, 11(1), 86.
中文文獻
田維哲. (2007). 初次全人工髖與膝關節置換術的盛行率與病人的醫療費用分析─ 從 1996 年~ 2004 年(碩士)
周正亮, 宋文旭, 柳復威, 李雪楨, 黃麗龍, & 陳俊忠. (2013). 復健介入對退化性膝關節炎接受玻尿酸注射患者之健康促進效益研究. 臺灣復健醫學雜誌, 41(1), 39-49.
林妙秋, 呂明錡, & 蔡宗益. (2013). 臺灣類風濕性關節炎患者憂鬱症發生率之流行病學研究. 女性, 5(66.0), 2,890.
林訓正. (2005). 專題報導--退化性關節炎之物理治療.
張富勝, 張倩淇, & 簡郁芬. (2012). 退化性關節炎. 家庭醫學與基層醫療, 27(9), 324-329.
連賢明. (2008). 如何使用健保資料進行經濟研究. 經濟論文叢刊, 36(1), 115-143.
傅鈺翔, 張震鴻, 林彥輝, 胡儷馨, 徐永年, & 徐錦池. (2013). 葡萄糖胺治療骨關節炎之效果: 案例實證. 醫學與健康期刊, 2(1), 49-54.
黃鐙樂. (2010). 評估不同分子量玻尿酸對創傷性膝關節炎與原發退化性膝關節炎的軟骨保護效果與抗發炎效果. 臺灣大學醫學工程學研究所學位論文, 1-114.
溫啟邦, 衛沛文, 詹惠婷, 詹益辰, 江博煌, & 鄭丁元. (2007). 從分析運動熱量談當前台灣全民運動政策-比較台灣與美國民眾的運動習慣, 強度與頻率. 臺灣公共衛生雜誌, 26(5), 386-399.
溫靜微. (2012). 台灣地區全膝關節置換需求及未來趨勢預測. (碩士), 東海大學, 台中市
葉天忻, & 梁蕙雯. (2012). 關節內注射玻尿酸治療膝部退化性關節炎. 台北市醫師公會會刊, 56(3), 31-34.
謝嘉娟, 林易申, 周稚傑, 唐淑貞, 高森永, 羅慶徽, & 高東煒. (2011). 台灣退化性膝關節炎長者玻尿酸注射治療後復健資源使用之探討. 中華職業醫學雜誌, 18(2), 93-101.
譚著文, 李妙紋, & 洪紹寧. (2013). 以實證醫學方法探討葡萄糖胺類製劑治療膝關節炎之效果. 醫學與健康期刊, 2(1), 31-39.
網站資料
Healthline
KneeReplacementCost.com
The Healthcare Cost and Utilization Project (HCUP) net
The Knee Society
The World Bank
台視常春專題報導
行政院主計處
行政院經濟建設會員會
全民健康保險資料庫
香港骨科醫學會
國立成功大學醫學院人體試驗委員會
國立成功大學醫學院附設醫院護理部
衛生福利部中央健保署
論文全文使用權限
  • 同意授權校內瀏覽/列印電子全文服務,於2020-12-31起公開。


  • 如您有疑問,請聯絡圖書館
    聯絡電話:(06)2757575#65773
    聯絡E-mail:etds@email.ncku.edu.tw