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  • 學位論文

探討住院病人跌倒事件影響因素及其醫療支出

Factors and Medical Expenditures Related to Fall Events Among Inpatients

指導教授 : 張文英

摘要


本研究目的旨在(一)探討住院病人發生跌倒事件之影響因素、(二)探討跌倒事件之影響因素與現行跌倒評估工具間之一致性、(三)探討住院病人跌倒事件對其醫療支出情形之影響。研究設計為回溯性個案控制(retrospective case-control design),以北部某區域教學醫院於2009年至2011年間住院病人在住院期間曾發生跌倒事件為主。而對照組則以性別、年齡±5歲、主診斷ICD-9相同但無跌倒者為配對之條件與順序。資料以研究者參考文獻及研究機構之異常通報作業系統所建構之資料收集表為研究工具。統計方法則包括描述性統計與推論性統計。 本研究共收160位(跌倒組80位及對照組80位)住院病人。研究結果,住院病人發生跌倒事件之影響因素包括:病人用藥種類數≧三類以上(Crude OR:3.67)、病人未使用點滴注射(Adjusted OR:0.42)及無家屬陪伴者(Adjusted OR:0.34),且達統計上之顯著意義。但本研究結果亦發現現行評估工具之敏感度及特異性亦不高,且影響跌倒因素與現行跌倒評估工具間是不一致的。在跌倒事件之醫療支出方面,本研究發現住院病人在住院期間發生跌倒事件,確實會讓醫療支出增加,且隨其跌倒傷害程度加重,其醫療支出也會增加,其中,以三級程度傷害病人之額外的醫療費用最高,平均達18,257元。 本研究結果能作為未來醫院在推動病人安全與預防跌倒發生之參考,並減少額外的醫療支出。

並列摘要


The aims of this study were 1) to understand the impact factors realted to fall events among inpatients, 2) to compare the consistency between the impact factors of fall events and the current fall assessment tool, and 3) to estimate the medical costs after falls. This study was a retrospective case-control design, using fall data from 2009 to 2011 in a regional teaching hospital of northern Taipei. Inpatients enrolled in this study should had the medical records and the reports in the Taiwan Quality indicator Project (TQIP) database. Patients in the control group were matched using the same gender, age±5 years, and ICD-9-CM code with patients in the fall group, but did not have falls. A data collection sheet was developed by reviewing of the literature and the study hospital incident report. Data were analyzed using descriptive and inferential statistics. A total of 160 inpatients participated in this study, 80 patients in the fall group, and 80 in the control group. The study results revealed that the impact factors related to fall among inpatients included the use more than 3 medications (Crude OR: 3.67), no IV drip injection use (Adjusted OR: 0.42) and no family accompany (Adjusted OR: 0.34) and reach statistical significance. However, we also found that the sensitivity and specificity were not very high in current fall assessment tool; thus, the impact factors related to fall events and current fall assessment tool were inconsistency. In terms of medical costs, the study results revealed that the medical costs were increased after fall and increased with the degree of injuries. The third degree of injury related to fall cost the highest compared to the first degree of injury. The average medical costs of third degree of injury were 18,257 New Taiwan dollars. The findings of this study can serve as references for future hospitals to promote patient safety, to prevent the occurrence of fall, and to reduce the medical costs.

參考文獻


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