Treatment Cost Analysis of Acute Burn Injury

燒傷醫療費用之分析

游彥辰(Yen-Chen Yu) ； 黃慧夫(Hui-Fu Huang) ； 林郁勳(Yu-Hsun Lin) ； 曾詠怡(Yung-Yi Tseng) ； 楊永健(Eng-Kean Yeong) ； 陳明庭(Ming-Ting Chen)

《臺灣整形外科醫學會雜誌》 22卷3期 (2013/09) Pp. 188-198

摘要

背景：由於現代燒傷照護的進步，治療燒傷病人的花費也逐漸增加，但在台灣卻少有報導針對燒傷病患治療的費用進行分析。為了降低高額的醫療費用，與費用相關的因子如住院天數、植皮手術的次數等，需要進一步的分析。本篇回溯性研究的目的，就是針對急性燒傷患者，分析與醫療費用相關的因素為何。目的及目標：分析和急性燒傷治療費用相關的因子。材料及方法：我們收集西元2011年4月至2012年4月至本院住院的急性燒傷患者，回溯性分析病患的基本資料、燒傷的特性、治療經過、以及醫療費用等進行分析。在以單變數迴歸分析後，凡是具相關性的因素（p值小於0.1），將之進行多變數迴歸分析，以評估具有獨立相關性的費用相關因子。結果：我們總共統計124 位病患的資料。結果顯示燒傷面積、加護病房住院天數、普通病房住院天數、以及植皮手術的次數是具有獨立相關性的顯著的費用相關因子。然而，在大面積燒傷的病人中，除了上述三項之外，傷口細菌培養陽性、燒傷的深度及部位也是具有獨立相關性的顯著的費用相關因子。結論：醫療費用相關因子在不同的病人分組中會有不同。總體來說，為降低醫療花費，應努力減少住院天數、以及植皮手術的次數。此外應避免燒傷面積的高估，以減少不適當的健保給付及不必要的醫療費用。最後，作者認為將燒傷治療標準化是達成合理醫療費用必須的手段。

並列摘要

Background:Advances in the treatment of burn injuries have lead to increasingly high medical expenses for burn injuries. However, cost analysis of burn treatment is rarely reported in Taiwan. In order to reduce high medical expenses, cost-related factors such as length of hospital stay, number of grafting operations and other factors should be evaluated. The purpose of this retrospective study is to identify factors that are cost related in the treatment of burn injuries.Aim and Objectives:To analyze the cost-related factors in the treatment of acute burn injuries.Materials and Methods:From April of 2011 to April of 2012, patients admitted to our burn center were included in the study. Data regarding patient demographics, burn profiles, treatment courses, expenses and other data were collected and retrospectively reviewed. Following univariate analysis, covariates that found to have a p value ＜0.1 were included in a multivariate linear regression model for the determination of independent cost-related factors.Results:A total of 124 patients were included in our study. The results showed that area of burn injury (total body surface area, TBSA), length of hospital stay, and number of grafting operations were all significant independent cost-related factors in the general burn patient population. Meanwhile, in the subgroup of major burn patients, positive wound culture, depth and location of the burns as well as arterial catheter insertion were significant independent cost-related factors in addition to the factors stated in the general burn population.Conclusion:Each patient subgroup has different cost-related factors. In general, to reduce medical expenses, effort should be made to reduce length of hospital stay and the number of grafting operations performed. In addition, overestimation of the burn size should be avoided as it significantly increases medical expenses and leads to improper insurance reimbursement. Standardization of burn injury treatment is a necessary measure to achieve reasonable medical expenses.

並列關鍵字

cost-related factors ； total body surface area of burn ； length of hospital stay ； number of grafting operation ； insurance reimbursement