呼吸器依賴病人費用控管之成效暨相關因素探討-以某醫學中心為例

研究目的瞭解呼吸器依賴病人費用控管措施介入前後的人口學特性、疾病特質、醫療費用與醫療照護品質分布情形，以瞭解費用控管措施介入對醫療費用及醫療照護品質的影響。研究方法本研究屬於回溯性、橫斷式研究，係採用某醫學中心亞急性呼吸照護病房的病人資料庫為基礎。研究期間為2012年8月~2014年12月，共計二年五個月，研究樣本總計534筆。藉由住院期間病歷摘錄、醫院臨床資訊系統及醫療費用申報檔收集回溯性資料。為了瞭解費用控管措施介入前後的改變情形，將研究時間分為三個階段，資料收集以單因子變異數分析、薛費事後檢定、複迴歸分析、二項對數迴歸分析等統計方法進行分析。研究結果雙項費用控管措施、是否發生感染、是否作氣切、是否脫離呼吸器及呼吸器使用總天數會影響醫療費用。有發生感染者，醫療費用較高(P=.003，B= 46,001)；有氣切者，醫療費用較高（P=.023，B= 21,329）；脫離呼吸器者，醫療費用較低(P=.017，B= - 24,998)；雙項費用控管措施介入後醫療費用較低(P=.001，B= -35,265)；呼吸器使用天數≧34天者，醫療費用較使用呼吸器≦33天者高（P＜.0005，B= 153,350）。費用控管措施介入前後醫療照護品質指標結果沒有差異。結論與建議本研究顯示雙項費用控管措施介入可以有效降低醫療費用，且不會影響醫療照護品質。因應健保總額給付制度，為維持醫療照護品質及使有限的醫療資源發揮最有效的作用，專責主治醫師輔以住院醫療費用即時查詢是值得採行的方式。

關鍵字

呼吸器依賴；費用控管

並列摘要

Objectives Learn respirator dependent patients cost control measures before and after the intervention of demographic characteristics, disease characteristics, medical expenses and health care quality distributions in order to understand the impact of cost control measures involved in medical costs and health care quality. Methods This study belongs to the retrospective, cross - sectional study, the Department of a medical center in sub-acute respiratory care wards based patient database. During the study period of August 2012 - December 2014, a total of two years five months, a total of 534 pen study sample. With excerpts from medical records during hospitalization, hospital clinical information systems and medical expenses declaration file collecting retrospective data. In order to understand the costs of control measures to change the situation before and after the intervention, the study time is divided into three phases of data collection to one-way analysis of variance, Scheffe post-test, multiple regression analysis, binomial logistic regression analysis, statistical methods for analysis. Results Supplemented by a dedicated physician-patient medical expenses hoc query system, whether the infection, whether as a tracheostomy, whether out respirators and respirator use the total number of days will affect medical expenses. Occurred infection, medical costs higher (P = .003, B = 46,001); tracheostomy who have medical expenses higher (P = .023, B = 21,329); The patient was successfully weaned from mechanical ventilator, lower medical costs (P = .017, B = -24,998); medical costs low entry cost control measures after double intervention (P = .001, B = -35,265); Patients using mechanical ventilator days ≧ 34 days or medical costs compared with use of a respirator ≦ 33 days were higher (P <.0005, B = 153,350). Cost control measures healthcare quality indicators before and after the intervention was no difference in the results. Conclusions and Suggestions This study shows that the cost of double-entry control measures can effectively reduce the medical costs involved in, and will not affect the quality of medical care. In response to the total health care benefit system, in order to maintain the quality of medical care and the limited medical resources to play the most effective role, Supplemented by a dedicated physician-patient medical expenses hoc query system can adopt ways.