- 期刊
加護病房設置專責重症專科醫師對照護品質和醫療資源使用之影響
Impact of the Intensivists System on Intensive Care Unit Quality of Care and Utilization of Resources
摘要
研究目的：評估加護病房設置專責重症專科醫師(intensivists)前後對於照護品質和醫療資源利用之效益，籍以作為發展台灣專責重症專科醫師之實證資料。研究方法：本研究設計採用類實驗研究法，以某醫學中心內科加護病房自1998-2005年每年11-12月病患為研究樣本，探討加護病房設置專責重症專科醫師前後之效益，以及預測影響加護病房費用、加護病房住院天數的相關因素。 研究結果：設置專責重症專科醫師前後，病患人口特質無顯著差異；但在設置專責重症專科醫師後，至2005年平均加護病房住院天數為5.8天、平均呼吸器使用天數為6.3天、加護病房費用為130083元及加護病房標準化死亡比為0.57，均呈明顯下降。預測影響加護病房費用、加護病房住院天數之相關因素為APACHEⅡ分數、專責重症專科醫師設置前後、呼吸器使用狀況等因素。 結論：加護病房設置專責重症專科醫師後，可降低病患死亡率、加護病房住院天數、呼吸器使用天數，及減少醫療費用。
並列摘要
Objective: To evaluate the effects of full-time intensivists on intensive care unit (ICU) quality of care and utilization of health resources. Methods: A quasi-experimental study design method was used to study patients in a medical ICU at a medical center during November and December of each year from 1998 to 2005. The effects of full-time intensivists on ICU expenditure and ICU stay were explored. Results: There were no significant differences in the demographic characters of patients in the 'before-intensivists' group and those in the 'after-intensivists' group. ICU stay, ventilator days, ICU expenditure and ICU standardized mortality were significantly lower in the 'after-intensivists' group. The risk factors for ICU mortality include Acute Physiology and Chronic Health Evaluation II (APACHE II) score, ICU stay, hospital stay, ventilator use and input of intensivists. The prediction factors for ICU expenditure and ICU stay include APACHE II score, administration of intensivists and use of ventilators. Conclusion: The administration of full-time intensivists in the ICU can effectively reduce mortality rate, shorten patient's ICU stay and number of ventilator use days, and decrease utilization of health resources.