中風病患在慢性復健科病房住院醫療費用預測因子之探討

Determinants of Stroke Inpatient Charge in Chronic Rehabilitation Wards of a Community Hospital in Taiwan

許嘉麟(Allen C.L. Hsu) ； 陳妙旼(Miao-Ming Chen) ； 陳智光(Chih-Kuang Chen)

《台灣復健醫學雜誌》 47卷2期 (2019/12) Pp. 145-153

https://doi.org/10.6315/TJPMR.201912_47(2).0008

摘要

腦中風是一種對病患本身以及整個社會經濟造成巨大負擔的疾病。在已開發國家中，腦中風患者所需的醫療費用占到整個醫療體系費用的3-4%。而隨著老年化人口的增加以及腦中風患者死亡率的降低，失能腦中風患者所需的復健及長期照護需求的費用也可預期地將會再增加。本研究的目的即在分析腦中風病患在慢性復健病房費用的影響因子，以期望能更有效的運用醫療資源。本研究收集台灣某地區醫院，計有249床慢性復健科病房，於2005年七月至八月間出院的腦中風病患，符合ICD-9分類碼430-434、436-438者，共156名。病患的基本資料包括住院天數、既有疾病數、會診次數、各感染症天數以及各管路置放天數等與住院費用相關的因子皆被納入，再以逐步線性回歸加以分析。分析結果顯示，平均住院費用為108365.80 ± 53825.90元，平均住院天數則為50.92 ± 20.57天。而與住院費用相關的顯著因子，則依序為（1）住院天數（R^2=0.739）、（2）鼻胃管置放天數（R^2=0.160）、（3）會診次數（R^2=0.008）、（4）氣切管置放天數（R^2=0.004）及（5）尿管置放天數（R^2 =0.004）。本研究顯示，在慢性復健科病房中，住院天數仍為單一最重要的因子。然而，三種管路的置放天數亦有顯著影響。在台灣健保涵蓋率高達99%人口的影響下，病患及家屬都傾向於住院，以獲得較好的醫療照護，住院天數並非純然依循醫療原則的可控制因素。相對而言，及早移除非必要性管路，應是在台灣慢性復健科病房中有效降低住院費用的醫療處置。

關鍵字

腦中風（stroke） ； 住院費用（inpatient cost） ； 復健（rehabilitation）

並列摘要

Stroke is a disease with severe consequences which impose a considerable socio-economic burden on patients and society. In developed countries, stroke patients alone generate about 3-4% of the direct costs within the healthcare system. The costs of rehabilitation and long-term care of disabled stroke survivors are expected to rise even further because of the increasing number of the aging population and declining stroke case-fatality rates. The aims of the paper are to evaluate the factors that may influence costs of stroke patients in chronic rehabilitation wards for better management of medical resources. This study was conducted at a local general hospital including 249 chronic rehabilitation beds in Taiwan. The dataset initially included information on 156 discharged stroke patients in July and August 2005, based on compliance with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 430-434 and 436-438 diagnosis codes. In these patients, demographic and clinical data were collected, including principal diagnosis, length of hospital stay (LOHS), comorbid conditions, the number of specialist consultations, infection and catheter intubation days. A multivariate linear regression analysis was then performed to determine factors with an independent influence on the inpatient charge. The mean cost and LOHS in our study were NTD 108365.80 (SD=53825.90) and 50.92 days (SD = 20.57) respectively. On multivariate analysis the significant predictors associated with costs were: (1) LOHS (R^2=0.739) (2) NG tube intubation (days) (R^2 =0.160) (3) consultation times (R^2=0.008) (4) endotracheal tube (days) (R^2 =0.004) and (5) Foley tube (days) (R^2 =0.004). In our study, length of hospital stay is still the most important determinant of stroke patient costs in rehabilitation wards. However, the three types of tubal treatments days are also important. In Taiwan, 99% of the total population was covered by the National Health Insurance system. As a result, stroke patients and their families tend to stay at hospitals for better medical care and length of hospital stay, therefore, is not a controllable factor based on medical principle. Early removal of unnecessary catheter may be a more important factor for the better control of the increasing costs of stroke patients in chronic rehabilitation wards in Taiwan.

並列關鍵字

stroke ； inpatient cost ； rehabilitation

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