影響某區域醫院缺血性腦中風初患病患住院醫療費用之相關因素

Factors Affecting the Medical Costs of Caring for Patients with Acute Ischemic Stroke

蔡宜秀(Yi-Xiu Tsai) ； 孫明輝(Ming-Feng Sun) ； 洪麗珍(Li-Chen Hung) ； 郭憲文(Hsien-Wen Kuo)

《Mid-Taiwan Journal of Medicine》 13卷3期 (2008/09) Pp. 143-151

https://doi.org/10.6558/MTJM.2008.13(3).5

摘要

背景／目的　探討某區域教學醫院急性缺血性腦中風病患住院醫療費用及其影響相關之因素。
方法　以某區域教學醫院初次診斷之274位急性缺血性腦中風患者爲研究對象，再依Oxfordshire Community Stroke Proiect (OCSP)分類法及National Institutes of Health stroke scale (NIHSS)評分法評估急性缺血性腦中風患者的嚴重席，山腦中風個案管理師收集個案臨床診治過程相關資料，其住院成本來源取自此醫院向中央健保局申報之健保金額。
結果　急性缺血性腦中風患者平均每人住院醫療費用爲新台幣46,8003元（平均每天爲4,294元）；平均住院天數爲10.1天。約五成患者診斷爲小洞性梗塞，平均入出院時NIHSS爲78分及5.8分，中風患者最常見之合併症爲尿路感染、肺炎及24小時內發燒。以線性複迴歸分析顯示影響病患住院醫療費用之因素，包括性別、住院天數、出院時NIHSS分數、曾住加護病房、合併症、醫療處置及是否存活等變項。
結論　若能有效控制急性缺血性腦中風患者合併症的發生，即可減少醫療處置及住院天數，進而降低患者住院的醫療費用。

關鍵字

急性缺血性腦中風 ； 住院醫療費用 ； 腦中風患者分類法

並列摘要

Background/Purpose. To assess the medical costs of caring for stoke patients and the factors that affect those costs.
Methods. We used the Oxfordshire Community Stroke Project (OCSP) classification system and the National Institutes of Health Stroke Scale (NIHSS) to classify the levels of severity in 274 stroke patients at a teaching hospital in Taichung. Patients' medical information and the total costs billed by the hospital to the Bureau of National Insurance on behalf of each patient were collected.
Results. Overall, the average medical cost for the duration of hospitalization was NT$46,803 (NT$4,294/day); the average hospital stay was 10.9 days. The average NIHSS score was 7.8 at the time of admission and 5.8 at the time of discharge. Common complications included urinary infections, pneumonia, and 24-hour history of fever.
Based on the results of multiple linear regression analysis, the factors affecting medical costs included gender, length of hospital stay, NIHSS score, complications, the number of medical treatments, whether or not the patient required emergency room services, and survival or death.
Conclusion. If complications can be prevented, then the number of medical treatments and total length of hospital stay can be reduced, thereby reducing total medical costs.

並列關鍵字

acute ischemic stroke ； medical cost ； OCSP classification system