台灣老年人口在不同外傷嚴重度之醫療資源耗用分析－以南部某醫學中心為例

Analysis of Healthcare Resource Utilization for Senior Citizens with Various Injury Severity Scores in Taiwan: Experience of a Medical Center in Southern Taiwan

顏淑婷(Shu-Ting Yen) ； 王志榮(Chih-Jong Wang) ； 應純哲(Jeremy C. Ying) ； 黃詩芳(Shih-Fang Huang) ； 沈延盛(Yan-Shen Shan)

《寶建醫護與管理雜誌》 11卷2期 (2013/12) Pp. 1-9

https://doi.org/10.29681/PCJHM.201312_11(2).0002

摘要

背景與目的：外傷為無法避免且持續不斷發生的事件，老年人跌倒意外亦是常見的嚴重問題。隨著人口快速老化，台灣老年人口在2007年已突破10%，預計2020年更會達到14%。為因應社會人口結構改變，特別探討老年人口於不同外傷嚴重度的醫療資源耗用，提供相關單位對於未來推行高齡化之中、長期照護及外傷導入住院診斷關聯群（Tw-DRGs）之決策參考。方法：本研究採病歷回溯方式，以台灣南部某醫學中心外傷資料庫為基礎，將65歲以上老年人口列為研究對象，探討外傷嚴重度、疾病複雜度、年齡對於住院天數、加護病房住院天數的影響。結果：相關分析顯示年齡與外傷嚴重度、疾病複雜度、住院天數、加護病房住院天數並沒有顯著相關，但是外傷嚴重度、疾病複雜度與住院天數及加護病房住院天數其有顯著正相關。單因子變異數分析顯示外傷嚴重度在住院天數與加護病房住院天數具有顯著差異，ISS 16-24及ISS 25以上這兩組外傷嚴重度的住院天數及加護病房天數顯著高於另兩組ISS 1-8及ISS 9-15；而且迴歸分析顯示外傷嚴重度每增加1分，住院天數會增加0.35天，加護病房住院天數會增加0.23天。疾病複雜度有五個診斷碼的病患其住院天數顯著大於四個以下診斷碼的住院天數；另外迴歸分析亦顯示每增加1個疾病複雜度，住院天數增加2.62天，加護病房住院天數會增加0.43天。在接受手術方面，骨科手術病人的住院天數顯著小於接受他科手術的病人住院天數，而接受非骨科手術及接受骨科手術的病患其外傷嚴重度分別為12.57及8分，在統計上具有顯著差異；但疾病複雜度方面則是無論是否接受骨科手術在統計上都是沒有顯著差異。ISS 9-15分病患到院24小時內接受手術與到院48小時內接受手術在住院天數也並沒有顯著性的差異。結論與建議：外傷病患的外傷嚴重度、疾病複雜度都會影響住院天數與加護病房住院天數。而住院天數、加護病房住院天數在嚴重外傷（ISS 16-24）及極嚴重外傷（ISS 25以上）這兩組都高於輕度外傷（ISS 1-8）及中度外傷（ISS 9-15）。且接受非骨科手術的病患其平均住院日及外傷嚴重度皆顯著高於接受骨科手術的病患。建議衛生主管機關與醫院針對嚴重外傷（ISS 16-24）及極嚴重外傷（ISS 25以上）的老年病患訂定不同的照護標準與臨床路徑，以便控制醫療資源耗用與維持良好的醫療照護品質。

關鍵字

老年人口 ； 外傷嚴重度 ； 醫療資源耗用

並列摘要

Background and aim: Trauma is inevitable and happens frequently. Fall incidence among senior citizens is a common and serious problem. In terms of the elevated ageing status in Taiwan, the proportion of senior citizen (65+ y/o) was over 10% in 2007, and it will reach 14% by 2020. Due to the significant change of population structure, we aimed to explore the utilization of health care resource among senior citizens with various Injury Severity Scores (ISS). The results are able to shed some light on policy making of mid- and long-term care and trauma category of Tw-DRG by the health authority for the ageing society in the future. Methods: This is a retrospective medical record review study on the trauma database of a medical center in southern Taiwan. Study population was the senior citizens who sought medical care in the case hospital due to trauma. We examined the impacts of age, ISS and comorbidity on average length of stay (ALOS) and Intensive Care Unit (ICU) stay. Results: Age was not significant associated with ISS, ALOS, and ICU stay; however, significant positive correlations among ISS, comorbidity, ALOS, and ICU stay were found. The ANOVA illustrated significant differences in ALOS and ICU stay among categorized ISS. The ALOS and ICU stay of ISS 16-24 and 25+ were significantly greater than those of ISS 1-8 and 9-15. Subjects with 5 comorbidities tended to have significantly greater ALOS than their counterparts. Linear regression models projected that every single ISS augment would lead to ALOS and ICU stay increase of 0.35 and 0.23 days respectively; every single comorbidity augment would lead to ALOS and ICU stay increase of 2.62 and 0.43 days separately. Subjects with osteological surgeries tended to have less ALOS and lower ISS than their counterparts; however, no significant difference was found in comorbidity. In addition, we didn't find significant difference in ALOS among subjects of ISS 9-15, in terms of surgical operations within 24 hours and 48 hours. Conclusion and Recommendation: ISS and comorbidity had significant impact on ALOS and ICU stay among senior citizens. The ALOS and ICU stay for severe trauma (ISS 16-24) and extreme severe trauma (ISS 25+) senior citizens were significantly greater than those of minor trauma (ISS 1-8) and moderate trauma (ISS 9-15). In order to control healthcare resource utilization and improve quality of care, we strongly recommend that Department of Health and Welfare as well as medical centers should establish specific protocol and clinical path for senior citizens with severe and extreme severe trauma.

並列關鍵字

Senior citizen ； Injury Severity Score ； healthcare resource utilization