中繼照護病床之成本效果分析－以台北市某醫學中心為例

A Cost-Effectiveness Analysis of the Intermediate Care Ward－The Case of A Medical Center in Taipei City

邱曉萱(Hsiao-Hsuan Chiu)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2006年)

https://doi.org/10.6342/NTU.2006.02875

摘要

本研究目的在於分別由病人和醫院觀點，分析內科ICU轉出的病人，住在中繼照護病房（以下簡稱中繼組）或普通病房（以下簡稱普通組）等兩種照護方式的成本與效果。資料分析所需之參數，主要來源是台北市某醫學中心，不足之處則由專家意見、文獻補足。
本研究的重要結果如下：
(1)從2004年10月起到2005年底期間，轉出內科ICU的病人中，有279位符合轉到中繼病房或普通病房。轉入中繼病房的101位病人中，有9位在轉出ICU七天內發生重返、另有5位死亡，重返比率為8.91%（含死亡為13.86%）；轉入普通病房的178位病人中，有18位在轉出ICU七天內發生重返、另有13位死亡，重返比率為10.11% （含死亡為17.42%）。根據此一效果，中繼組較普通組佳。
(2)以醫院觀點而言，中繼組每人每天成本為7886.08元，普通組每人每天成本為7572.01元，中繼組比普通組多了314.07元。
(3)以病人觀點而言，中繼組每人每天成本為3513.29元，普通組每人每天成本為3032.97元，中繼組比普通組多了480.32元。
(4) 以醫院觀點而言，相較於普通組，使一位病人因轉入中繼而使七天內的重返降低1%，則醫院需要多支出的成本為2197.99元，平均一天要花費314元；若包括降低死亡的機會，則七天需多支出617.55元，平均每天多支出88.22元。以普通組為基準校正後，則七天內降低1%重返機會，需多支出的成本降為473.63元，包含死亡則降為98.68元。
(5)以病人觀點而言，相較於普通組，使一位病人因轉入中繼而使七天內重返降低1%的機會，則每人需多付出的成本為2861.87元，平均一天要花費408.84元；若包括降低死亡的機會，則七天需多花134.92元，平均每人每天多花134.92元。以普通組為基準校正後，則七天內降低1%重返機會需多花的成本降為1059.4元，包含死亡則降為221.17元。
本研究結論為中繼照護病床雖然會花費較高的成本，但也有較好的效果，考量到以病人為中心的重要性以及總額支付制度，建議醫院可以考慮發展中繼照護病床。

關鍵字

中繼照護病床 ； 經濟評估 ； 成本效果分析

並列摘要

Readmission to ICU will use a lot of medical resources, and patients’ prognosis would be bad. For these reasons, the readmission rate is long regarded as an important medical quality indicator. The study hospital recently set up an intermediate care ward use assessment tools to identify those with high readmission risk from ICU discharge patients. a lower nurse to bed ratio, the medical team will focus on the cooperation and communication about the discharge plan with patients and their relatives. In this unit, patients would receive the connective therapy and be transferred to the general ward when they are stable. It is believed that this unit could reduce the incidence of readmission to ICU.
The purpose of this study is to estimate in the cost and effectiveness of patients transferred to the intermediate care ward and to the general ward after they were discharged from the ICU. The analysis was conducted from the viewpoints of hospital and patients, respectively. Main source of parameters for analysis came from the study medical center in Taipei City, only limited data came from expert opinions and existing literature.
The major results of this study are as follow：
(1) From October, 2004 to the end of 2005, there were 279 patients discharged from the medical ICU who were qualify to be transferred to either the intermediate care ward or general wards. Among 101 patients transferred to the intermediate care ward, 9 patients readmitted to ICU and, in addition, 5 patients died in 7 days since they had discharged from ICU. The readmission rate of intermediate care ward is 8.91% (13.86% including death). On the other sidehand, among 178 patients transferred to general wards were collected in group2, 18 patients readmitted to ICU and additional 13 patients died in 7 days since discharged from ICU. The readmission rate of general ward is 10.11% (17.42% including death). Judging from the readmission rates, the intermediate care ward is more effective than general wards.
(2) In the view of the hospital, the cost per patient per day of intermediate care ward is $ 7886.08 and the cost of general ward is $ 7572.01.
(3) In the view of patients, the cost per patient per day of intermediate care ward is $ 353.29 and the cost of general ward is $ 480.32.
(4)In the view of the hospital, compared to general ward, the cost of reducing 1% readmission rate is $2197.99 ($617.55 if including death) in 7 days after a patients was admitted to the intermediate care ward. If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $473.63($98.68 if including death)
(5)In the view of patients, compared to general ward, the cost of reducing 1% readmission rate is $1497.01 ($504.61 if including reducing death). If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $1059.4($224.17 if including death)

We conclude that the intermediate care ward will cost more then general wards but reduce more admission rate and death rate within7 days after patients were discharged from ICU. It is worthwhile for hospitals to consider establishing an intermediate care ward.

並列關鍵字

Intermediate Care Ward ； Economic Evaluation ； Cost-effectiveness Analysis

參考文獻

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