頭部外傷住院病患醫療資源耗用及其相關因素之探討

本研究主要在探討頭部外傷病患住院天數與醫療費用之情形，並比較不同人口學特性及疾病特質其住院天數與醫療費用之差異，同時探討影響住院天數與醫療費用之人口學特性及疾病特質之因素。本研究採回溯性次級資料分析，收集自2004年至2006年南部某醫學中心頭部外傷住院病患為對象，符合研究之樣本數為1,527人。同時由三位神經外科專科護理師，經病歷審查方式收集病患昏迷指數；另外醫療費用資料則取自於醫院向健保局申報健保費用之資料。研究結果顯示頭部外傷以男性較多(56.3％)，年齡以19-34歲最多(26.3％)，其次65歲以上(23.1％)，嚴重度以輕度頭部外傷最多(74.7％)，疾病複雜度以有四個次診斷最多(29.5％)，其次為兩個次診斷(23.8％)，其中有開顱手術佔18.2％，有住加護病房佔52.6％。頭部外傷病患住院天數平均10.5天，總醫療費用平均73,425元，明顯低於全國醫學中心頭部外傷住院病患(13.07天、95,436元)，各醫療費用細項中藥劑費、手術麻醉費及治療費 (9,801元、10,474元、13,648元)，遠低於全國醫學中心(16,198元、16,086元、18,427元)，其他醫療費用則相近；可見藥劑費、手術麻醉費、治療費的管控是影響總醫療費用的重要因素。本研究指出影響住院天數的主要因素為性別、年齡、出院狀況、嚴重度、複雜度、開顱手術、住加護病房。而影響醫療總費用的主要因素為出院狀況、嚴重度、複雜度、開顱手術、住加護病房。根據研究結果建議醫院管理者，重視此問題，並提出因應之道，以期降低醫療費用支出。

關鍵字

頭部外傷；昏迷指數；醫療資源耗用；住院天數；醫療費用

並列摘要

This study aims to explore the hospital stay and medical costs of head-injured patients, to compare the differences based on the demographic characteristics and disease features as well as to analyze the demographic and disease factors which affect hospital stay and medical expense. Retrospective Secondary Data Analysis is conducted to do this study. Hospitalized head-injured patients data were obtained from a medical center in southern Taiwan from 2004 to 2006. The medical records of 1,527 patients were analyzed. The Glasgow Coma Scale Score of patients were collected through sureying the records of patients by three neurosurgical nursing practitioners. The data of medical expense were obtained from the claimed reimbursement data of the medical center to the Bureau of National Health Insurance. The rate of male head-injured patients was 56.3% that is more than the rate of female head-injured patients. Most of head-injuried patient (26.3%)are aged betwem 19to34, followed by those aged 65+ years old (23.1%). The most prevalent injuries were mild head injuries (74.7%). most complicated cases were accompanied with 4 sub-diagnoses (29.5%), followed by 2 sub-diagnoses (23.8). The patients with cranial surgery made up 18% of all the head-injured patients, with 52.6% of ICU care .The averaged hospital stay was 10.5 days and the averaged medical costs amounted to NTD73,425, less than the average duration and costs of other medical centers in Taiwan (13.07 days, NTD95,436). Among the medical costs, pharmacy, surgical anesthesia, and treatment (NTD9,801, 10,474, 13,648) were also less than the average costs of medical centers in Taiwan (NTD16,198, 16,086, 18,427). The other cost were approximated to the average costs of other medical centers in Taiwan. It inferred that the costs of pharmacy, surgical anesthesia and treatment are important determinator of the total medical costs. The main factors affecting hospital stay were sex, age, finally discharged situation, injury types, injury complication, cranial surgery, and ICU care. While the main factors affecting total medical costs included health situation when a patient discharged, injury types, injury complication, cranial surgery, and ICU care. The hospital managers should focus on these issues and find out way to reduce the medical expense.

並列關鍵字

Head Injuries ； Glasgow Coma Scale Score ； Medical Resources Utilization ； hospital stay ； Medical Costs

參考文獻

Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1-10.

中文部份