追蹤腦中風病人之長期就醫流向及其對醫療利用之影響

摘要研究目的 : 藉由腦中風病人選擇長期照護方案之探討，瞭解需要後續照護的腦中風病人出院後選擇長期照護方式與出院前預期之差異，並追蹤腦中風病人出院後就醫流向及其醫療利用情形。研究方法 : 本研究係追蹤蔡淑真(2002)碩士論文之研究對象，原採立意取樣，調查對象為高雄地區二家醫學中心之腦神經內科、外科及復健科的腦中風住院病人，腦中風病人係指診斷為ICD-9-CM前三碼430-438之住院病人，於病人出院前三天左右進行問卷訪查。再依據收案病人追蹤其出院後實際照護方式和其就醫流向、醫療利用情形。研究結果：腦中風病人出院後實際選擇照護方式與住院中原期望照護方式相同的有196人，與原期望不同的有98人。選擇不同照護方式，在門診次數及門診總費用並無差異，選擇居家照護方式的個案平均住院天數為33.41天，住院總費用為133431.73元，選擇機構照護方式的個案平均住院天數為60.28天，住院總費用為296165.84元。在就醫流向方面選擇同院追蹤的平均門診次數為9.78次，門診總費用為22764.53元，平均住院天數為31.67天，住院總費用為134229.02元，選擇不同院追蹤的平均門診次數為41.94次，門診總費用為76135.02元，平均住院天數為70.63天，住院總費用為332727.3元。討論與建議：腦中風病人出院後實際選擇照護方式與住院中原期望照護方式大部分都是相同的。選擇不同照護方式，在門診次數及門診總費用並無差異，但在住院天數和住院總費用，選擇居家照護要比選擇機構照護減少很多。而在就醫流向方面，選擇同院追蹤的個案，無論是在門診次數、門診總費用、住院天數、住院總費用，都要減少很多。對於腦中風的病患，若能在出院前給予適當的出院輔導，出院後有完善的追蹤管理計畫，對於病患的醫療利用，尤其是在住院方面可改善很多。關鍵詞：就醫流向、長期照護、醫療利用、腦中風

關鍵字

長期照護；就醫流向；醫療利用；腦中風

並列摘要

Abstract Research purpose: This research is to study whether stroke patients needing follow-up care have received anticipated treatment after they leave the hospitals. Furthermore, this research also studies the patients’ medical treatment and which hospital they seek medical advice after leaving the original hospitals. Research Methodology: The objects of this study are the patients studied in the essay (2002) by Sue-Zhen Tsai. In the essay, they were respectively hospitalized in two medical centers in Kaoshiung and were surveyed before leaving the hospitals. These cases were further observed and surveyed about their practical care and medical treatment after leaving the hospitals. Research result: There are 196 stroke patients receiving long-term care as they expected when being hospitalized, and there are the other 98 stroke patients given long-term care who do not meet their anticipation. Choosing different ways of care does not result in different numbers of times in outpatient services and fees. Nevertheless, it causes a distinguishing difference in the numbers of days of hospitalization and the fees. The average days of hospitalization of the patients who chose family caregivers are 33.41 days. The total fees of hospitalization are 1334311.73 NT dollars. The average days of hospitalization of the patients who chose institutional caregivers are 60.28 days. The total fees for hospitalization are 296165.84 NT dollars. Further, 9.78 is the average number of times in outpatient services for the patients choosing the same hospital for further diagnosis. 31.67 is the average days of hospitalization. 22764.53 NT dollars is the total fees for diagnosis and 134229.02 NT dollars is the average fees for hospitalization. However, for the patients choosing different hospitals for further diagnosis after leaving the hospital, the average number of times in outpatient services is 41.94, the average days of hospitalization is 70.63, total fees for diagnosis is 76135.02 NT dollars, and the total fees for hospitalization is 332727.3 NT dollars. Discussions and suggestions: Most stroke patients receive the care as they anticipated. Choosing different ways of care does not result in different number of times in outpatient services and different fees in outpatient service. Nevertheless, it causes diverse days of hospitalization and total fees. The survey shows family caregivers brings to the patients more contribution than the institutional ones. The patients choosing the original hospital for further diagnosis receive much less times in outpatient services, give less fees in outpatient services and hospitalization, and less days of hospitalization. It will help the sstroke patients a lot in medical treatment and especially in hospitalization if they can be given proper medical counseling before leaving the hospitals and be offered complete follow-up diagnosis arrangements. Keyword: patient flow , long-term care, service utilization , stroke