重大外傷病人於外傷科成立前後醫療資源耗用及醫療品質差異分析

The Effectiveness of Trauma Team on Medical Resource Utilization and Quality of Care for Patients with Major Trauma

顏淑婷(Shu-Ting Yen)

指導教授 ： 應純哲

共同指導教授 ： 許素貞(Su-Chen Hsu)

義守大學/醫學院/醫務管理學系/碩士(2014年)

https://doi.org/10.6343/ISU.2014.00214

摘要

摘 要
研究動機與目的：台灣外傷的主要族群發生在男性青壯年，且因外傷造成的醫療資源耗用每年超過141億元。全球每天約有16,000多人死於外傷，根據統計，2010年美國重大外傷病人比例占外傷住院人數約為23.41%。故本研究目的為 (1) 瞭解重大外傷病人的醫療照護情形及醫療資源使用情況 (2) 分析重大外傷病人特性對於醫療品質及醫療資源耗用之差異性 (3) 探討成立外傷科前後對於重大外傷病人的醫療品質及醫療資源耗用之差異性影響。
研究方法與問題：本研究以病歷回溯方式，分析外傷資料庫及住院醫療服務點數清單，運用SPSS 18.0統計軟體，以獨立樣本t檢定和卡方檢定方法，針對台南市某醫學中心收治的重大外傷病人在外傷科成立前後各項醫療資源耗用與醫療品質指標部份，分析以下研究問題：(1) 重大外傷病人平均住院天數、加護病房住院天數在外傷科成立後是否有顯著的減少？(2) 重大外傷病人接受一級刀手術的等候時間在外傷科成立後是否有顯著的減少？ (3) 接受一級刀手術的重大外傷病人於急診停留時間在外傷科成立後是否有顯著的減少？(4) 重大外傷病人醫療服務點數在外傷科成立後是否有顯著的降低?
研究結果：重大外傷病人的醫療資源耗用在外傷科成立後有顯著降低。極嚴重外傷 (ISS≧25) 的類別在外傷科流程管理介入之後，一級刀手術等候時間則有顯著的減少。醫療資源耗用部份尤其在存活出院的病人群中，七個變項中有三項醫療費用點數降低，為資源耗用項目減少最多的部份。在嚴重外傷 (ISS=16~24) 及極嚴重外傷 (ISS≧25) 兩類病人中分別為放射線診療費及檢查費顯著降低；而有接受手術病人則在檢查費及總醫療費用兩項費用中有顯著降低；非一級刀手術的病人在放射線診療費用亦有降低。
結論與建議：外傷科成立對重大外傷病人醫療資源耗用（費用）的降低具有顯著效果，但對醫療品質提升並沒有產生顯著影響。本研究結果可以提供給個案醫院的高層主管對臨床科別成立後的效果評估做為範本，並且對醫療服務的資源耗用與品質研究提供依據，同時也提供給衛生主管機關作為未來推動重大外傷病人臨床路徑規劃之參考。

關鍵字

重大外傷 ； 醫療資源耗用 ； 醫療品質

並列摘要

Abstract
Background & aim: In Taiwan, trauma cases mainly occurred among young males, and it cost medical resource utilization over 14.1 billion NT dollars annually. About 16,000 people expired due to trauma per day worldwide. In the US, major trauma patients accounted for 23.41% of trauma inpatients in 2010. The purpose of this study were: (1) understand the major trauma patients’ medical care status and their medical resource utilization; (2) analyze the differences of medical quality of care and medical resource utilization among major trauma patients’ clinical characteristics; and (3) explore the effectiveness of trauma team on medical quality of care and medical resource utilization among major trauma patients.
Methods & questions: This was a retrospective chart review study, using trauma registry bank and admission medical service charge date bases. T-test and Chi-square analyses were used for examining indicators of medical quality of care and medical resource utilization. The study subjects were major trauma patients admitted to a medical center in Tainan during 2009 and 2013. In order to examine the effectiveness of trauma team, the research questions were: (1) Are average length of stay (ALOS) and Intensive Care Unit (ICU) stay significant declined after the establishment of trauma team? (2) Are patients with urgent operation waiting time significant declined after the establishment of trauma team? (3) Are patients with urgent operation staying in Emergency Department (ED) significant dropped after the establishment of trauma team? and (4) Are inpatient medical resource utilizations significantly reduced after the establishment of trauma team?
Results: Significant reductions for several items of medical resource utilization were identified after the establishment of trauma team. The waiting time of urgent operation for severe trauma category (ISS≧25) had a significant decline after the establishment of trauma team. Especially in the group of patients who survived to discharge, three items medical resource utilization had been reduced. The radiation treatment charge and examination charge were significantly reduced in the groups of ISS=16~24 and ISS≧25. Patients who underwent surgery had significant reductions in examination charge and total medical charge. Radiation treatment charge was significantly reduced for patients with non-urgent operation.
Discussion & suggestion: The establishment of trauma team had significant effects on the reduction of medical resource utilization for major trauma patients, but had minimal effects on the improvement of medical quality of care. The results of this study can be used as a model of evaluation study for the establishment of clinical divisions, and offer a reference for health service research of medical resource utilization and quality. It can also provide the healthcare authority to promote clinical pathway for the major trauma patients in the future.

並列關鍵字

major trauma ； medical resource utilization ； medical quality of care

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