缺血性腦中風病人出院後照護連續性與照護結果及醫療費用之關係

Associations of continuity of postdischarge care with healthcare outcomes and expenses among patients with ischemic stroke

林映萱(Ying-Hsuan Lin) ； 董鈺琪(Yu-Chi Tung)

《台灣公共衛生雜誌》 41卷1期 (2022/02) Pp. 69-80

https://doi.org/10.6288/TJPH.202202_41(1).110091

摘要

目標：腦中風病患出院後死亡率、再住院率高，醫療費用亦高，病人出院後接受片段式照護導致住院率及醫療費用增加。過去研究指出腦中風病人照護連續性越高，出院後死亡率越低，然而照護連續性與住院次數及醫療費用之關係仍未明瞭。本研究針對缺血性腦中風病人，探討照護連續性與照護結果及費用之相關性。方法：使用衛生福利部衛生福利資料科學中心代表性全國樣本，以缺血性腦中風住院之病人納為研究對象。依出院後一年門診申報資料計算照護連續性指標（continuity of care index, COCI），將樣本分為低、中、高三組，利用羅吉斯迴歸、負二項迴歸及伽瑪迴歸，分析門診照護連續性對出院後一年內的死亡風險、住院次數、總醫療費用之相關性。結果：共納入2,447位研究對象。缺血性腦中風病人出院後高照護連續性與低死亡率及低住院次數相關，亦與低醫療費用相關。結論：缺血性腦中風病人照護連續性高與降低住院次數及死亡風險相關。因此建議衛生主管機關可提升病人照護連續性改善照護結果，達到降低總醫療費用之目的。

關鍵字

缺血性腦中風 ； 照護連續性 ； 照護結果 ； 醫療費用

並列摘要

Objectives: The mortality and readmission rates of patients with stroke after discharge are high, and the associated medical costs are high. Patients receiving fragmented care after discharge have an increased hospitalization rate and higher medical expenses than other patients. Studies have indicated that the better is the continuity of care among patients with stroke, the lower is their mortality rate after discharge. However, the relationship between the continuity of care and hospitalizations and medical expenses is unclear. This study explored the associations of the continuity of postdischarge care with healthcare outcomes and expenses among patients with ischemic stroke. Methods: Patients hospitalized for ischemic stroke were included in a nationally representative sample using data from the Health and Welfare Data Science Center, Ministry of Health and Welfare. The continuity of care index (COCI) was calculated using outpatient data after discharge. The patients were divided into low, medium, and high COCI groups. Logistic regression, negative binomial regression, and gamma regression were used to explore the associations of care continuity with mortality, hospitalizations, and medical expenses. Results: A total of 2,447 patients were included. High continuity of care was related to low mortality, low hospitalizations, and low medical expenses. Conclusions: High continuity of care among patients with ischemic stroke is associated with a reduction in hospitalizations and a low risk of death. Therefore, healthcare authorities can increase the continuity of care to improve patient outcomes and reduce medical expenses.

並列關鍵字

ischemic stroke ； continuity of care ； outcomes of care ； medical expense

參考文獻

陳啟禎、鄭守夏：照護連續性之文獻回顧。台灣衛誌 2013；32：116-28。doi:10.6288/TJPH2013-32-02-03。Chen CC, Cheng SH. A literature review of continuity of care. Taiwan J Public Health 2013;32:116-28. doi:10.6288/TJPH2013-32-02-03. [In Chinese: English abstract]

江蕙如、董鈺琪：急性心肌梗塞病患照護連續性與照護結果及醫療費用之關係。台灣衛誌 2017；36：161-73。doi:10.6288/TJPH201736105105。Chiang HJ, Tung YC. Association of continuity of care with healthcare outcomes and expenses among acute myocardial infarction patients. Taiwan J Public Health 2017;36:161-73. doi:10.6288/TJPH201736105105. [In Chinese: English abstract]

邱翰憶、鄭守夏、董鈺琪：心臟衰竭病人出院後照護連續性及就醫機構層級與照護結果及費用之相關性。台灣衛誌 2016；35：66-79。doi:10.6288/TJPH201635104065。Chiu HY, Cheng SH, Tung YC. Associations of continuity and level with outcomes and expenses of post-discharge care for patients with heart failure. Taiwan J Public Health 2017;35:66-79. doi:10.6288/TJPH201635104065. [In Chinese: English abstract]

McCombs JS, Nichol MB, Newman CM, Sclar DA. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care 1994;32:214-26. doi:10.1097/00005650-199403000-00003.

Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res 2017;120:439-48. doi:10.1161/CIRCRESAHA.116.308413.