- 期刊
外展復健模式與醫院就診復健模式之成本效果
The Cost-Effectiveness Analysis between Outreach and Hospital Rehabilitation Models
摘要
當民眾因疾病而尋求醫療服務時，通常是到醫療院所接受服務。然而，對於需長期看病的年邁老人而言，頻繁至醫療院所就醫極爲不便，如能改由醫師至其居住的地方提供診療服務，不僅增加就醫之可近性，也可免去老人外出可能面臨的危險以及感染；病患也較能按時就診，進而提高治療的成效。有鑑於此，本研究之復健模式以復健醫師外診、物理治療師與職能治療師駐診治療的方式，與安養中心簽約，在安養中心設置與復健診所同規模之復健診療室。由於此模式爲國內特殊醫療之模式，現今無研究探討此外展模式與一般的到院就醫模式在成本效果以及復健成效上有何不同，故以本研究來探討外展復健模式與醫院就診復健模式之間的差異。 本研究爲回溯型研究，在2005年1月至2006年12月間，收集出院三週內之外診組與醫院組各50位病人從開始復健日至研究結束時之巴氏量表分數以及復健所花費之醫療費用，最多收集五次。統計方法除描述性統計t檢定、卡方檢定外，利用一般線性模式之重複測量分析兩模式之長期效果是否一致。 研究結果顯示復健介入前，研究組因疾病導致的功能喪失顯著較對照組高，平均巴氏量表分數爲30.5分，對照組爲40.1分。然而，在五次測量中，研究組的巴氏量表分數進步較大，平均進步42.9分，對照組爲34分。不過在醫療花費上，第一至第七個月研究組花費較對照組高。作成本效果分析後，兩組的復健成果並沒有顯著差異。由於研究組之外展復健模式可促進醫療可近性，由醫師外診且物理治療師與職能治療師駐院治療可使病患依醫囑按時復健，在不會造成額外之醫療費用負擔的情況下，是值得推廣的復健模式。
並列摘要
Hospitals and clinics are usually the places where patients receive medicare. However, it is extremely inconvenient for the elderly to frequently go between the homes and hospitals/clinics for long-term medicare. With doctor-served home care, the accessibility of medical treatment would increase; the risk of trauma or infection from traveling in-between would be avoided; more prompt and timely treatment-offered effectiveness would rise. However, there has been no study on the difference between the cost effectiveness of outreach versus hospital rehabilitation. Thence, the peculiarity of the outreach rehabilitation regarding the physiatrists providing medical services and the physical therapists and occupational therapists offering rehabilitation programs in nursing homes where there is National Health Insurance Bureau approved hardware equipment was investigated herein. This retrospective study from January 2005 to December 2006 selected patients discharged from the hospital within 3 weeks and included the outreach and hospital rehabilitation groups of 50 each. The Barthel index scores in the patients were collected five times maximally, and so were the rehabilitation fees. Descriptive statistics, t-test, and Chi-squared test were available. Additionally, general linear model with repeated measurements was to analyze if the long-term effect of both groups was consistent. Resultantly, disease-caused function loss in the study group was more significantly different than in the control group. The Barthel index score was averagely 30.5 in the study group and 40.1 in the control group. During 5 measurements, the Barthel index score in the study group was improved (about 42.9 difference) more than that in the control group (34 difference). For medicare expenses, those of the study group from the first to 7th month were higher than those of the control group. After the cost-effectiveness analysis, the 2 groups showed no significant difference. In the study group, the outreach rehabilitation could meliorate the convenience of medicare. With no wasted medicare expenses, thus the model is worth promoting.