頁籤選單縮合
題 名 | 急性呼吸窘迫症候群醫療資源耗用與相關因子之探討=Medical Resource Utilization and Related Factors of Patients with Acute Respiratory Distress Syndrome |
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作 者 | 陳惠娟; 黃佩瑜; 吳惠東; | 書刊名 | 呼吸治療雜誌 |
卷 期 | 12:1 2013.01[民102.01] |
頁 次 | 頁23-33 |
分類號 | 419.45 |
關鍵詞 | 醫療資源耗用; 醫療費用; ARDS; Medical resource utilization; Hospital cost; Hospital LOS; |
語 文 | 中文(Chinese) |
中文摘要 | 本研究的目是探討急性呼吸窘迫症候群(acute respiratory distress syndrome ;簡稱ARDS),其醫療資源耗用情形與探討影響醫療費用之相關因子。本研究個案自2004年至2009年間,以北部某大醫學中心,急性呼吸窘迫症候群患者進行選 樣,診斷為急性呼吸窘迫症候群並符合美國-歐洲共識研討會(American-European consensus conference, AECC) ARDS的定義,年齡大於18歲,總個案為794人,分為院内死亡组共有589人, 院內存活組共有205位,比較院内死亡組與院内存活組醫療費用,存活組個案進行病歷回溯取得 人口學特徵、醫療記錄與臨床資料,並串聯衛生署死亡檔取得離院後存活情形,進行分析ARDS 醫療費用之相關因子。研究結果為院內存活者相較於院内非存活者,須更高的醫療費用(93.27±93.06 vs. 57.87±54.18 萬元,/>< 0.001),以及院內存活者相較於院内死亡者總住院天婁奴Hospital LOS)較長(65.18±55.31 vs. 28.86±29.01天,P< 0.001);主要花費最多的為藥物費用,再來為病房費用包含護理費用。花費 較多的相關因子包括:年齡較輕者、出院後死亡者、加護病房併發症數目越多者、APACHE II得 分越高者及氣切患者。 |
英文摘要 | Objective: Acute respiratory distress syndrome came with a high mortality rate as well as high comorbidity. Previous research has devoted the hospital survival rate and to identify high-risk factors associated with it. Little attention has been paid to ARDS medical resource utilization. The purpose of this study was to explore ARDS medical resource utilization and hospital costs which the relative factors and cost allocation. Methods: This was a retrospective cohort study using survival analysis on 794 ARDS patients. We conducted a retrospective review of all patients who had ARDS in the National Taiwan University Hospital from January 2004 to June 2009. The study population consisted of 794 adult patients consecutively admitted to the medical and surgical ICUs who met the criteria of ARDS as defined by the 1994 American/European Consensus Conference with mechanical ventilation. Data on the survival status from their discharge to June, 2010 were obtained via data bank of the National Health Insurance under the permission from the Department of Health. Independent-sample t test and generalized linear model analyses were used to identify relation factors. Results: Medical resource utilization and hospital costs were related to younger age, more ICU cormobidity and more severity of illness in ICU, Post ARDS tracheostomy, discharge from hospital and non-survival patient. The largest portion of hospital costs for a survivor of ARDS was the pharmacy costs and the second most important cost was nursing costs. The ICU LOS was 28.44±23.4 and Hospital LOS was 65.7±55.1。 In conclusion, we found that every ARDS patients average Medical Resource Utilization, so that it can pay hospitals by identifying ARDS per capita payment (capitated payment) in the future. Further studies leading to a more cost-effective health care system is necessary. |
本系統中英文摘要資訊取自各篇刊載內容。