科技部專題研究計畫主持人
MOST104-2410-H037-006-SS2
論日計酬制腦中風急性後期照護之成本效益分析:前瞻性及統合性研究
Cost-Effectiveness Analysis of Post-acute Care for Stroke under Per Diem System : A Prospective and Meta-Analysis Study
科技部
Ministry of Science and Technology
高雄醫學大學
Kaohsiung Medical University
許弘毅
Hon-Yi Shi
醫務管理暨醫療資訊學系
Department of Healthcare Administration and Medical Informatics
許弘毅
教授
07-3134735#2648#40
hshi@kmu.edu.tw
計畫執行期間起:2015-08-01
計畫執行期間迄:2017-07-31
2015-08-31
2017-06-30
全國PAC
1
001,002
01,02,03
中風,急性後期照護,成本效益分析
Stroke, post-acute care, rehabilitation, cost-effectiveness analysis
目的: 探討不同住院途徑中每日津貼支付系統對卒中患者的急性期後護理(PAC)如何影響醫療保健的使用和功能狀態。 設計,設置和患者: 一項針對台灣南部醫院和患者的181名急性 卒中患者的縱向前瞻性隊列研究分為兩組:從地區醫院轉移的患者(第1組)和從醫療中心轉診的患者(第2組)。 介入: 干預是針對腦血管疾病患者的以醫院為基礎,以功能為導向,3至12週的康復PAC干預。 測量: Barthal指數,功能性口服攝入量表,日常生活量表的器樂活動,EuroQoL生活質量量表和Berg平衡量表。 結果: 與第2組(17.11天)相比,第1組(9.88天)中風發病日和入院日之間的平均持續時間顯著(P <0.001)。與第2組(34.11天)相比,第1組(25.51天)PAC的平均持續時間也顯著(P <0.01)。最後,與第2組(3450美元)相比,第1組(2637美元)的每日支付PAC 的平均成本顯著降低(P <0.01)。接受康復治療的PAC患者的功能狀態顯著改善(P <0.05)。但是,兩組的功能狀態沒有顯著差異。 結論: 降低卒中患者PAC費用的最有效方法是在轉入康復PAC之前盡量縮短住院時間。因為它大大降低了醫療費用,康復PAC應該算是標準的護理對中風病人。
OBJECTIVE: To explore how post-acute care (PAC) for stroke patients delivered by per-diem payment system in varying hospitalization paths affects medical care utilization and functional status. DESIGN, SETTING AND PATIENTS: A longitudinal prospective cohort study of 181 acute stroke patients in a southern Taiwan hospital and patients were separated into two groups: patients transferred from regional hospitals (group 1) and patients referred from medical centers (group 2). INTERVENTION: The intervention was a hospital based, function oriented, 3- to 12-weeks rehabilitative PAC intervention for patients with cerebrovascular diseases. MEASUREMENTS: Barthal Index, Functional Oral Intake Scale, Instrumental Activities of Daily Living Scale, EuroQoL Quality of Life Scale, and Berg Balance Scale. RESULTS: The average duration between day of stroke onset and day of admission to PAC ward was significantly (P < 0.001) shorter in group 1 (9.88 days) compared to group 2 (17.11 days). The average duration of PAC was also significantly (P < 0.01) shorter in group 1 (25.51 days) compared to group 2 (34.11 days). Finally, the average cost of PAC under per-diem payment was significantly lower (P < 0.01) in group 1 (US$2637) compared to group 2 (US$3450). Functional status significantly (P < 0.05) improved in patients who had received rehabilitative PAC. However, functional status did not significantly differ between the two groups. CONCLUSIONS: The most effective way to reduce the costs of PAC for stroke patients is to minimize the duration of their hospital stay before transfer to rehabilitative PAC. Because it substantially reduces medical costs, rehabilitative PAC should be considered standard care for stroke patients.
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