目的：本研究旨在分析專責重症專科醫師照護之加護病房及呼吸器使用病患中長期照護品質及醫療資源利用之影響。並探討加護病房病患死亡之風險因子及預測影響加護病房費用之相關因素。方法：本研究資料來源爲某醫學中心，2002年1月至2005年12月入住專責醫師照護下之內科加護病房所有病患。探討加護病房病患及使用呼吸器病患之照護品質（含ICU天數、死亡率及呼吸器使用天數等）及醫療資源使用（ICU費用）之情況。結果：在加護病房病患方面，2002年至2005年期間人口特質無顯著差異。疾病嚴重度在2005年與2003年比較有顯著上升(P<0.05)；疾病型態中之肺部疾病與2002年比較有逐年上升趨勢(P<0.001)，敗血症則有下降情形(P<0.05)。平均ICU天數、呼吸器使用天數及平均ICU費用無統計上差異，但標準化死亡比呈現下降趨勢。在使用呼吸器病患方面，人口特質及疾病嚴重度無顯著差異。肺部疾病各年與2002年比較有逐年上升趨勢(P<0.05)，敗血症則有下降情形(P<0.05)。平均ICU天數、呼吸器使用天數及平均ICU費用無統計上差異，而標準化死亡比在2005年呈現下降情形。影響ICU死亡之風險因子爲年齡、APACHE Ⅱ分數(P<0.001)及疾病型態(P<0.05)。影響ICU費用之相關因素爲性別(P<0.05)、年齡、APACHE Ⅱ分數、疾病型態、呼吸器使用天數及ICU天數(P<0.001)。結論：中長期實施專責重症專科醫師制度之加護病房，雖然APACHEⅡ分數上昇，其平均ICU天數、呼吸器使用天數及平均ICU費用卻無顯著差異，且標準化死亡比有下降情形。

Objectives: To analyze the influence of mid-to long-term care by intensivists on the quality of medical services and the utilization of medical resources for critically ill patients and patients on ventilator support. The risk factors for mortality and predictors of expenditure in the intensive care unit (ICU) were also evaluated. Methods: Data for patients in one medical ICU of a tertiary medical center were collected from January 2002 to December 2005. We analyzed the effectiveness of the quality of care including length of stay (LOS) and mortality rate in the ICU, ventilator days, and resource utilization (medical expenditures) for patients with critical illness and mechanical ventilation under continuous care by intensivists. Results: There were no significant differences in patients' characteristics during the period of care by intensivists from 2002 to 2005, except that the disease severity score increased in 2005 as compared with 2003 (p<0.05). No statistically significant differences were noted in ICU LOS, ventilator days or medical expenditures, but a declining trend was noted in the standardized mortality ratio. There were no significant differences in patient characteristics or severity scores for those who had been on ventilator support, except that the incidence of lung diseases increased (p<0.05) and the incidence of sepsis decreased (p<0.05) when compared 2003 to 2005 with 2002. There were no significant differences in ICU LOS, ventilator days or medical expenditures, but there was a decrease trend in the standardized mortality ratio for patients receiving mechanical ventilation from 2002 to 2005. The risk factors for mortality included age, APACHE Ⅱ score (p<0.001) and disease pattern (p<0.05). The factors related to ICU expenditures were gender (p<0.05), age, APACHE Ⅱ score, disease pattern, ventilator days and LOS in the ICU (p<0.001). Conclusions: There were no significant differences in ICU LOS, ventilator days, or medical expenditures, but there was a decrease in the standardized mortality ratio, even with an elevation of the APACHE Ⅱ score in ICU patients under mid-to long-term care by intensivists.