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題名：臺灣腦中風病人急性後期照護需要之探討
書刊名：臺灣公共衛生雜誌
作者：吳冠穎／吳肖琪／洪燕妮 引用關係／吳君誠／林麗嬋／胡漢華
作者(外文)：Wu, Kuan-ying／Wu, Shiao-chi／Hung, Yen-ni／Wu, Chun-chen／Lin, Li-chan／Hu, Han-hwa
出版日期：2012
卷期：31:3
頁次：頁251-262
主題關鍵詞：急性後期照護；腦中風；超長住院；再住院；Post-acute care；Stroke；Prolonged hospital stay；Readmission
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(8) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:8
  • 共同引用共同引用:68
  • 點閱點閱:475
目標：推估腦中風病人急性後期照護（Post-Acute Care，以下簡稱PAC）需要，並探討影響腦中風病人PAC需要之相關因素。方法：採回溯性世代研究法，自2005年健保申報資料擷取腦中風新個案為對象，以超長住院（≧29天）、再住院（1、14日內）、合併當次住院超長及再住院為概似指標（proxy）推估腦中風病人PAC需要。採用多層次分析（multilevel analysis）探討病人特質與醫院特質對PAC需要之影響因素。結果：腦中風病人以男性、年齡≧80歲、蜘蛛網膜下腔出血、有共病、入住復健科、有手術者，較有PAC需要；入住醫學中心者超長住院風險較高，入住地區醫院者較容易有再住院情形。腦中風病人約10.11（以當次住院超長估算）-23.13%（以合併當次住院超長及14日內再住院估算）有PAC需要；PAC人日占率為16.94-44.68%。實施PAC後平均每人約可節省急性醫療天數2.06-8.17天；估算病床之使用約可減少306-1,210張。結論：約10.11-23.13%腦中風病人可能需要PAC，衛生主管機關思考實施PAC支付／給付制度之可行性，以撙節急性醫療資源。
Objectives: To estimate the need for post-acute care (PAC) and to determine the factors related to that need for stroke patients in Taiwan. Methods: All new cases of stroke reported to the National Health Insurance Database (NHID) in 2005 were identified in this retrospective cohort study. Prolonged hospital stay (PHS, ≥29 days), readmission within 1 to 14 days, and combined PHS with readmission were the proxies for estimating the need for PAC. Multilevel analysis was used to examine the relationships among patients, hospital characteristics, and the need for PAC. Results: Risk markers for the need for PAC in stroke patients included male gender, age over 80, subarachnoid hemorrhage, comorbidity, index hospitalization in a division of rehabilitation medicine, and strokes related to surgery. Stroke patients hospitalized in medical centers were more likely to receive PHS while those hospitalized in district hospitals were more likely to be readmitted. Stoke patients with a prolonged hospital stay or readmission within 14 days were used as indicators to estimate the need for PAC; these accounted for 10.11-23.13% of stroke patients. PAC days accounted for 16.94-44.68% of the total length of stay. The hospital days per stroke patient may be reduced by 2.06-8.17 days, and hospital bed occupancy may be reduced by 306-1,210 beds after implementation of PAC. Conclusions: As many as 10.11-23.13% of stroke patients may need PAC. PAC payment/reimbursement policy may be considered in order to reduce acute medical expenditures.
期刊論文
1.吳肖琪(20080800)。急性醫療與慢性照護的橋樑--亞急性與急性後期照護。護理雜誌，55(4)，5-10。new window  延伸查詢new window
2.Romano, P. S.、Roos, L. L.、Jollis, J. G.(1993)。Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives。J. Clin. Epidemiol.，46，1075-1079。  new window
3.溫福星、邱皓政(20090600)。多層次模型方法論：階層線性模式的關鍵議題與試解。臺大管理論叢，19(2)，263-293。new window  延伸查詢new window
4.吳肖琪、吳義勇、朱慧凡、林嘉彥、李鐘祥、張錦文、藍忠孚(20020400)。我國醫院醫療品質指標使用之情形。醫療品質，2(2)，1-14。new window  延伸查詢new window
5.林麗嬋(20100400)。無縫式照顧服務的關鍵：亞急性照護。長期照護雜誌，14(1)，1-9。  延伸查詢new window
6.葉馨婷、吳肖琪(20080800)。不同超長住院定義對急性住院病患之影響。臺灣公共衛生雜誌，27(4)，301-308。new window  延伸查詢new window
7.Department of Health, Executive Yuan, R.O.C.(2003)。受理醫院設立或擴充案件審查原則一覽表。  延伸查詢new window
8.Young, J.、Forster, A.、Green, J.(2003)。An estimate of post acute intermediate care need in an elderly care department for older people。Health Soc Care Community，11，229-231。  new window
9.Kane, R. L.、Lin, W. C.、Blewett, L. A.(2002)。Geographic Variation in the Use of Post-acute Care。Health Services Research，37(3)，667-682。  new window
10.Buntin, M. B.、Colla, C. H.、Deb, P.、Sood, N.、Escarce, J. J.(2010)。Medicare spending and outcomes after postacute care for stroke and hip fracture。Medical Care，48(9)，776-784。  new window
11.Tseng, M.-C.、Lin, H.-J.(2009)。Readmission after hospitalization for stroke in Taiwan: results from a national sample。Journal of the Neurological Sciences，284(1/2)，52-55。  new window
12.Department of Health and Human Services(1999)。Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1999 rates。Fed Regist，64，41489-41641。  new window
13.Hoverman, C.、Shugarman, L. R.、Saliba, D.、Buntin, M. B.(2008)。Use of postacute care by nursing home residents hospitalized for stroke or hip fracture: how prevalent and to what end?。Journal of the American Geriatrics Society，56(8)，1490-1496。  new window
14.Lee, H.、Chang, K.、Lan, C.、Hong, C.、Huang, Y.、Chang, M.(2008)。Factors associated with prolonged hospital stay for acute stroke in Taiwan。Acta Neurologica Taiwanica，17，17-25。  new window
15.Chiu, H.、Man, L.、Lee, L.、Hsieh, H.(2003)。Inappropriate hospital utilization for long-stay patients in southern Taiwan。Kaohsiung J Med Sci，19，225-231。  new window
16.Bravata, D.、Ho, S.、Meehan, T.、Brass, L.、Concato, J.(2007)。Readmission and death after hospitalization for acute ischemic stroke: 5-year follow-up in the medicare population。Stroke，38，1899-1904。  new window
17.Anderson, C.、Rubenach, S.、Mhurchu, C.、Clark, M.、Spencer, C.、Winsor, A.(2000)。Home or hospital for stroke rehabilitation? Results of a randomized controlled trial. I:health outcomes at 6 months。Stroke，31，1024-1031。  new window
18.Snjiders, T.、Bosker, R.(1999)。Multilevel Analysis: An Introduction to Basic and Advanced Multilevel Modelling。  new window
19.Qureshi, A. l.、Suri, M. F.、Nasar, A.(2007)。Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001。Stroke，38，2180-2184。  new window
20.Claesson, L.、Gosman-Hedstrom, G.、Lundgren-Lindquist, B.、Fagerberg, B.、Blomstrand, C.(2002)。Characteristics of elderly people readmitted to the hospital during the first year after stroke. The Goteborg70+ stroke study。Cerebrovasc Dis，14，169-176。  new window
21.Chang, K.、Tseng, M.、Weng, H.、Lin, Y.、Liou, C.、Tan, T.(2002)。Prediction of length of stay of first-ever ischemic stroke。Stroke，33，2670-2674。  new window
會議論文
1.吳肖琪、林麗嬋(2002)。探討與釐清急性、亞急性、長期照護之分工與整合。行政院二代健保規劃小組九十一年期末檢討聯席會，台灣師範大學 。  延伸查詢new window
學位論文
1.李雪楨(2007)。臺灣腦中風患者住院天數與費用之預測及其臨床照護與衛生政策意涵。  延伸查詢new window
2.戴桂英(2007)。中風出院病人後續醫療照護之研究(博士論文)。國立臺灣大學。  延伸查詢new window
圖書
1.Rosner, B.(2006)。Fundamentals of biostatistics。Thomson-Brooks/Cole。  new window
2.Raudenbush, Stephen W.、Bryk, Anthony S.(2002)。Hierarchical linear models: Applications and data analysis methods。Sage。  new window
3.MedPAC(2008)。A Data Book: Healthcare Spending and the Medicare Program。Washington, DC。  new window
4.MedPAC(2010)。A Data Book: Healthcare Spending and the Medicare Program。Washington, DC。  new window
5.Kramer, A.、Holthaus, D.、Goodrish, G.、Epstein, A.(2006)。A Study of Stroke Post-Acute Care Costs and Outcomes: Final Report。Washington, DC。  new window
6.Pratt, J.(2009)。Long-Term Care: Managing Across the Continuum。Maynard。  new window
7.AHD(2006)。FY2006 STAC DRG Table。American Hospital Directory。American。  new window
 
 
 
 
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