| Abstract: | 本研究針對中部某醫學中心的中期照護中心，自2014年1月1日至12月31日期間住院且接受急性後期照護品質計畫，排除小於20歲之個案，採病歷回溯方式，共收案90人。研究顯示接受該品質計畫之病人以神經內科(75.6%)、男性(64.4%)居多。年齡分布以61~70歲(25.6%)最多，大於80歲者次之(22.2%)。病因以缺血性腦中風型態(72.2%)居多，平均住院天數16.11天，平均費用為109925元。總費用中以護理費(16.09％)最高，第二為病房費(12.09％)、第三為藥費(10.44％)，第四為特殊材料費(10.10％)。患者被歸類為查爾森共病指標1者(53.3％)最多，然而，被歸類為指標0者醫療耗用最高，0與1群組經t檢定有顯著差異(P值=0.027)。加入高血壓、高血脂、頸動脈狹窄、心房纖維顫動等四項腦中風常見危險因子，將0群組依疾病史分為「絕對0」及「相對0」群組。結果顯示，指標1與絕對0在總費用項目無顯著差異，細項中僅腦電波檢查費(p值=0.006)有顯著差異。指標1與相對0在總費用項目亦無顯著差異，但細項中護理費(p值=0.042)、病房費(p值=0.045)、藥費(p值=0.026)及手術費(p值=0.0043)皆有顯著差異。同時，在科別(p值=0.038)與年齡(p值=0.0)也有顯著差異，足見高血壓、高血脂、頸動脈狹窄及心房纖維顫動疾病在腦中風因子具有重要性。
This study was conducted with backtracing method at an interim care unit in a medical center in central area of Taiwan on patients who took post cerebral apoplexy care program. Patients who are under 20 years old are excluded and 90 cases were filed from January 1, 2014 to December 31.It showed that neurology cases (75.6%) and male (64.4%) are the most. Patients with age between 61 to 70 (25.6%) are the most, next are who over 80 years old (22.2%)。Patients of ischemic stroke type (72.2%) are majority and with an average stay 16.11 days and cost of 109,925 NTD. Within the total cost nursing fee (16.09%) is the highest, ward cost (12.09%) is secondly, pharmaceutical expenditure (10.44%) is thirdly, and special materials (10.10%) is fourthly.Patients who are classified as Charlson Comorbidity Index group1 (53.3%) is the highest however, medical expense of patients of group 0 is the highest among all groups. There are significant differences between group 0 and 1 with a p = 0.027.In addition, to classify patients by hypertension, hyperlipidemia, carotid artery stenosis, and atrial fibrillation, group 0 can be devided into " 0 absolute " and " 0 relative " according to patients’ disease records. It showed that there is no significant difference between group 1 and 0 absolute for total expense. But when breakdown, it reveals significant difference in EEG examination fee (p = 0.006 ). No significant difference exists between group 1 and 0 relative for total expense either. However, nursing fee, ward cost, pharmaceutical expenditure and surgery are significantly different when breakdown with p equal to 0.042, 0.045, 0.026, and 0.0043, respectively. In other words, hypertension, hyperlipidemia, carotid artery stenosis, and atrial fibrillation are important factors to treat cerebral apoplexy. |
