台灣腦中風病人急性後期照護需要之探討

The Need for Post-Acute Care for Stroke Patients in Taiwan

10.6288/TJPH2012-31-03-05

吳冠穎(Kuan-Ying Wu)；吳肖琪(Shiao-Chi Wu)；洪燕妮(Yen-Ni Hung)；吳君誠(Chun-Chen Wu)；林麗嬋(Li-Chan Lin)；胡漢華(Han-Hwa Hu)

急性後期照護 ； 腦中風 ； 超長住院 ； 再住院 ； Post-Acute Care ； Stroke ； Prolonged Hospital Stay ； Readmission

台灣公共衛生雜誌

31卷3期（2012 / 06 / 01）

251 - 262

繁體中文

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.

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