總額預算對呼吸器依賴患者實施整合性計畫之照護品質影響

The Influence of Healthcare Quality of Global Budgets System on Integrated Delivery Services for Ventilator-Dependent Patients

洪惠苓(Huei-Ling Hung)；鍾聿修(Yu-Hsiu Chung)；王金洲(Chin-Chou Wang)；王逸熙(Yi-Hsi Wang)；高旭卿(Hsu-Ching Kao)；張秋霞(Chiu-Hsia Change)；陳瓊珠(Chiung-Chu Chen)

呼吸器依賴患者 ； 整合性照護計畫 ； 總額預算制度 ； 照護品質 ； ventilator-dependent patients ； integrated delivery services ； global budgets system ； healthcare quality

中華職業醫學雜誌

21卷2期（2014 / 04 / 25）

91 - 99

繁體中文

Current studies on ventilator focus more on prediction of weaning and physical indices, while few explore healthcare quality. Therefore, this study aimed to investigate the influence on healthcare quality to ventilator- dependent patients on Integrated Delivery Services (IDS) before and after the implementation of global budgets system.As a retrospective research, this study investigated patients of 17-year-old and above who used ventilators for 21 consecutive days and over based on the data from the National Health Insurance (NHI) Administration, Taiwan from 2001 to 2008. Group 1 referred to patients who are on IDS for one to two years (that is one to two years before the implementation of the Global Budgets System); Group 2 referred to those on IDS one to two years after the Global Budgets System; and Group 3 referred to those on IDS three to four years after the Global Budgets System. Those who developed dependence on IDS ventilator were referred to as ”Receivers.” After the hospital's intervention with the global budgets system, the healthcare quality was affected and led to cases of atelectasis (Group A), pneumonia (Group B) and death (Group C). The first batch of samples consisted of 553 receivers of IDS cases transferred from ICU to RCC and RCW from 2001 to 2008. The secondary samples were used to compare the influences before and after the intervention of global budgets system through time. Cases with over two IDS between 2001 and 2006 were selected so that the length of hospital stay and repeated calculation of medical expenses, evaluation would not cause estimate error; and data of the first IDS were sampled. After the screening, 295 cases were selected. The relevance between the receivers and the variables after the intervention of global budgets system are as follows:(1) Significantly correlative with Group A: cancer (P=0.014) on disease characteristics, hospital level (P＜0.001) and hospital region (P=0.013) on institution characteristics;(2) Two factors significantly correlative with Group B: gender (P＜0.011) and disease severity (P＜0.001);(3) Significantly correlative with Group C: hospital ownership (P=0.033).According to the logistic regression analysis on healthcare quality after the global budgets system, the predicted results showed: (1) Group A was not influenced by the intervention of global budgets system (P=0.273); (2) there was no significant difference with the intervention of global budgets system (P=0.440), and Groups 2 and 3 showed no significant difference (P=0.320 and P=0.996), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group B by the intervention of global budgets system. (3) there is no significant difference between the invention of global budgets system and Group C (P=0.139). and Groups 2 and 3 showed no significant difference (P=0.417 and P=0.399), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group C by the intervention of global budgets system.The results indicated that no influence was caused to the healthcare quality of IDS by the hospital's implementation of global budgets system.

Current studies on ventilator focus more on prediction of weaning and physical indices, while few explore healthcare quality. Therefore, this study aimed to investigate the influence on healthcare quality to ventilator- dependent patients on Integrated Delivery Services (IDS) before and after the implementation of global budgets system.As a retrospective research, this study investigated patients of 17-year-old and above who used ventilators for 21 consecutive days and over based on the data from the National Health Insurance (NHI) Administration, Taiwan from 2001 to 2008. Group 1 referred to patients who are on IDS for one to two years (that is one to two years before the implementation of the Global Budgets System); Group 2 referred to those on IDS one to two years after the Global Budgets System; and Group 3 referred to those on IDS three to four years after the Global Budgets System. Those who developed dependence on IDS ventilator were referred to as ”Receivers.” After the hospital's intervention with the global budgets system, the healthcare quality was affected and led to cases of atelectasis (Group A), pneumonia (Group B) and death (Group C). The first batch of samples consisted of 553 receivers of IDS cases transferred from ICU to RCC and RCW from 2001 to 2008. The secondary samples were used to compare the influences before and after the intervention of global budgets system through time. Cases with over two IDS between 2001 and 2006 were selected so that the length of hospital stay and repeated calculation of medical expenses, evaluation would not cause estimate error; and data of the first IDS were sampled. After the screening, 295 cases were selected. The relevance between the receivers and the variables after the intervention of global budgets system are as follows:(1) Significantly correlative with Group A: cancer (P=0.014) on disease characteristics, hospital level (P＜0.001) and hospital region (P=0.013) on institution characteristics;(2) Two factors significantly correlative with Group B: gender (P＜0.011) and disease severity (P＜0.001);(3) Significantly correlative with Group C: hospital ownership (P=0.033).According to the logistic regression analysis on healthcare quality after the global budgets system, the predicted results showed: (1) Group A was not influenced by the intervention of global budgets system (P=0.273); (2) there was no significant difference with the intervention of global budgets system (P=0.440), and Groups 2 and 3 showed no significant difference (P=0.320 and P=0.996), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group B by the intervention of global budgets system. (3) there is no significant difference between the invention of global budgets system and Group C (P=0.139). and Groups 2 and 3 showed no significant difference (P=0.417 and P=0.399), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group C by the intervention of global budgets system.The results indicated that no influence was caused to the healthcare quality of IDS by the hospital's implementation of global budgets system.