Analysis of care quality of ICU patients during hospitalization

• Main Authors: Shao-You Fang, 方芍又
• Other Authors: Shiao-Chi Wu
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/79621042668952795407

碩士 === 國立陽明大學 === 衛生福利研究所 === 94 === Intensive care unit (ICU) is a part that combines intensive technology and much healthcare manpower in hospital; healthcare resource allocation and consumption is more than that of a general wards. In addition to the danger associated with it. Therefore, it’s necessary to analyze the care quality of ICU. This study analyzed care quality of ICU patients and associated factors based on the national health insurance data. The 143,175 subjects included in this study were patients who were hospitalized in ICU for the first time in 2002, excludeing these under the age of 19 or those who had ICU hospitalizations during half a year before 2002. Nosocomial infection (NI), Ventilator-associated pneumonia (VAP), Catheter-associated Urinary tract infection (CA-UTI), surgical site infection (SSI), readmission to ICU after discharge (48 hours, 14 days, 30 days), and death (during hospitalization, after discharge of 30 days) serve as care quality indices, and be analyzed from the patient and hospital levels. At the patient level, the main outcomes are as follows: The rates of NI, VAP, CA-UTI and SSI are 20.59%, 3.30%, 11.15% and 2.8%. The rate of readmission to ICU after discharge of 48 hours, 14 days and 30 days is 4.61%, 6.17%, and 7.48% respectively. The rate of death during hospitalization is 24.09%, and the rate of death after discharge of 30 days is 5.64%. The significantly relative factors include age, comorbility, medical department, and use of catheters and devices. Besides, the ICU patients acquired better quality of care at academic, higher accreditatinal level, and higher volume hospitals , but contrasted with SSI. At the hospital level, after adjusting for gender, age, educational level, comorbility and medical department of patients, the range and average of hospital ICU care qulity indices are as follows: The rate of NI is between 0.00%~51.49%, and the average is 23.39%. The rate of VAP is between 0.00%~30.88%, and the average is 3.81%. The rate of CA-UTI is between 0.00%~37.86%, and the average is 12.43%. The rate of SSI is between 0.00%~14.16%, and the average is 2.01%. The rate of readmission to ICU after discharge of 48 hours, 14 days and 30 days is betwwen 0.00%~27.32%, 0.00%~27.30%, and 0.00%~34.58% seperatedly. The average of readmission to ICU after discharge of 48 hours, 14 days and 30 days is 7.73%, 9.07%, and 10.30% independently. The rate of death during hospitalization is between 0.00%~54.08%, and the average is 24.84%. The rate of death after discharge of 30 days is between 0.00%~18.15%, and the average is 7.00%. As a whole, the care quality between hospitals is no significant differences, after adjusting patientscharacteristics, but it’s still abnormal value that the abnormal status of higher indices value at few hospitals. This study suggests that Bureau of Natinal Health Insurance (BNHI) may subsume the nine indices, and serve as the monitoring indices of care quality of ICU patients. The risk adjustment of patients should be done between hospital’s comparisons, so that monitor the care quality of ICU reasonably. Moreover, it should reward the hospital of excellent performance, and strongly monitor and coach the hospital of having abnormal values and indices, and raise the care quality of ICU.