| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 96 === Medical care expenditure of patients chronically dependent on ventilators is generally higher than of average patients. To improve medical care quality and result efficient allocation and utilization of medical care resource, Bureau of National Health Insurance promoted managed care demonstration program for ventilator dependent patients in 2000, which will contribute medical care of better quality across the board.
This research analyzes the conditions and related factors of medical care utilization and quality based on the database of National Heath Insurance for participants, non-participants of managed care demonstration program. Samples are ventilated in 2002, those were subsequently discharged. Where patients had two or more admissions in the same year, records from first admissions only are used. In addition, independent of ventilator or related complications for at least half a year prior to their admissions, age seventeen or higher then seventeen, subjects meeting the selection criteria comprise of 1,453 participants and 10,529 non-participants. Measure of medical resource usage is based on total days of hospitalization (including days on hospitalization, general ward, ICU, RCC and RCW), days on ventilators and admission costs. The main outcomes are as follows, the complications rates of the admission(during hospitalization、ICU、RCC、RCW)、the complications rates after discharge in 60/90 days、the rates of readmission(60/90 days readmission、rejoin managed care demonstration program、readmission in ICU、readmission in the same hospital) and death (during hospitalization, after discharge of 14/30/60/90 days).
RESULTS: participants utilized significantly higher medical resource in terms of mean total days of hospitalization (78.06 and 54.36 days), duration of general ward stay (58.05 and 28.31 days) and days on ventilators (67.89 and 43.38 days), non-participants required longer ICU stay and higher hospitalization cost（NT162,880、NT392,160）. In terms of care quality, participants exhibited higher incidence on the complications rate of the hospitalization（61.53%、49.38%）、the rates of death during hospitalization (45.56%、43.90%)、the rates of readmission to the program after discharge of 60/90 days(6.94%、0.27% / 13.77%、0.46%) and the rates of death after discharge of 14/30/60/90 days（12.90%、10.65 / 19.97%、16.47% / 28.95%、24.60 / 33.88%、30.18）; but in the terms of care quality, non-participants exhibited higher incidence in the rates of complications after discharge of 60/90 days（13.35%、23.78% / 28.68%、34.21%）、the rates of readmission after discharge of 60/90 days(25.98%、35.56% / 47.61% / 49.01%)、the rates of readmission to the ICU after discharge of 60/90 days (4.63%、8.55% / 8.22%、11.78%) and the rates of readmission to the same hospital after discharge of 60/90 days (3.56%、10.57% / 8.41%、18.84%).
Recommend Bureau of National Heath Insurance to take into account with the indexes of the complications rates during hospitalization、the rate of complications after discharge、the rate of readmission、the rate of readmission to the program、the rate of readmission to ICU、the rate of readmission to the same hospital、the rate of death during hospitalization and the rate of death after discharge as monitor indexes of medical care for long-term ventilator dependent patients.
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