| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 101 === Abstract
Objectives
Ventilator-associated pneumonia (VAP) causes prolonged lengths of stay (LOS) and increases mortality. In this study, cases were collected by providing services at a regional hospital in order to identify the important factors that contribute to the development of VAP . The aims of this study were to analyze the trend of VAP and to explore the key factors affecting medical resource utilization and medical efficiency.
Methods
Adult ICU patients admitted to a regional teaching hospital in southern Taiwan. The 276 subjects'' medical records between January 2005 and December 2012 were retrospective collected. Relevant cases obtained from the Office of Infection Control were copied in detail according to the variables specified in this study.It was approved by the IRB of Kaohsiung Medical University Chung-Ho Memorial Hospital. A p-value <0.05 was defined as statistically significant.
Results
The ratios of patients with VAP due to trauma(OR 3.80) and who were from the Department of Neurology(OR 2.30) increased .The ratios decreased with bacterial infections of ORSA(OR 0.17) and who used mechanical ventilator for more than 22 days(OR 0.43).The LOS have reduced as well≦30days(OR 1.76) >30days(OR 0.44). Surgery(P=0.041), abnormal leukocytes(P=0.006), durations of mechanical ventilation(P<0.001), durations from the admission date to the infection date(P<0.001) durations from the start date of mechanical ventilation to the infection date(P<0.001) had significant impacts on LOS.Heart diseases(P=0.012), surgery(P<0.001), use of antibiotics(P=0.045), durations of mechanical ventilation(P<0.001), durations from the admission date to the infection date(P<0.001), durations from the start date of mechanical ventilation to the infection date(P<0.001) and being a surgical patient(P=0.044) all had an effect on the total hospital costs.Kidney diseases(P=0.004), bleeding of the upper gastrointestinal tract(P=0.003), and artificial airways with intubation and tracheostomy(P=0.001) all significantly increased mortality rates during hospitalizations.Kidney diseases(P=0.011), blood transfusions(P<0.001), artificial airways with intubation and tracheostomy (P<0.001)as well as durations from the start date of mechanical ventilation to the infection date(P<0.001) were found to greatly affect ventilator dependence as well. Artificial airways with intubation and tracheostomy(P=0.025) and being a surgical patient(P=0.047) are both highly associated with the rates of patients transferred to respiratory care ward (RCW).
Conclusions and Suggestions
We identified the key factors that affect medical resource utilization and medical efficiency. It is hoped that the results obtained may help to improve the quality of medical care by providing healthcare providers with the information to implement precise policies as well as to provide guidance on the training of healthcare professionals.
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