| Summary: | 碩士 === 國立中山大學 === 醫務管理碩士學位學程 === 102 === Because of medical advances, the survival and life expectancy of people suffering from spinal cord injury has continued to improve in recent years. Helping patients with spinal cord injury enhance quality of life, and integrate into the community as well as promoting employment through rehabilitation is critical.
Once a patient with spinal cord injury is in stable condition, inpatient rehabilitation comprising various rehabilitation activities should begin to improve the patient''s physiological functions and prevent complications. A rehabilitation team for spinal cord injury includes physiatrists, physiotherapists, occupational therapists and speech therapists. Physiatrists are responsible for assessing the patient''s condition, planning rehabilitation program, and integrating other professionals. Rehabilitating for spinal cord injuries can promote the recovery of limbs, improve the daily life of self-care, and enhance the quality of life. Although rehabilitating patients with spinal cord injury is crucial, the research on rehabilitation use is rare.
In this study, we used data from patients with traumatic spinal cord injury derived from a sampled registry of beneficiaries in National Health Insurance Research Database, from 2002 to 2007. According to the first phase Andersen’s behavioral model of health services, we analyzed the usage rates, therapy sessions, and rehabilitation costs, and established a predictive regression model.
We enrolled 737 patients with traumatic spinal cord injury. Among these patients, 213(28.9%) used inpatient rehabilitation services. Among the patients who used rehabilitation, 207 patients (97.2%) received physical therapy, 121 patients (56.8%) received occupational therapy, 5 patients (2.3%) receiving speech therapy. During hospitalization, the median number of therapy sessions was 22.9, the median number of physical therapy sessions was 15.05, and the median number of occupational therapy sessions was 14.45,and the median number of speech therapy sessions was 2.8. The median cost of rehabilitation was NTD$ 11,474.The inpatient rehabilitation expenses to total medical expenses ratio averaged 8.24% .The factors that affected inpatient rehabilitation usage rate were gender, injury sites, associated injuries, spinal surgery, causes of injury, hospital ownership, hospital accreditation level, hospital location and co-payment.
According to the average treatment sessions and fee, medical centers provide more services than metropolitan hospitals do and metropolitan hospitals provide more services than community hospitals do. Regarding hospital ownership, public hospitals and corporate hospitals provide more services than private hospitals. In addition, this study determined that patients who underwent spinal surgery and were exempt from co-payment had higher therapy session and rehabilitation costs than those who did not undergoing spinal surgery and required co-payment.
The logistic regression result indicated that rehabilitation was significantly related to the injured sites, causes of injury, hospital accreditation level, and co-payment. The multiple regression result indicated that the following factors significantly predicted the numbers of therapy sessions and the rehabilitation fee. Rehabilitation fee: spinal surgery, hospital accreditation level, and co-payment. (Adjusted R2 = 0.199).Numbers of therapy sessions: spinal surgery, hospitals ownership, and co-payment. (Adjusted R2 = 0.123).
This study investigated the factors that affect rehabilitation utilization for traumatic spinal cord injury in Taiwan and determined that rehabilitation utilization and rehabilitation costs were low. This is possibly why some patients did not receive the necessary or received inadequate rehabilitation. The result can provide a reference for medical authorities to formulate policies and allocate medical resources.
|
|---|
