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Rehabilitation Practice and Science

Translated Title

中風病患在慢性復健科病房住院醫療費用預測因子之探討

Abstract

Stroke is a disease with severe consequences which impose a considerable socio-economic burden on patients and society. In developed countries, stroke patients alone generate about 3-4% of the direct costs within the healthcare system. The costs of rehabilitation and long-term care of disabled stroke survivors are expected to rise even further because of the increasing number of the aging population and declining stroke case-fatality rates. The aims of the paper are to evaluate the factors that may influence costs of stroke patients in chronic rehabilitation wards for better management of medical resources. This study was conducted at a local general hospital including 249 chronic rehabilitation beds in Taiwan. The dataset initially included information on 156 discharged stroke patients in July and August 2005, based on compliance with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) 430-434 and 436-438 diagnosis codes. In these patients, demographic and clinical data were collected, including principal diagnosis, length of hospital stay (LOHS), comorbid conditions, the number of specialist consultations, infection and catheter intubation days. A multivariate linear regression analysis was then performed to determine factors with an independent influence on the inpatient charge. The mean cost and LOHS in our study were NTD 108365.80 (SD=53825.90) and 50.92 days (SD = 20.57) respectively. On multivariate analysis the significant predictors associated with costs were: (1) LOHS (R^2=0.739) (2) NG tube intubation (days) (R^2 =0.160) (3) consultation times (R^2=0.008) (4) endotracheal tube (days) (R^2 =0.004) and (5) Foley tube (days) (R^2 =0.004). In our study, length of hospital stay is still the most important determinant of stroke patient costs in rehabilitation wards. However, the three types of tubal treatments days are also important. In Taiwan, 99% of the total population was covered by the National Health Insurance system. As a result, stroke patients and their families tend to stay at hospitals for better medical care and length of hospital stay, therefore, is not a controllable factor based on medical principle. Early removal of unnecessary catheter may be a more important factor for the better control of the increasing costs of stroke patients in chronic rehabilitation wards in Taiwan.

Language

Traditional Chinese

First Page

145

Last Page

153

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