應用個案管理於控制腦中風病患成本效益之成效探討

Application of Case Management on Patients with Stroke: Examining Cost Benefit

本研究之目的在探討應用個案管理對控制腦中風病患住院天數與醫療費用之成效，以及影響住院天數與醫療費用之因素。採類實驗設計，依住院先後次序及選案條件選取114位腦中風病患分派至實驗組與對照組各57人。實驗組病患接受個案管理方案，對照組病患則接受常規照護方案。資料來源從病歷、病患基本資料調查表、臨床路徑流程表與研究機構資料統計中心取得，研究者於病患住院期間完成收集。 以chi-square test、t-test、paired t-test、multiple-regression 等進行檢定分析。研究結果顯示：接受個案管理方案病患的平均住院天數較短、平均醫療費用較少及發生醫囑與護理人員延遲之差異原因次數較少，且均達顯著差異。病患未接受個案管理方案、有差異原因、意識昏迷指數低、有肺炎合併症及腦梗塞等五個變項，可預測病患住院天數長與醫療費用高，其可解釋之變異量分別為61%及39%，顯示應用個案管理可有效的控制住院天數及醫療費用。於因應保險給付制度變更之時，提供護理行政管理者，作為管理成本及建立護理照護模式之參考。

The purpose of this study was to investigate the influence of case management in length of stays and medical cost in hospitalization for the cerebrovascular accident (CVA) patients. The Quasi-experimental design was used in this study. Based on the hospitalization order and the study inclusion criterion, the total sample consisted of 114 CVA patients. The subjects were divided into two groups, 57 subjects in each group. The subjects in the experimental group received case management method and the subjects in the control group received the routine care method. Data was collected from the patient's chart, the demographic data sheet, the clinical path sheet and the center of statistic institutions. During the period of patient's hospitalization. Data were analyzed by using the chi-square test, t-test, paired t-test and multiple-regression. The results indicated that subjects in the experimental group had significantly less average length of stays, medical cost and the frequency of variance causes case management, variance causes, pneumonia, coma scale index and diagnosis could predict the length of stays and medical cost. The total explained sources of variation were 61% and 39%. Base on the study results. It was concluded that the implication of case management method could effectively control length of stays and medical cost. The findings can provide a reference on managing cost to the nursing administrators.