脊髓損傷病人使用復健醫療資源之預測因子

Predicting Factors for Rehabilitation Resource Use in Patients with Spinal Cord Injury

自從民國八十四年實施全民健康保險制度以來，為建立合理的給付基準，發展本土化的復健醫療資料庫系統實有其需要。經由有系統地收集復健科個案的資料，並分析其資料內容，可作為臨床研究與應用的根據。本文的主要的目的是建立脊髓損傷病患資源使用(resource utilization)的因果關係模式，作為評估復健成效及保險給付之參考。本研究包括68位來自北部2家教學醫院復健科住院病房的脊髓損傷病人。病人於住院一週內，透過病歷查詢、詢間病患或照顧者，以及觀察病人表現來取得相關的資料，並使用台灣復健功能量表(TaRFs)來測試病人的功能狀態。其中，72%的病人為男性病患，其平均年齡約43歲，而平均住院日數約41天。本研究採用徑向分析，以建構並驗證復健醫療資源使用的最佳模式。本模式中涵蓋了4個預測因子（性別、日常生活功能、認知社會功能和主觀安適感），以及1個成效因子（住院日數）。結果顯示，日常生活功能對住院日數的總影響最大；認知——社交功能和主觀安適感具有直接和間接的影響力，以決定病人的住院日數；主觀安適感受到性別的影響，進而影響病人的住院日數。本研究所建構的資源使用之模式，將可作為促進病人功能進展之參考模式，並使脊髓損傷者之復健，達到較佳的經濟效益。

Taiwan had implemented national health insurance plan since 1995. In order to assist to establish a rational reimbursement system, a database system for medical rehabilitation was developed. The purpose of the study is to construct and validate a causal model of rehabilitation resource use for patients with spinal cord injury. Sixty-eight patients with spinal cord injury (SCI) were recruited from two rehabilitation units in university-affiliated hospitals. The mean age of the patients was 43 years old and 72 percent of patients were male. The average length of hospitalization was 41 days. All patients were tested on the Taiwanese Rehabilitation Functional Scale (TaRFS) and were interviewed to secure relevant database information at the first week upon admission. Path analysis was used to validate the proposed model for patients with SCI. The proposed model consists of one outcome variable (length of rehabilitation stay, LOS) and four predicting variables: personal characteristics variables (gender and age), activity of daily living (ADL), cognitive-social skill (CSS), and subjective well-being (SWB). The findings revealed that ADL had the largest total effect on LOS. The CSS and SWB had direct effect on LOS. Whereas CSS and gender had indirect effect on LOS through ADL and SWB respectively. The causal model indicates that ADL, CSS, and SWB have effects on LOS of the patients. The consideration of these factors into the reimbursement system of the National Health Insurance Plan can facilitate the achievement of rehabilitation outcomes for clients with SCI.