腦中風患者個案管理模式之住院成本估計與效果之評價

Evaluation of the Efficacy and Hospital Cost among Stroke Patients with Case Management Model

據衛生署統計台灣地區十大死亡原因中，腦中風高居第二位，佔全部死亡人數18％左右。而在六十五歲以上的老人中，腦中風死亡率約21.7％，比惡性腫瘤的14.1％為高，已成為老人主要的殺手。比較「個案管理模式」與「傳統照護模式」對腦中風個案照護之成效，同時探討此兩種模式病患住院時醫療成本之差異。以本院經醫師診斷為腦中風住院病患為主，可分為腦出血（ICH、SAH、SDH）和腦梗塞。實驗組是實施腦中風病患個案管理模式後之個案為主，由專業照護團隊共同發展個案管理照護計劃共計68名，對照組則以前一年未實施個案管理模式前之腦中風病患共計66名，其住院成本來源取自本院向中央健保局申報之健保給付資料，對照組則採回溯方式收集。實驗組病患入院與出院在巴氏量表之改善為7.3分顯著性高於對照組5.2分；在住院醫療成本相對也減少34％，在一年內之患者返診率也高於對照組，且在第一個月有顯著性之差異。醫院若實施腦中風病患個案管理之模式，除可增加患者日常活動之能力與提高出院後之返診率、亦有助於降低其住院醫療成本。

Based on report from Department of Health, mortality of stroke was second in the ten leading cause of death in Taiwan. 18% of total death was attributed to stroke. In elderly, 21.7% of mortality from stroke was higher than the mortality from cancer of 14.1%. Stroke has been a main killer of elderly society in Taiwan. The objective of study was to assess the efficacy using the case management model and calculates the costs of medical care for stroke patients. 68 stroke patients with ICH and SAH, diagnosed by specialist physician using a new case management model, were enrolled at a teaching hospital in central Taiwan. A specific medical care team was developed a care program of stroke, which included medical care, treatment and transferring process etc. However, 66 stroke patients, collected using the traditional model, were taken as comparison group. The periodical feedback to clinic, medical cost and scores of activities of daily life (ADL) of stroke patients in the two groups were monitored. Comparison of the ADL scores among stroke patients between inpatient and outpatient, 7.3 scores in stroke patient using new case management model was significantly higher than 5.2 scores in traditional group. Furthermore, 34% of the medical cost relatively decreased and significantly increased among strokes patients with the new case management model during one follow-up year. Case management model for stroke patients will promote the increase of activity ability and reduce the medical cost during hospitalization as well as to upgrade the rate of return.