設置專責醫師對加護病房呼吸器使用病患之照護品質及呼吸照護資源利用之影響

Influence of Closed Medical Intensive Care Unit on Quality and Medical Resources Use for Patients with Ventilator

目的：有關國內加護病房（intensive care unit, ICU）呼吸器使用病患之醫療品質和 資源使用之文獻缺乏，本研究在於探討加護病房設置專責重症專科醫師制度對呼吸器 使用病患醫療品質和資源利用之變化，並預測影響死亡風險因子和醫療費用及天數的 因素。 方法：樣本為1 8-2005年（每年11-12月）某醫學中心13床內科加護病房呼吸器 使用患者。依變項屬性分別使用卡方檢定和單因子變異數，以多元邏輯式迴歸和多元 複迴歸預測風險因子。統計工具使用SPSS for windows 12.0版。 結果：加護病房呼吸器使用病患人口特質及疾病嚴重度在設置專責醫師前後無 顯著差異。平均呼吸器使用天數、ICU天數、ICU費用在設置後中、後期呈顯著下降 （P<0.001），平均ICU每人每日費用在設置後中、後期則呈現上升趨勢（P<0.05）。 疾病嚴重度為影響病患死亡之風險因子（P<0.05）。設置後三期皆為影響病患ICU費用 及住院天數之預測因素（P<0.001）。 結論：呼吸器使用病患死亡率逐年降低，住院醫療資源耗用也逐年減少。專責醫 師設置應有助於提升呼吸器使用照護品質，且減少醫療資源使用，顯示品質和成本之 反向關係。

Objectives: The aim of study is intend to examine impact of intensivist or closed ICU on quality and resource use for medical ICU patients with ventilator, and further to explore the factors associate with mortality, medical charge and hospital average length of stay. Methods: Study sample are patients with ventilator who admitted to medical ICU at one medical center between 199 8 and 2005 (November and December). Chi-square and Analysis of Variance is used to examine categorical and continuous variable respectively. SPSS for Windows is used to perform the analyses. Results: No statistical difference was found in patients demographic and disease severity between the implementation of the intensivist. Average day of ventilator, average of ICU day, average charge was decreasing (p<0.001) after the intervention. Disease severity is significant predictor for patient mortality (p<0.05); while post intervention periods are important predictors of average length of stay and medical charges (p<0.001). Conclusions: We found closed medical ICU reduced patient’s mortality, and spend less healthcare dollars as compared with open ICU. The ICU physician arrangement suggests the inverse relationship between quality care and healthcare utilization for ICU patients.