住院病人跌倒事件之原因分析及醫療成本

Factors and Medical Costs Associated With Fall Events in Hospitalized Patients

背景 跌倒是醫院中常見的不良事件，但病人一旦跌倒後，可能會造成個人、家庭在經濟和照護上的負擔。目的 分析住院病人發生跌倒之原因及跌倒後之住院天數與醫療處置費用。 方法 本研究為回溯性配對個案控制設計。資料來源為北部某區域醫院，2009年至2011年間住院且發生跌倒的病人，而對照組為無跌倒的病人，以性別、年齡 ± 5歲、主診斷ICD-9-CM（International Classification of Diseases, Ninth Revision, Clinical Modification）相同者為配對條件。資料統計方法包括描述性與推論性統計。 結果 本研究共收160位住院病人（跌倒組80位及對照組80位）。結果發現住院期間跌倒的病人，有過去跌倒經驗與平均總住院天數較對照組多。經多項式羅吉斯迴歸分析後，與住院病人跌倒之三個危險 因子為：無陪伴者、有使用易跌倒藥物 ≥ 三類及無點滴注射者。本研究也發現，隨著跌倒後之傷害級數增加，其醫療處置成本支出也隨之增加，其中，又以三級傷害程度的醫療處置費用最多，佔 75.6%，其平均每位跌倒的醫療成本約新台幣18,257元。 結論／ 實務應用 本研究結果能作為未來醫院在推動病人安全與預防病人跌倒之參考，以減少額外的醫療成本支出。

Background: Patient falls are a common, adverse event in hospitals that may result in economic and care burdens on the patient and his/her family afterward. Purpose: To analyze the factors that relate to falls among inpatients and to estimate the associated days of hospitalization and medical costs. Methods: The present study used a retrospective matched case-control design to analyze inpatient fall data for 2009 to 2011 from a regional teaching hospital in northern Taipei. We matched fallers and controls according to gender, age ± 5 years, and ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code. Data were analyzed using descriptive and inferential statistics. Results: A total of 160 inpatients participated in the present study (80 fallers in the fall group and 80 nonfallers in the control group). The results revealed that fallers had more previous fall experiences and longer hospital stay than nonfallers. Multiple logistic regression analysis revealed that the risk factors that were significantly associated with inpatient falls included: no family accompaniment, use of more than 3 fall-related medications, and no intravenous catheter placement. Results further found that medical costs increased with the degree of injury. Third-degree injuries bore the highest post-fall medical costs of all of the injury-degree categories. The average medical cost for patients with third-degree injuries was 18,257 New Taiwan dollars. Conclusion / Implications for Practice: The findings provide a reference for hospitals to promote patient safety, to prevent the occurrence of inpatient falls, and, ultimately, to reduce fall-associated medical costs.