探討胸腔物理治療對肺部感染病人住院天數、醫療費用之影響

Impact of Chest Physical Therapy on Length of Stay and Medical Expenditures for Patients With Pulmonary Infection

背景：肺部痰液蓄積容易造成肺部反覆感染，導致呼吸困難及肺部損傷。胸腔物理治療是協助肺部感染病人清除呼吸道分泌物最常被使用的方法，除能協助痰液清除、預防呼吸道阻塞外，更能降低肺部感染。目的：旨在探討胸腔物理治療對肺部感染病人住院天數、醫療費用之影響。方法：採回溯性相關性研究設計，從病歷的次級資料進行分析，以台灣南部某醫學中心之內科病房2013至2017年之病人為研究樣本，逐年分析肺部感染病人介入胸腔物理治療，對住院天數、醫療費用及再入院之差異。結果：本研究收集胸腔內科肺部感染住院之病人共707人，平均年齡75.4（±13.8）歲。研究發現逐年增加胸腔物理治療後，病人的平均住院天數（F＝6.66, p＜.001）及醫療費用（F＝5.34, p＜.001）均有顯著下降。另外，在同一疾病14天內再入院方面，由2013年的6.9％逐年下降至2017年的1.7％，且達顯著性差異（x^2＝5.84, p＝.016）。結論／實務應用：逐年比較後，發現胸腔物理治療後能降低住院天數、14天內再入院率與節省醫療費用支出，可做為未來肺部感染病人介入胸腔物理治療之參考。

Background: Sputum retention increases significantly the risk of repetitive respiratory tract infections, which may result in dyspnea and lung injury. Chest physical therapy is the most commonly used method to assist patients to expel sputum. This intervention promotes sputum clearance and prevents airway obstruction, thereby reducing the risk of lung infection. Purpose: The purpose of this study was to investigate the impact of chest physical therapy on the length of hospitalization and the medical expenditures of patients with pulmonary infection. Methods: A retrospective-correlation study was used. Data were collected from 2013 to 2017 in the medical ward of a medical center located in southern Taiwan. The annual differences in the length of stay, medical expenditures, and readmission rates for patients with pulmonary infection after chest physical therapy were analyzed. Results: A total of 707 patients with pulmonary infection were recruited and enrolled as participants. The mean age of the participants was 75.4 (± 13.8) years. The results showed that length of stay (F = 6.66, p < .001) and medical expenditures (F = 5.34, p < .001) were both significantly lower after chest physical therapy and that the corresponding readmission rates had decreased significantly, from 6.9% in 2013 to 1.7% in 2017 (x^2 = 5.84, p = .016). Conclusion/ Implications for Practice: After conducting a yearly comparison, the results of this study indicate that administering chest physical therapy may be an effective strategy for reducing the length of stay, readmission rates, and medical expenditures of patients with pulmonary infection. The findings of this study may serve as a reference for the clinical implementation of chest physical therapy in patients with pulmonary infection.