影響某區域醫院缺血性腦中風初患病患住院醫療費用之相關因素

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(1)143. 1. 2,3. 1 2 3. / 274 Oxfordshire Community Stroke Project (OCSP). National Institutes of Health. Stroke Scale (NIHSS) 46,803 ). (. 10.1. 4,294. NIHSS. 5.8. 7.8. 24 NIHSS. 2008;13:143-51. 18.9/1,000. p < 0.01) (6.84/1,000). 6.71/1,000). (. 3,964 (. 27.4%). [1] (OR = 1.32, 95% CI = 1.22-1.43). 45-64. ≥ 80. 70% [2]. 2000 [3,4]. 19.8/1,000. [2,4]. 6.87/1,000 (20.7/1,000 vs. 404. 91. 2007. 1. 25. 2008. 6. 30. 2007. 3. 23. (t-PA).

(2) 144. NIHSS) Oxfordshire Community Stroke Project (OCSP) [5,6] (Lacunar infarction (stroke manager). LACI). (Total anterior circulartion. infarction [7-9]. TACI). (Partial. anterior circulation infarction. [10,11]. PACI). (Posterior circulation infarction (. POCI). OTHERS). [12,13] [4]. (. )977. 80,023 110,124. (stroke in evaluation or progress) (. 38). 2 (. (. NIHSS. NIHSS. ). NIHSS. ). 274. (CT) (MRI) SPSS for Windows 10.0. (coagulation test) (EKG). (CD) (TCD). (National Institute of Health and Stroke Scale. χ2 test. oneway ANOVA. 2.

(3) 145. 57% 18.9%. 56.2% 43.8%. 32. 88. 67.2. 63.1% 1 NIHSS. ). 5.8. NIHSS. (LACI). 55.1% 10.9. 65. 8.7 0. (. 41 7.8. (. (. 7.9. ) 10.1. 5 LACI. 46,803. PACI. 12,364. 26%. TACI. NIHSS. 19.9 8.2. 4.7. 9,653. 16.8. 8.4. TACI. 6,817. ). TACI. 4. (21%). NIHSS. 10.5 POCI. 5.7. NIHSS. LACI. POCI. (15%) LACI. 8% TA C I. 7% 100,613 (11%). 34%. 31,913. 3. 68,324. 24 (. (23%). (N = 274) (%) 154/120. /. 67.2. ( ) < 50 50-64 65-79 ≥ 80 OCSP LACI TACI PACI POCI OTHERS ( ) NIHSS (0-38 ) NIHSS (0-38 ) (0-5 ) (0-4 ) (1-41 ) (8504-438089. 11.3. 22 ( 8.0) 79 (28.8) 134 (48.9) 39 (14.2). 151 (55.1) 39 (14.2) 45 (16.4) 26 ( 9.5) 13 ( 4.7). ). OCSP = Oxfordshire Community Stroke Project LACI = TACI = POCI = NIHSS = National Institute of Health Andstroke Scale. 7.8 5.8 0.2 0.3 10.9 46803. 7.9 8.7 0.6 0.8 7.3 49617 PACI =. ).

(4) 146. OCSP. OCSP (. ). ( ) NIHSS ( ) NIHSS ( ) ( ) ( ). (N = 151) 8.4 5.8* 4.7 3.4 2.9 4.1 0.1 0.5 0.1 0.5. (N = 39) 16.8 10.3 19.9 10.4 16.0 12.9 0.7 0.9 1.2 1.2. (N = 45) 10.4 6.8 8.2 5.3 6.3 7.1 0.1 0.4 0.2 0.6. (N = 26) 9.2 6.1 5.7 5.6 5.7 9.6 0.2 0.5 0.4 0.9. (N = 13) 9.9 5.9 10.5 11.2 7.9 12.3 0.9 1.1 0.9 1.4. (N = 274) 10.1 7.3 7.8 7.9 5.8 8.7 0.2 0.6 0.3 0.8. p < 0.001 < 0.001 < 0.001 < 0.001 < 0.001. *. (N = 274) (N = 151) 0 (0.0) * 1 (0.7) 1 (0.7) 1 (0.7) 3 (2.0) 3 (2.0) 1 (0.7) 1 (0.7) 1 (0.7) 12 (7.9). 24. *. (N = 39) 3 ( 7.7) 4 (10.3) 7 (17.9) 3 ( 7.7) 6 (15.4) 1 ( 2.6) 1 ( 2.6) 1 ( 2.6) 3 ( 7.7) 29 (74.4). (N = 45) 0 ( 0.0) 1 ( 2.2) 2 ( 4.4) 1 ( 2.2) 1 ( 2.2) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 5 (11.1). (N = 26) 1 ( 3.8) 1 ( 3.8) 1 ( 3.8) 0 ( 0.0) 3 (11.5) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 0 ( 0.0) 6 (23.1). (N = 13) 1 ( 7.7) 1 ( 7.7) 2 (15.4) 1 ( 7.7) 2 (15.4) 0 ( 0.0) 0 ( 0.0) 1 ( 7.7) 3 (23.1) 11 (84.6). (N = 274) 5 ( 1.8) 8 ( 2.9) 13 ( 4.7) 6 ( 2.2) 15 ( 5.5) 4 ( 1.5) 2 ( 0.7) 3 ( 1.1) 7 ( 2.6) 63 (23.0). (%). (5.5%). (4.7%). 24. TACI. (2.9%) 84.6%. 13.5%. 74.4%. TACI. (54.1%). (46.2%) 17.9% (13.9%) (4.4%). (13.5%). 38.5% (0.7%). (20.0%). LACI (12.6%). TACI (35.9%) POCI (7.7%). PACI.

(5) 147. 3.6% 15.4% (. TACI. OCSP. ) (multiple linear. OCSP. regression) (. ). NIHSS OCSP NIHSS [14-16] NIHSS. OCSP. 80% NIHSS. LACI. [1,3,5] 8.4 (. 4.7. NIHSS 2.9. ). TACI 16.8. NIHSS. *n (%). LACI (N = 151). TACI (N = 39). PACI (N = 45). 3 ( 2.0) * 6 ( 4.0) 3 ( 2.0) 0 ( 0.0) 4 ( 2.6) 19 (12.6) 1 ( 0.7). 21 (53.8) 20 (51.3) 6 (15.4) 0 ( 0.0) 20 (51.3) 14 (35.9) 6 (15.4). 4 ( 8.9) 5 (11.1) 0 ( 0.0) 0 ( 0.0) 4 ( 8.9) 9 (20.0) 1 ( 2.2). LACI =. TACI =. (N = 274) POCI (N = 26). = 1) ) ( ) NIHSS ( ) NIHSS ( ) ( = 0) ( ) ( ) ( = 0) R 2 = 0.80. p = 0.003. 5 (38.5) 4 (30.8) 2 (15.4) 1 ( 7.7) 6 (46.2) 5 (38.5) 1 ( 7.7) POCI =. ). p 7731.2 185.7 2802.5 605.7 1744.3 30184.6 6104.0 18571.7 48832.5. 2732.3 122.0 243.1 320.1 408.4 6290.2 2753.1 2781.4 13198.2. p < 0.001 < 0.001 < 0.001 < 0.001 0.002 Others =. (N = 274). B ( (. Others (N = 13). 5 (19.2) 2 ( 7.7) 1 ( 3.8) 1 ( 3.8) 3 (11.5) 2 ( 7.7) 1 ( 3.8). PACI =. (. NIHSS. 0.005 0.129 < 0.001 0.060 < 0.001 < 0.001 0.027 < 0.001 < 0.001.

(6) 148. (19.9. 16.0. (0.7. ). 1.2). 51.3%TACI. PACI NIHSS. [4] TACI. 4.3. POCI. NIHSS. 80,023. 110,124. ( ) NIHSS LACI. [17-19]. 6 NIHSS [3,20]. OCSP NIHSS 46,803 26%. 21%. 15%. [19,21]. TACI. 100,613 34%. LACI [7,20,22]. (. 23%) 57%. 18.9%. [1]. 148 333,625 154,441 91,242 [23] 431,579 402,043. 286,212 602,513. 524,382. 718,191.

(7) 149. 1. 2000 2. 2004 3. -. [18,19] 2003 4. 1999 5.. [15,24]. 1999 6. Chang KC, Tseng MC, Weng HH, et al. Prediction of Length of Stay of First-Ever Ischemic Stroke. Stroke 2002;33:2670-4. 7. Holloway R, Dick AW. Editorial comment--stroke costeffectiveness research: are acceptability curves acceptable? Stroke 2004;35:203-4. 8. Patel A, Knapp M, Perez I, et al. Alternative strategies for stroke care: cost-effectiveness and cost-utility analyses from a prospective randomized controlled trial. Stroke 2004;35:196-203. 9. Webb DJ, Fayad PB, Wilbur C, et al. Effects of a specialized team on stroke care: The first two years of the Yale stroke program. Stroke 1995;26:1353-7. 10. Teasell RW, Foley NC, Bhogal SK, et al. Early. (Early Mobilization). supported discharge in stroke rehabilitation. Top Stroke Rehabil 2003;10:19-33. 11.Donnelly M, Power M, Russell M, et al. Randomized controlled trial of an early discharge rehabilitation. [21,25]. service: the Belfast Community Stroke Trial. Stroke. 4294. 10.1. 55.1% NIHSS. 7.8. 5.8 24. 2004;35:127-33. 12. Dewey HM, Thrift AG, Mihalopoulos C, et al. Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2003;34:2502-7. 13. Patel A, Knapp M, Evans A, et al. Training care givers. NIHSS. of stroke patients: economic evaluation. BMJ 2004;328: 1102. 14. Mead GE, Wardlaw JM, Dennis MS, et al. Relationship. NIHSS. OCSP. Between Pattern of Intracranial Artery Abnormalities on Transcranial Doppler and Oxfordshire Community Stroke Project Clinical Classification of Ischemic Stroke. Stroke 2000;31:714-9..

(8) 150. 15. Pinto AN, Melo TP, Lourenco ME, et al. Can a clinical. 21.Caro JJ, Huybrechts KF, Duchesne I. Management. classification of stroke predict complications and. patterns and costs of acute ischemic stroke: An. treatments during hospitalization. Cerebrovasc Dis. 1998;8:204-9.. International Study. Stroke 2000;31:582-90. 22. Jørgensen HS, Nakayama H, Raaschou HO, et al. The. 16. Ilzecka J, Stelmasiak Z. Practical significance of. Effect of a Stroke Unit: Reductions in Mortality,. ischemic stroke OCSP (oxfordshire Community Stroke. Discharge Rate to Nursing Home, Length of Hospital. Project) classification. Neurol Neurochir Pol 2000;34:. Stay, and Cost: A Community-Based Study. Stroke. 11-22.. 1995;26:1178-82.. 17. Reed SD, Blough DK, Meyer K, et al. Inpatient costs,. 23.. length of stay, and mortality for cerebrovascular events in community hospitals. Neurol 2001;57;305-314. 18. Chang KC, Tseng MC. Costs of acute care of first-ever ischemic stroke in Taiwan. Stroke 2003;34:e219-e1. 19. Diringer MN, Edwards DF, Mattson DT, et al.. 2006;2:10918 24. Spieler JF, Lanoe JL, Amarenco P. Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovascular Diseases 2004;17:134-42.. Predictors of acute hospital costs for treatment of. 25. Jørgensen HS, Nakayama H, Raaschou HO, et al. Acute. ischemic stroke in an academic center. Stroke 1999;30:. stroke care and rehabilitation: An analysis of the direct. 724-8.. cost and its clinical and social determinants: The. 20. Yoneda Y, Uehara T, Yamasaki H, et al. Hospital-based study of the care and cost of acute ischemic stroke in Japan. Stroke 2003;34:718-24.. Copenhagen stroke study. Stroke 1997;28:1138-41..

(9) 151. Factors Affecting the Medical Costs of Caring for Patients with Acute Ischemic Stroke 1. 2,3. Yi-Xiu Tsai, Ming-Feng Sun, Li-Chen Hung , Hsien-Wen Kuo 1. Center of Stroke, Kuang-Tien General Hospital; School of Nursing, Hungkuang Institution of Technology, 2. 3. Taichung; Institute of Environmental Health, China Medical University, Taichung; Institute of Environmental and Occupational Health Sciences, National Yang Ming University, Taipei, Taiwan.. Background/Purpose. To assess the medical costs of caring for stoke patients and the factors that affect those costs. Methods. We used the Oxfordshire Community Stroke Project (OCSP) classification system and the National Institutes of Health Stroke Scale (NIHSS) to classify the levels of severity in 274 stroke patients at a teaching hospital in Taichung. Patients’ medical information and the total costs billed by the hospital to the Bureau of National Insurance on behalf of each patient were collected. R e s u l t s . Overall, the average medical cost for the duration of hospitalization was NT$46,803 (NT$4,294/day); the average hospital stay was 10.9 days. The average NIHSS score was 7.8 at the time of admission and 5.8 at the time of discharge. Common complications included urinary infections, pneumonia, and 24-hour history of fever. Based on the results of multiple linear regression analysis, the factors affecting medical costs included gender, length of hospital stay, NIHSS score, complications, the number of medical treatments, whether or not the patient required emergency room services, and survival or death. Conclusion. If complications can be prevented, then the number of medical treatments and total length of hospital stay can be reduced, thereby reducing total medical costs. ( Mid Taiwan J Med 2008;13:143-51 ). Key words. acute ischemic stroke, medical cost, OCSP classification system. Received : 25 January 2007.. Revised : 23 March 2007.. Accepted : 30 June 2008. Address reprint requests to : Hsien-Wen Kuo, Institute of Environmental Health, China Medical University, 91 Hsueh-Shih Road, Taichung 404, Taiwan..

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