Patient Characteristics and Medical Resources Utilization of Intensive Care Patients Who Discharged from Hospitals and then Readmitted to Intensive Care Units
Date Issued
2004
Date
2004
Author(s)
Tsai, Chun-Ting
DOI
zh-TW
Abstract
The intensive care units (ICUs) are the medical units which admit critical patients. ICU requires intensive manpower and equipment in the hospital, and utilizes a significant portion of hospital resources. With the increase of aging population, the demand for ICUs grows. Taking an example of the United States, though the number of ICU beds accounted for 10% of all hospital beds, the resources the intensive care utilizes were accounted for 30% of health expenditure in 1994. On the other hand, due to the tight control of health insurances expenditures, the longer the LOS in ICUs are, the more possible the medical claims would be cut down and damage to hospital finance. However, excessively early transferring from ICUs will not only readmit the patients back to ICUs, but also utilize more medical resources, and damage to patients and hospital finance.
The management of readmission to ICU can improve the utilization of medical resources; it has positive influence on medical quality control at the same time. According to these, the Society of Critical Care Medicine Task has set it as one of the important quality indicators, and Taiwan Joint Commission on Hospital Accreditation also has set it as an intensive care indicator of the Taiwain Quality Indicator Project (TQIP). However, with the payment system and the integrated patient centered health care orientation changing, we not only observe the patients’ status of admission, but also the treatment and final health outcome in one’s HMO, even the whole health care system while evaluating the medical quality of admission and medical resources utilization. Therefore, this study discusses the present condition of patients who discharged from hospitals and then readmitted to ICUs, and analyzed their characteristics and medical resources utilization.
This is a secondary empirical data analysis study. Through the analysis of nation-wide NHI database, we probe the present situations of the post-discharging readmission to ICUs in the same and different hospitals among multi-level hospitals, in order to understand the ICU patients in Taiwan and their readmission to ICUs. Also, we would like to appreciate the appropriateness of taking post-discharging readmission to ICUs as one of the quality indicators.
The results show that gender, age, and disease pattern are the risk factors of post-discharging readmission to ICUs. Male and aged 65 years old and upper take the majority of these patients. We discover that cardiovascular and respiratory diseases are their major diagnoses, septicemia, and gastroinstinal diseases appear the next. In the chronic disease diagnoses, chronic liver diseases and liver cirrhosis often give the priority. Notably, the more the second diagnoses are, the higher the probability of post-discharging readmission to ICUs is.
Furthermore, the results show that the patients with post-discharging readmission to ICUs experience had shorter LOS in their preceding hospitalization than the ones without this experience. The reason to explain these could be the excessively early transferring of the patient whose unstable health conditions and it brought out the later readmission to ICUs. Judging from the death rate of post-discharging readmission to ICUs in different hospitals, we find higher mortality in lower level hospital where the patients readmitted to ICUs. It is reasonable that most patients readmitted to ICUs in higher or the same level hospitals, but the results show that there are still a little ones readmitted to lower level hospitals, lacking of better equipments and higher density intensive care service, the survival rate of the readmitted patients dropped, indicating that patient dumping might exist. Due to the column loss of NHI database, we cannot discuss the readmission to ICUs in the same hospitalization for further. Besides, this study finds that the patients who discharged from hospitals and then readmitted to ICUs have higher mortality and medical resources utilization.
According to the above findings, this study suggests that the health related authorities should keep the columns denote the tire of beginnings and endings of the medical orders, and add the clinical information related to the patients, such as the diagnostic codes and scores of APACHE II. Thus, by analyzing the database, we can evaluate the patients admit to or transfer from ICUs, and benefit to patient management and academic researches in the future. This study also suggests that we can absorb the concept, post-discharging readmission to ICUs management, in the monitor of total admission medical quality, but we should avoid to use it as part of the bonus-penalty system in case of the cream skimming effect. On the other side, we should enhance the system of differential medical facilities and referral, and integrate the patient centered medical information, so that we can decline the avoidable health expense.
Subjects
品質指標
加護病房
醫療品質
醫療資源耗用
以病人為中心
健康保險
重返加護病房
病人安全
Medical resources utilization
Patient safety
Quality indicator
Medical quality
Health insurance
Intensive care unit
Patient centered care
Readmission to ICU
Type
thesis
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