A Cost-Effectiveness Analysis of the Intermediate Care Ward－The Case of A Medical Center in Taipei City
|Keywords:||中繼照護病床;經濟評估;成本效果分析;Intermediate Care Ward;Economic Evaluation;Cost-effectiveness Analysis||Issue Date:||2006||Abstract:||
Readmission to ICU will use a lot of medical resources, and patients’ prognosis would be bad. For these reasons, the readmission rate is long regarded as an important medical quality indicator. The study hospital recently set up an intermediate care ward use assessment tools to identify those with high readmission risk from ICU discharge patients. a lower nurse to bed ratio, the medical team will focus on the cooperation and communication about the discharge plan with patients and their relatives. In this unit, patients would receive the connective therapy and be transferred to the general ward when they are stable. It is believed that this unit could reduce the incidence of readmission to ICU.
The purpose of this study is to estimate in the cost and effectiveness of patients transferred to the intermediate care ward and to the general ward after they were discharged from the ICU. The analysis was conducted from the viewpoints of hospital and patients, respectively. Main source of parameters for analysis came from the study medical center in Taipei City, only limited data came from expert opinions and existing literature.
The major results of this study are as follow：
(1) From October, 2004 to the end of 2005, there were 279 patients discharged from the medical ICU who were qualify to be transferred to either the intermediate care ward or general wards. Among 101 patients transferred to the intermediate care ward, 9 patients readmitted to ICU and, in addition, 5 patients died in 7 days since they had discharged from ICU. The readmission rate of intermediate care ward is 8.91% (13.86% including death). On the other sidehand, among 178 patients transferred to general wards were collected in group2, 18 patients readmitted to ICU and additional 13 patients died in 7 days since discharged from ICU. The readmission rate of general ward is 10.11% (17.42% including death). Judging from the readmission rates, the intermediate care ward is more effective than general wards.
(2) In the view of the hospital, the cost per patient per day of intermediate care ward is $ 7886.08 and the cost of general ward is $ 7572.01.
(3) In the view of patients, the cost per patient per day of intermediate care ward is $ 353.29 and the cost of general ward is $ 480.32.
(4)In the view of the hospital, compared to general ward, the cost of reducing 1% readmission rate is $2197.99 ($617.55 if including death) in 7 days after a patients was admitted to the intermediate care ward. If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $473.63($98.68 if including death)
(5)In the view of patients, compared to general ward, the cost of reducing 1% readmission rate is $1497.01 ($504.61 if including reducing death). If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $1059.4($224.17 if including death)
We conclude that the intermediate care ward will cost more then general wards but reduce more admission rate and death rate within7 days after patients were discharged from ICU. It is worthwhile for hospitals to consider establishing an intermediate care ward.
|Appears in Collections:||健康政策與管理研究所|
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