探討醫院緊急醫療能力分級標準之實施對於急性缺血性腦中風患者照護過程與照護結果之影響

Abstract

研究背景：腦血管疾病為我國第三大主要死因。為提升腦中風患者之照護過程與結果，各國成立腦中風中心，並結合腦中風責任醫院計畫，朝區域化腦中風照護體系發展。台灣於2009年7月實施醫院緊急醫療能力分級制度，結合腦中風中心及責任醫院之概念，期望能達到改善腦中風患者之照護過程及結果之目標。目前，探討腦中風責任醫院計畫是否能有效提升腦中風患者照護過程及照護結果之研究並不多。 研究目的：探討醫院緊急醫療能力分級評定之實施，對於急性缺血性腦中風病患之照護過程與照護結果之影響。 研究方法：本研究使用全民健康保險研究資料庫2005年百萬承保抽樣歸人檔進行次級資料分析，以2006年至2011年急性缺血性腦中風病患為研究對象，利用廣義估計方程式(Generalized Estimating Equations, GEE)控制病患特性及醫院特性，探討醫院緊急醫療照護能力分級標準之實施對於急性缺血性腦中風病患照護過程與照護結果之影響。 研究結果：醫院緊急醫療能力分級標準實施後，全國血栓溶解劑之使用率增加之情形，達統計邊際顯著水準；CT/MRI檢查呈現上升趨勢，達統計上顯著差異。 研究結論：台灣醫院緊急醫療能力分級標準之實施，對於急性缺血性腦中風患者部份照護過程有改善的情形，但對於患者照護結果則未見顯著差異。

Backgrounds: Cerebrovascular disease is the third leading cause of death in Taiwan. To improve processes and outcomes of care in acute ischemic stroke patients, many countries have developed the acute stroke system toward the regionalization by establishing the stroke centers and implementing the stroke center designation project. The hierarchical system of emergent rescuer responsive hospitals which combines the concept of stroke center with responsive hospitals was implemented in Taiwan in July 2009. Recently, there is little research to analyze the effectiveness of the stroke center designation project in the processes and outcomes of care. Objectives: The main purpose of this study is to evaluate the association of the implementation of the hierarchical system of emergent rescuer responsive hospitals with processes and outcomes of care for patients with acute ischemic stroke. Methods: A retrospective population-based study used claims data of 1 million sampled registry from Taiwan National Health Insurance Research Database. The study population were all patients admitted with acute ischemic stroke to each hospital from 2006 to 2011. Generalized Estimating Equations (GEE) were used to test the hypotheses, adjusting for the characteristics of patients and hospitals. Results: After implementing the hierarchical system of emergent rescuer responsive hospitals, the utilization of the recombinant tissue plasminogen activator (rt-PA) has increased and reached marginally significant. The utilization of CT/MRI has significantly increased after the implementation. Conclusions: Due to the implementation of the hierarchical system of emergent rescuer responsive hospitals, there are improvements in certain processes of care, but there is no improvement in outcomes of care for patients with acute ischemic stroke.