探討我國精神病床利用情形

Abstract

背景：各國陸續發展去機構化而使精神病床數逐年減少，在各國精神病床數減少之時，我國急慢性精神病床仍持續增加。目前國內對於精神病床之合理利用量尚無明確定義，故本研究利用健保資料庫，分析我國精神病床利用情形及適用性。 方法：以2006年全民健保申報精神科出院病患為對象，將1、2、30日內再住院併入同次住院。利用不同方式定義超長住院，包含急性住院天數超過30、60或90日；慢性住院天數超過60、90、150或180日；迴歸模式校正性別、年齡、DRG、共病、性別與年齡交互作用後，校正後住院日>75百分位或90百分位之日數；以及利用美國精神病人DRG平均住院天數為標準，計算台灣與美國住院日數差值，以分析我國精神病床利用情形。 結果：以與美國精神病人同一DRG住院天數計算，併入30日內再住院，國內一年急性超長住院人日達1,634,732人日，慢性超長住院人日達2,258,471人日；以迴歸模式校正大於90%計算，當次住院，國內一年急性超長住院為216,407人日，併入30日內再住院，慢性超長住院為136,335人日，將超長住院人日除以365天，則急性病床可節省593-4,479床；慢性病床可節省374-6,188床。 結論：利用迴歸模式校正超長住院天數可控制病患間差異；納入美國平均住院天數進行探討可瞭解與國際間之差異。我國每萬人口精神病床數較部分OECD國家高，國內精神病人超長住院情形嚴重，建議政府重視精神病床及資源之合理配置。

Objectives: The reduction in the psychiatric bed rate in many countries was initially based on a preference for deinstitutionalization and the number of psychiatric beds increased at the same time in Taiwan. The reasonable utilization of psychiatric beds is undefined. The National Health Insurance (NHI) database was used to explore the utilization of psychiatric beds under different categories of overstay in Taiwan. Methods: In this cross-sectional study, the discharged psychiatric inpatients in 2006 were collected from the NHI databases. The length of stay of patients with readmission within 1, 2 or 30 days was accumulated into the previous admission. The categories of overstay were divided into : 1) over 30, 60 or 90 acute hospital days, 2) over 60, 90, 150 or 180 chronic hospital days, 3) Length of stay over 75 or 90 percentile of inpatients, after adjusted the patients’ sex, age, DRG and co-morbidity by regression, and 4) over American average length of stay (LOS) of each psychiatric Medicare Severity Diagnosis Related Groups (MS-DRG), to estimate the total length of overstay in Taiwan. Results: Under the same category of DRG as America and the length of stay of patients with readmission within 30 days was accumulated into the previous admission, overstay of acute inpatients and chronic inpatients were 1,634,732 and 2,258,471 person-days per year, respectively. Using risk adjusted length of stay over 90 percentile of acute inpatients were 216,407 person-days per year and the length of stay of patients with readmission within 30 days was accumulated into the previous admission, chronic inpatients were 136,335 person-days per year. After dividing by 365 days to produce the conserved beds, 593 - 4,479 acute beds and 374 - 6,188 chronic beds can be conserved, respectively. Conclusions: The number of psychiatric beds per 10,000 population in Taiwan is more than some OECD countries, and the psychiatric inpatients has significant higher overstay in Taiwan. It is important to concern the psychiatric beds and resource allocation.