Chen Tzeng-Ji, Lin Ming-Hwai, Chou Li-Fang, Hwang Shinn-Jang
Department of Family Medicine, Taipei Veterans General Hospital, Shih-Pai Road, Section 2, No 201, Taipei 11217, Taiwan.
BMC Health Serv Res. 2006 Aug 4;6:94. doi: 10.1186/1472-6963-6-94.
The severe acute respiratory syndrome (SARS) epidemic threw the world into turmoil during the first half of 2003. Many subsequent papers have addressed its impact on health service utilization, but few have considered palliative (hospice) care. The aim of the present study was to describe changes in hospice inpatient utilization during and after the SARS epidemic in 2003 in Taiwan.
The data sources were the complete datasets of inpatient admissions during 2002 and 2003 from the National Health Insurance Research Database. Before-and-after comparisons of daily and monthly utilizations were made. Hospice analyses were limited to those wards that offered inpatient services throughout these two years. The comparisons were extended to total hospital bed utilization and to patients who were still admitted to hospice wards during the peak period of the SARS epidemic.
Only 15 hospice wards operated throughout the whole of 2002 and 2003. In 2003, hospice utilization began to decrease in the middle of April, reached a minimum on 25 May, and gradually recovered to the level of the previous November. Hospices showed a more marked reduction in utilization than all hospital beds (e.g. -52.5% vs. -19.9% in May 2003) and a slower recovery with a three-month lag. In total, 566 patients were admitted to hospice wards in May/June 2003, in contrast to 818 in May/June 2002. Gender, age and diagnosis distributions did not differ.
Hospice inpatient utilization in Taiwan was indeed more sensitive to the emerging epidemic than general inpatient utilization. A well-balanced network with seamless continuity of care should be ensured.
2003年上半年，严重急性呼吸综合征（SARS）疫情使全球陷入动荡。许多后续论文探讨了其对医疗服务利用的影响，但很少有人考虑姑息（临终关怀）护理。本研究的目的是描述2003年台湾SARS疫情期间及之后临终关怀住院患者利用情况的变化。
数据来源是国民健康保险研究数据库中2002年和2003年住院患者的完整数据集。对每日和每月的利用情况进行前后比较。临终关怀分析仅限于这两年中提供住院服务的病房。比较范围扩大到医院总床位利用情况以及在SARS疫情高峰期仍入住临终关怀病房的患者。
2002年全年和2003年只有15个临终关怀病房运营。2003年，临终关怀利用在4月中旬开始下降，5月25日降至最低，随后逐渐恢复到前一年11月的水平。临终关怀机构的利用率下降幅度比所有医院床位更为明显（例如，2003年5月为-52.5%对-19.9%），且恢复较慢，滞后三个月。2003年5月/6月共有566名患者入住临终关怀病房，而2002年5月/6月为818名。性别、年龄和诊断分布没有差异。
台湾临终关怀住院患者的利用情况确实比一般住院患者利用情况对新出现的疫情更为敏感。应确保建立一个护理无缝衔接的均衡网络。
