Chung Hui-Chun, Wang Lih-Shinn, Wu Jung-Lun, Hsieh Tsung-Cheng
Department of Nursing, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Division of Infectious Disease, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Tzu Chi Med J. 2019 Jul-Sep;31(3):182-187. doi: 10.4103/tcmj.tcmj_63_18.
The objectives of this study are to explore medical care utilization associated with promoting the central venous catheter (CVC) care bundle plan using Taiwan's National Health Insurance Research Database (NHIRD).
We performed a cross-sectional, secondary analysis of the data from patients who were admitted to a medical center for the first time between July 1, 2010, and June 30, 2012, in the NHIRD. The control group was patients who were admitted at nine medical center hospitals that participated in the pilot plan, and the study group was patients who were admitted at other ten medical center hospitals that did not participate in the pilot plan, and the differences between groups were analyzed.
After implementing the CVC care bundle, the average hospital stay decreased significantly (18.43 ± 12.96 vs. 15.49 ± 10.16, < 0.05). In addition, the study group patients were clinically less likely to require antibiotics than the control group (odds ratio = 0.33, 95% confidence interval [CI] = [0.07, 1.71] vs. 0.62, 95% CI = [0.40, 0.96], = 3768), and their medical expenses were lower (220, 618 ± 226, 419 vs. 208, 079 ± 193, 610, > 05). Furthermore, the incidence rate of CVC-associated sepsis decreased from 12.59% to 5.66%.
By implementing the CVC care bundle in clinical practice in accordance with national policies, medical utilization decreased, thereby considerably improving medical resource usage. These results confirmed that implementing the CVC care bundle possibly decreased medical utilization in clinical practice.
本研究的目的是利用台湾国民健康保险研究数据库（NHIRD），探讨与推行中心静脉导管（CVC）护理集束计划相关的医疗服务利用情况。
我们对2010年7月1日至2012年6月30日期间首次入住某医学中心的患者数据进行了横断面二次分析，这些数据来自NHIRD。对照组为入住参与试点计划的9家医学中心医院中的患者，研究组为入住未参与试点计划的其他10家医学中心医院中的患者，并对两组之间的差异进行了分析。
实施CVC护理集束计划后，平均住院时间显著缩短（18.43±12.96天 vs. 15.49±10.16天，P<0.05）。此外，研究组患者临床上使用抗生素的可能性低于对照组（优势比=0.33，95%置信区间[CI]=[0.07, 1.71] vs. 0.62，95%CI=[0.40, 0.96]，P=3768），且其医疗费用更低（220,618±226,419元 vs. 208,079±193,610元，P>0.05）。此外，CVC相关脓毒症的发生率从12.59%降至5.66%。
通过按照国家政策在临床实践中实施CVC护理集束计划，医疗服务利用减少，从而显著提高了医疗资源的使用效率。这些结果证实，在临床实践中实施CVC护理集束计划可能会降低医疗服务利用。
