Tzeng I-Shiang, Chien Kuo-Liong, Tu Yu-Kang, Chen Jau-Yuan, Ng Chau Yee, Chien Cheng-Yu, Chen Jih-Chang, Chaou Chung-Hsien, Yiang Giou-Teng
Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Department of Statistics, National Taipei University, Taipei, Taiwan.
Health Policy Technol. 2018 Jun;7(2):149-155. doi: 10.1016/j.hlpt.2018.01.010. Epub 2018 Jan 31.
The protocol for early goal-directed therapy (EGDT) is effective for improving both the costs and outcomes of septicemia treatment, including a significant reduction in case fatality. However, this complicated protocol may have a downside. Furthermore, the Joint Taiwan Critical Care Medicine Committee has launched a nationwide educational program after the publication of the Surviving Sepsis Campaign (SSC) to improve the overall survival rate from septicemia in the emergency care system of Taiwan.
To assess the impact of the EGDT protocol and SSC education programs on island-wide septicemia-related emergency department (ED) visits.
Segmented regression techniques were utilized to assess the differences in annual rates and changes in septicemia-related ED visits between 1998 and 2012. We considered annual incidence of two medical comorbidities as potential confounders: metastatic malignant neoplasms and malignant neoplasms of the lymphatic and hematopoietic tissues.
The EGDT protocol was associated with decreased septicemia-related ED visits in 2002 (level change; < 0.001), while the SSC education program led to a slight increase in septicemia-related ED visits in 2007 (slope change; < 0.001). For the EGDT protocol, the number of patient visits decreased by 32.9% after the protocol was implemented in 2002 compared with the expected number without the intervention. For the SSC education program, the number of patient visits increased by 20.2% (compared with the predicted number) in 2007 after the education program was implemented.
The EGDT protocol and SSC education program were associated with significant immediate changes and lagged intervention effects on island-wide septicemia-related ED visits.
早期目标导向治疗（EGDT）方案对于改善败血症治疗的成本和结果有效，包括显著降低病死率。然而，这个复杂的方案可能存在不利之处。此外，台湾重症医学联合委员会在《拯救脓毒症运动》（SSC）发布后开展了一项全国性教育项目，以提高台湾急诊医疗系统中败血症的总体生存率。
评估EGDT方案和SSC教育项目对全岛与败血症相关的急诊科就诊情况的影响。
采用分段回归技术评估1998年至2012年间与败血症相关的急诊科就诊年率差异及变化情况。我们将两种合并症的年发病率视为潜在混杂因素：转移性恶性肿瘤以及淋巴和造血组织恶性肿瘤。
EGDT方案与2002年与败血症相关的急诊科就诊次数减少有关（水平变化；<0.001），而SSC教育项目导致2007年与败血症相关的急诊科就诊次数略有增加（斜率变化；<0.001）。对于EGDT方案，2002年实施该方案后，患者就诊次数比无干预时的预期次数减少了32.9%。对于SSC教育项目，2007年实施教育项目后，患者就诊次数比预测次数增加了20.2%。
EGDT方案和SSC教育项目与全岛与败血症相关的急诊科就诊情况的显著即时变化和滞后干预效果有关。
