ICU service in Taiwan

Springer Science and Business Media LLC - Tập 2 - Trang 1-8 - 2014
Kuo-Chen Cheng1,2,3, Chin-Li Lu4, Yueh-Chih Chung1, Mei-Chen Huang5, Hsiu-Nien Shen6, Hsing-Min Chen1, Haibo Zhang7
1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
2Department of Safety Health and Environmental Engineering, Chung Hwa University of Medical Technology, Tainan, Taiwan
3Department of Medicine, National Defense Medical Center, Taipei, Taiwan
4Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
5Bureau of National Health Insurance Kao-Ping Branch, Kaohsiung, Taiwan
6Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan
7The Keenan Research Centre in Biomedical Science, St. Michael’s Hospital, Toronto, University of Toronto, Toronto, Canada

Tóm tắt

The aim of the study was to understand the current status of intensive care unit (ICU) in order to optimize the resources achieving the best possible care. The study analyzed the status of ICU settings based on the Taiwan National Health Insurance database between March 2004 and February 2009. A total of 1,028,364 ICU patients were identified. The age was 65 ± 18 years, and 61% of the patients were male. The total ICU bed occupancy rate was 83.8% which went up to 87.3% during winter. The ICU bed occupancy was 94.4% in major medical centers. The ICU stay was 6.5 ± 0.5 days, and the overall ICU mortality rate was 20.2%. The hospital stay was 16.4 ± 16.8 days, and the average cost of total hospital stay was approximately US$5,186 per patient. The rate of ICU bed occupancy was dependent on seasonal changes, and it reached near full capacity in major medical centers in Taiwan. The ICU beds were distributed based on the categories of hospitals in order to achieve a reasonable cost efficiency. ICU faces many challenges to maintain and improve quality care because of the increasing cost of state-of-the-art technologies and dealing with aging population.

Tài liệu tham khảo

Halpern NA, Pastores SM: Critical care medicine in the United States 2000–2005: an analysis of bed numbers, occupancy rates, payer mix, and costs. Crit Care Med. 2010, 38: 65-71. 10.1097/CCM.0b013e3181b090d0. Halpern NA, Pastores SM, Greenstein RJ: Critical care medicine in the United States 1985–2000: an analysis of bed numbers, use, and costs. Crit Care Med. 2004, 32: 1254-1259. 10.1097/01.CCM.0000128577.31689.4C. Wunsch H, Angus DC, Harrison DA, Collange O, Fowler R, Hoste EA, de Keizer NF, Kersten A, Linde-Zwirble WT, Sandiumenge A, Rowan KM: Variation in critical care services across North America and Western Europe. Crit Care Med. 2008, 36: 2787-2793. 10.1097/CCM.0b013e318186aec8. Kahn JM, Angus DC: Reducing the cost of critical care: new challenges, new solutions. Am J Respir Crit Care Med. 2006, 174: 1167-1168. 10.1164/rccm.200609-1388ED. Wen CP, Tsai SP, Chung WS: A 10-year experience with universal health insurance in Taiwan: measuring changes in health and health disparity. Ann Intern Med. 2008, 148: 258-267. 10.7326/0003-4819-148-4-200802190-00004. Cheng SH, Chiang TL: The effect of universal health insurance on health care utilization in Taiwan. Results from a natural experiment. JAMA. 1997, 278: 89-93. 10.1001/jama.1997.03550020017009. Lu JF, Hsiao WC: Does universal health insurance make health care unaffordable? Lessons from Taiwan. Health Aff. 2003, 22: 77-88. National Health Insurance Research Database. Available at http://w3.nhri.org.tw/nhird//en/index.htm. Accessed 14 September 2011 Wennberg JE, McPherson K, Caper P: Will payment based on diagnosis-related groups control hospital costs?. N Engl J Med. 1984, 311: 295-300. 10.1056/NEJM198408023110505. Charlson ME, Pompei P, Ales KL, MacKenzie CR: A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987, 40: 373-383. 10.1016/0021-9681(87)90171-8. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM: How to measure comorbidity: a critical review of available methods. J Clin Epidemiol. 2003, 56: 221-229. 10.1016/S0895-4356(02)00585-1. Klabunde CN, Potosky AL, Legler JM, Warren JL: Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000, 53: 1258-1267. 10.1016/S0895-4356(00)00256-0. Hospital accreditation. Available at http://mohwlaw.mohw.gov.tw. Accessed 24 February 2012 Taiwan has become an ageing society. Available at http://www.npf.org.tw/post/1/338. Accessed 14 September 2011 [in Chinese] Reinikainen M, Uusaro A, Ruokonen E, Niskanen M: Excess mortality in winter in Finnish intensive care. Acta Anaesthesiol Scand. 2006, 50: 706-711. 10.1111/j.1399-6576.2006.01041.x. Sheth T, Nair C, Muller J, Yusuf S: Increased winter mortality from acute myocardial infarction and stroke: the effect of age. J Am Coll Cardiol. 1999, 33: 1916-1919. 10.1016/S0735-1097(99)00137-0. Keatinge WR: Winter mortality and its causes. Int J Circumpolar Health. 2002, 61: 292-299. Dall TM, Gallo PD, Chakrabarti R, West T, Semilla AP, Storm MV: An aging population and growing disease burden will require a large and specialized health care workforce by 2025. Health Aff. 2013, 32: 2013-2020. 10.1377/hlthaff.2013.0714. Young WW, Swinkola RB, Zorn DM: The measurement of hospital case mix. Med Care. 1982, 20: 501-512. 10.1097/00005650-198205000-00006. Lilly CM, Cody S, Zhao H, Landry K, Baker SP, McIlwaine J, Chandler MW, Irwin RS: Hospital mortality, length of stay, and preventable complications among critically ill patients before and after tele-ICU reengineering of critical care processes. JAMA. 2011, 305: 2175-2183. 10.1001/jama.2011.697. Garfield M, Ridley S, Kong A, Burns A, Blunt M, Gunning K: Seasonal variation in admission rates to intensive care units. Anaesthesia. 2001, 56: 1136-1140. 10.1046/j.1365-2044.2001.01984.x. Cooke MW, Wilson S, Halsall J, Roalfe A: Total time in English accident and emergency departments is related to bed occupancy. Emerg Med J. 2004, 21: 575-576. 10.1136/emj.2004.015081. Hospital bed occupancy. Available at http://www.adf.com.au/archive.php?doc_id=168. Accessed 24 February 2014 Department of Health (UK): Shaping the Future NHS: Long Term Planning for Hospitals and Related Services: Consultation Document on the Findings of the National Beds Inquiry. 2000, London: Department of Health Cunningham JB, Kernohan WG, Sowney R: Bed occupancy and turnover interval as determinant factors in MRSA infections in acute settings in Northern Ireland: 1 April 2001 to 31 March 2003. J Hosp Infect. 2005, 61: 189-193. 10.1016/j.jhin.2005.04.014. Robert R, Reignier J, Tournoux-Facon C, Boulain T, Lesieur O, Gissot V, Souday V, Hamrouni M, Chapon C, Gouello JP: Refusal of intensive care unit admission due to a full unit: impact on mortality. Am J Respir Crit Care Med. 2012, 185: 1081-1087. 10.1164/rccm.201104-0729OC. Cardoso LT, Grion CM, Matsuo T, Anami EH, Kauss IA, Seko L, Bonametti AM: Impact of delayed admission to intensive care units on mortality of critically ill patients: a cohort study. Crit Care. 2011, 15: R28-10.1186/cc9975. Chang L: The effect of health payment reforms on cost containment in Taiwan hospitals: the agency theory perspective. J Health Care Finance. 2011, 38: 11-31. Global budget. Available at http://www.thrf.org.tw/EN/Page_Show.asp?Page_ID=124. Accessed 24 February 2014 Yan YH, Hsu S, Yang CW, Fang SC: Agency problems in hospitals participating in self-management project under global budget system in Taiwan. Health Policy. 2010, 94: 135-143. 10.1016/j.healthpol.2009.09.005. Chen FJ, Laditka JN, Laditka SB, Xirasagar S: Providers’ responses to global budgeting in Taiwan: what were the initial effects?. Health Serv Manage Res. 2007, 20: 113-120. 10.1258/095148407780744624. Health policy and data. 2014, Available at http://www.oecd.org/els/health-systems/. Accessed 24 February National health expenditures of Taiwan. http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4534. Accessed 24 February 2014 Wunsch H, Angus DC, Harrison DA, Linde-Zwirble WT, Rowan KM: Comparison of medical admissions to intensive care units in the United States and United Kingdom. Am J Respir Crit Care Med. 2011, 183: 1666-1673. 10.1164/rccm.201012-1961OC. Wunsch H, Rowan KM, Angus DC: International comparisons in critical care: a necessity and challenge. Curr Opin Crit Care. 2007, 13: 725-731. 10.1097/MCC.0b013e3282f1bb56. The ratio of the health expenditure and GDP per capita in 2010 data. http://twbusiness.nat.gov.tw/old/pdf/sec9. Accessed 03 December 2013