台湾中心静脉导管插入护理捆绑包的使用情况:国民健康保险研究数据库的横断面分析。

Hui-Chun Chung, Lih-Shinn Wang, Jung-Lun Wu, Tsung-Cheng Hsieh
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摘要

研究目的本研究旨在利用台湾国民健康保险研究数据库(NHIRD)探讨与推广中心静脉导管(CVC)护理捆绑计划相关的医疗护理利用情况:我们对 NHIRD 中 2010 年 7 月 1 日至 2012 年 6 月 30 日期间首次入住医疗中心的患者数据进行了横断面二次分析。对照组为参与试点计划的九家医疗中心医院收治的患者,研究组为未参与试点计划的其他十家医疗中心医院收治的患者,并分析了组间差异:结果:实施CVC护理捆绑后,平均住院时间明显缩短(18.43 ± 12.96 vs. 15.49 ± 10.16,P < 0.05)。此外,与对照组相比,研究组患者在临床上需要使用抗生素的几率更低(几率比=0.33,95% 置信区间[CI] = [0.07, 1.71] vs. 0.62,95% CI = [0.40, 0.96],P = 3768),医疗费用也更低(220, 618 ± 226, 419 vs. 208, 079 ± 193, 610,P > 05)。此外,CVC相关败血症的发生率从12.59%降至5.66%:结论:根据国家政策在临床实践中实施 CVC 护理捆绑包后,医疗使用率下降,从而大大改善了医疗资源的使用情况。这些结果证实,在临床实践中实施 CVC 护理捆绑可能会降低医疗使用率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Utilization of a central venous catheter insertion care bundle in Taiwan: A cross-sectional analysis of the National Health Insurance Research Database.

Objectives: 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).

Materials and methods: 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.

Results: After implementing the CVC care bundle, the average hospital stay decreased significantly (18.43 ± 12.96 vs. 15.49 ± 10.16, P < 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], P = 3768), and their medical expenses were lower (220, 618 ± 226, 419 vs. 208, 079 ± 193, 610, P > 05). Furthermore, the incidence rate of CVC-associated sepsis decreased from 12.59% to 5.66%.

Conclusions: 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.

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