目前相關呼吸器研究較著重於預測脫離、生理指標之探討，對照護品質面，卻甚少研究。故本研究探討總額計畫實施前後對呼吸器依賴患者整合性照護計畫(Integrated Delivery Services；IDS)在照護品質上是否有影響。此為回溯性研究；2001-2008年以台灣健保局資料中擷取17歲以上連續使用呼吸器≧21天個案，IDS實施1-2年後(總額計畫實施前1-2年；甲組)、總額計畫實施後1-2年；乙組、總額計畫實施後3-4年；丙組，是否會對IDS呼吸器依賴患者；收案者，在醫院總額介入後，對照護品質：產生肺塌陷；A組、感染肺炎；B組、病危死亡(死亡率)；C組，產生影響。首份樣本2001-2008年，個案由加護病房下轉至呼吸照護中心、呼吸照護病房，樣本數共553位。次要樣本：探討總額實施介入前後比較，經時間呈現，讓整體樣本不因住院天數及醫療費用重複計算、評估誤差，選取2001-2006年有兩次以上的IDS個案，只取第一次的資料。經篩選後共295位。總額後收案者和各變項的相關性：(1).與A組有顯著相關：疾病特質中的癌症(P=0.014)、機構特質醫院層級(P<0.001)及醫院地區(P=0.013).(2).與B組顯著相關有兩項：性別(P<0.011)、疾病嚴重度(P<0.001)/(3).與C組顯著相關有：醫院權屬(P=0.033)；總額後影響照護品質的邏輯式迴歸分析：(1).預測結果顯示：總額後A組未受到影響(P=0.273).(2).預測顯示：總額介入，B組並無顯著差異(P=0.440)，以甲組為參考，乙組及丙組和實施前無顯著差異(P=0.320和P=0.996)；因兩者P值皆＞0.05，故總額介入對B組未帶來影響.(3).結果顯示：總額介入與C組無顯著差異(P=0.139)，以甲組為參考，乙組及丙組和實施前亦無顯著差異(P=0.417和P=0.399)；因兩者P值皆＞0.05，故總額介入對C組未產生影響。此結果說明：醫院實施總額制度對整合性照護計畫(IDS)未影響照護品質。

Current studies on ventilator focus more on prediction of weaning and physical indices, while few explore healthcare quality. Therefore, this study aimed to investigate the influence on healthcare quality to ventilator-dependent patients on Integrated Delivery Services (IDS) before and after the implementation of global budgets system. As a retrospective research, this study investigated patients of 17-year-old and above who used ventilators for 21 consecutive days and over based on the data from the National Health Insurance (NHI) Administration, Taiwan from 2001 to 2008. Group 1 referred to patients who are on IDS for one to two years (that is one to two years before the implementation of the Global Budgets System); Group 2 referred to those on IDS one to two years after the Global Budgets System; and Group 3 referred to those on IDS three to four years
after the Global Budgets System. Those who developed dependence on IDS ventilator were referred to as “Receivers.” After the hospital’s intervention with the global budgets system, the healthcare quality was affected and led to cases of atelectasis (Group A), pneumonia (Group B) and death (Group C). The first batch of samples consisted of 553 receivers of IDS cases transferred from ICU to RCC and RCW from 2001 to 2008. The secondary samples were used to compare the influences before and after the intervention of global budgets system through time. Cases with over two IDS between 2001 and 2006 were selected so that the length of hospital stay and repeated calculation of medical expenses, evaluation would not cause estimate error; and data of the first IDS were sampled.After the screening, 295 cases were selected. The relevance between the receivers and the variables after the intervention of global budgets system are as follows:(1) Significantly correlative with Group A: cancer (P=0.014) on disease characteristics, hospital level(P<0.001) and hospital region (P=0.013) on institution characteristics;(2) Two factors significantly correlative with Group B: gender (P<0.011) and disease severity (P<0.001);(3) Significantly correlative with Group C: hospital ownership (P=0.033). According to the logistic regression analysis on healthcare quality after the global budgets system, the predicted results showed: (1) Group A was not influenced by the intervention of global budgets system (P=0.273); (2) there was no significant difference with the intervention of global budgets system (P=0.440), and Groups 2 and 3 showed no significant difference (P=0.320 and P=0.996), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group B by the intervention of global budgets system. (3) there is no significant difference between the invention of global budgets system and Group C (P=0.139). and Groups 2 and 3 showed no significant difference (P=0.417 and P=0.399), when using Group 1 as reference, compared to circumstances before the implementation. Since P is ＞0.05 in both, no influence is caused to Group C by the intervention of global budgets system.The results indicated that no influence was caused to the healthcare quality of IDS by the hospital’s implementation of global budgets system.