2014年度診療報酬改定基準における経口摂取回復率の検討

An Investigation of the Oral Intake Recovery Rate as Defined by the 2014 Medical Treatment Reward Revision in Japan

要旨　目的：2014年度診療報酬改定により経口摂取回復率が新たに定義され，35％以上であることが各種加算・減算要件で求められる．当院の経口摂取回復率を算出し問題点を検討した．方法：2012年4月〜2014年3月当院入院中，摂食嚥下障害に鼻腔栄養や胃瘻を導入した286例に関し，病態毎に年齢，性別，経管栄養からの離脱率，経口摂取回復率，離脱までの日数を後方視的に調べた．結果：離脱率は，直接障害を来さない病態やリハが効果的な病態（脳卒中，頭部外傷，口腔・咽喉頭癌）で概ね5割を超えたが，障害が進行・顕在化する病態（神経変性疾患，脳卒中・頭部外傷慢性期後遺症，呼吸器疾患）は35％未満であった．経口摂取回復率は，離脱率の分母分子から「1カ月以内に経口摂取に回復した」87例などが除外されほぼ全て35％未満となった．結論：現在の経口摂取回復率の基準は実状と乖離しており，病態毎の目標設定や早期リハの評価に関し再検討すべきである．

　Abstract　Objective : The 2014 Medical Treatment Reward Revision in Japan newly defines the oral intake recovery rate and requires a change of more than 35% to calculate various additions and subtractions. We calculated the recovery rate in various diseases and clarified some inherent problems. Methods : From April 2012 to March 2014, we retrospectively investigated the age, sex, removal rate from nasal nutrition or gastric fistula, oral intake recovery rate and days until removal of 286 inpatients with nasal nutrition or gastric fistula for dysphagia. Results : The removal rates for stroke, brain injury, oral and laryngopharyngeal cancer and other diseases were nearly always more than 50% because the disease did not cause dysphagia directly or the rehabilitation was effective for treating the remaining dysphagia. But the removal rates for neurodegenerative disease, complications due to stroke and brain injury in the chronic phase and respiratory disease did not reach 35% because the previous dysphagia progressed or actualized. Almost all oral intake recovery rates did not extend to 35% for exclusion of oral intake recovery within one month. Conclusion : The criteria of oral intake recovery rate needs to be reviewed in respect to setting goals to match the patient's underlying disease and to evaluate the possibility for early rehabilitation.