為了抑制醫療費用上漲所帶來的問題，健保局即將於2009年9月全面實施台灣版DRG(Taiwan Diagnostic Related Group；TW-DRG)支付制度來取代論量計酬制。TW-DRG的實施會為醫院經營管理帶來重大的改變，疾病分類編碼將左右DRG分派，並影響醫院收入，更可能間接影響醫師薪酬。因此ICD-9-CM編碼不一致將可能導致醫師與疾病分類人員間之衝突，並產生巨額溝通成本。由於相關研究較少探討醫師與疾病分類人員編碼的一致性，因此本研究將探討醫師與疾病分類人員編碼(ICD-9-CM、DRG分派)一致性與否，及其影響編碼一致性之因素。以及未來DRGs實施後，編碼一致性與否對於申報費用等影響。
本研究將分為兩階段，同時採用量性與質性的兩種方法來交互分析其結果。第一階段透過醫師與疾病分類人員在病患出院診斷之病歷個案做重複編碼，藉此探討醫生與疾病分類人員之間編碼結果是否達到一致，並分析其影響編碼一致性之因素。經由費雪精確檢定(Fisher's Exact test)、邏輯斯迴歸(Logistic Regression)等分析方法進行資料分析。第二階段研究為質性研究，以深入訪談和焦點群體法探討影響醫師與疾病分類人員編碼不一致之因素，並以內容分析法分析資料。
研究結果發現，編碼一致性比例為17%，編碼不一致性高達83%，
其中以合併症/併發症(C/C)與醫師接受疾病分類人員協助編碼、個人、疾病認知不同、專業領域之差異、病歷書寫品質等為影響編碼一致性之因素。另外，醫師申報之點數試算低於疾病分類人員。期望本研究結果在未來TW-DRGs全面實施時，可提供醫療院所及衛生行政相關單位因應之參考。 Considering the continuous inflation of medical costs in Taiwan, the Diagnostic Related Group (DRG) was proposed to replace Fee For Service (FFS) in the reimbursement system since September 1, 2009. However, the accuracy and validity of the present medical coding system of DRG in Taiwan is still controversial The implementation of DRG will bring changes in hospital administration, so as the inconsistent perceptions of disease coding by physicians and coders. The coding results may influence hospital income and physician salary, and the inconsistent perceptions of disease coding may bring conflicts between physicians and coders. Since there is lack of rigorous studies concerning the consistency of ICD-9-CM coding between physicians and coders, this study intends to discuss the consistency between the re-coding code by physicians and the original code by coders.
Two-phased study was conducted. A quantitative study involving the statistical differences analysis(Fisher's Exact test、Logistic Regression) was performed in the phase I study to explore the consistency of coding and its impact on DRGs. In the phase II study, in-depth interviews and focus groups with physicians and coders were be performed to explore the causes and effects of inconsistent coding. Content analysis was used to analyze the qualitative data.
The results showed that the proportions of coding are 17% consistent and 83% inconsistent. The factors resulting in coding inconsistency include comorbidity/complication(c/c)、physicians accepting the assistance from coders、different perceptions of diseases, poor writing quality of medical records, and the odiversity of professionals. The study results expect to addresses comments to national public hygiene policy and hospital management when facing the implementation of DRGs.
