| 摘要: | 目的：本研究主要在分析潛在可預防併發症次診斷案件之醫療資源利用，及其對全民健保住院診斷關聯群(Taiwan Diagnosis Related Groups, Tw-DRGs)群組分派之影響。方法：採回溯性病例對照研究法，實驗組為依美國2009年公告之十項潛在可預防併發症次診斷群組(併發症群組)之2006年至2008年健保住院案件共1,697件，對照組為經年度、主要診斷、Tw-DRGs、年齡與性別等配對選取無潛在可預防併發症案件1,617件。以獨立t檢定、卡方檢定和多變量共變數進行資料分析。結果：有潛在可預防併發症平均醫療費用與住院日均顯著較無潛在可預防併發症高(醫療費用：156,174點vs 98263點, p <0.001；住院日：18.87天vs 12.31天, p <0.001)。醫院層級與併發症群組會共同調節潛在可預防併發症對醫療費用與住院日之影響。刪除次診斷潛在可預防併發症後，Tw-DRGs 群組分派改變率16%，群組分派改率所減少的Tw-DRGs相對總權重為135.685，分派改變之案件平均診斷編碼個數顯著較無改變低(3.19 vs 3.69, p <0.001)。結論：潛在可預防併發症次診斷不予支付，可能降低健保醫療費用支出，然此意涵將受到診斷編碼個數之影響。
Objective: This study was conducted to determine the health care expenses and length of stay (LOS) of hospital-acquired conditions (HACs) defined by Centers for Medicare & Medicaid Services (CMS) in 2009 and its impact on the Tw-DRGs assignment. Methods: In this retrospective case-control study, patients with HACs presenting as a secondary diagnosis were obtained from the Inpatient Expenses by Admissions files of the National Health Insurance (NHI) research database, released by the NHI program in Taiwan for 2006-2008. The control patients were matched to the study group by admission year, principal diagnosis, Tw-DRG, sex and age. With-HACs (1,697) and without-HACs (1,617) population were compared for health care expenses and LOS. Two sample t test, chi-square test and MANCOVA (Charlson comorbidity index as covariate, p>0.05) analysis technique were used for data analysis. Results: Mean health care expenses (relative value unit, RVU) and LOS per admission in the with-HACs population were statistically significantly higher than in the without HACs population (health care expenses: 156,174 RVU vs. 98.263 RVU, P<0.001; LOS: 18.87 vs. 12.31, p<0.001). The impacts of HACs on the health care expenses and LOS were interactively moderated by hospital level and HACs categories. Among 1,697 admissions with HACs, 16% experienced a change in Tw-DRG assignment without the HAC factored into the assignment and decreased DRG relative weights in 135.685. Those admissions with Tw-DRG assignment changes when HACs were removed had significantly fewer additional number of diagnoses than those without Tw-DRG assignment changes (3.19 vs. 3.69, p<0.001). Conclusions: Patients with HACs had significantly higher health care expenses and LOS while hospitalized. The preliminary findings imply that NHI medical expenditures may result in decreasing when certain hospital-acquired conditions are no longer paid for the extra cost associated with complications by the Bureau of Taiwan’s NHI. However, it is possible that variation in coding practice may affect the implication of health care expenses saving. |
