Tw-DRGs支付制度實施：醫療服務之影響與意涵

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標題:	Tw-DRGs支付制度實施：醫療服務之影響與意涵 Tw-DRGs payment initiatives：Impact on and Implication for medical services
作者:	陳亞屏
貢獻者:	嘉南藥理科技大學：醫療資訊管理研究所楊美雪
關鍵字:	診斷關聯群病例組合指標 14天再入院住院天數合併症或併發症 Tw-DRGs CMI 14 day readmission comorbidity and complication length of stay
日期:	2011
上傳時間:	2011-10-26 15:41:55 (UTC+8)
摘要:	目的：本研究旨在探討Tw-DRGs實施前後對住院天數、併發症或合併症件數、14天再入院率與CMI值之影響。方法：以南部某大型醫院第一年導入的155項診斷關聯群於實施前後2009至2010年申報案件為研究對象，分析方法包括描述性統計、獨立樣本t檢定、卡方檢定與邏吉斯迴歸分析。結果：Tw-DRGs實施前平均住院天數為4.3±5.8天，實施後平均住院天數為4.0±5.5天 (p<.001)。實施後合併症及或併發症件數相對於實施前之勝算比為1.667(95% CI：1.504-1.848)。邏吉斯迴歸分析結果Tw-DRGs實施後相對於實施前之14天再入院的勝算比為2.601(95% CI：1.516-4.462)。有合併症住院案件14天再入院機率顯著高於無合併症之住院案件。CMI值於Tw-DRGs實施前後分別為1.60與 1.62，未達統計顯著差異。結論：因應 Tw-DRGs實施後醫院之醫療效率提升，再入院原因以合併症居多，醫院在因應此制度下仍維持著醫療品質。 Objectives：The purpose of the study intends to explore the effects of medical services before and after the practice of Tw-DRGs, which are including the average length of stay, cases of comobidity and complication , 14 days readmission, and CMI. Methods：The study samples 155 items in Tw-DRGs as the database of research, which was introduced in the first year in a substantial medical hospital in Southern Taiwan from 2009 to 2010. Analytic methods used in the study include descriptive statistics, independent t-test, and chi-square test. In addition, Logistic Regression is also used in the study. Results：The average length of stay before introducing Tw-DRGs is 4.3± 5.8 days. However, the average length of stay after introducing Tw-DRGs significantly changes and becomes 4.0± 5.5 days (p<.001). In contrast with Odd’s ratio before the introduction of Tw-DRGs, cases of comobidity and complication after introduction of Tw-DRGs have Odd’s ratio 1.667(95% CI：1.504-1.848). In addition, the 14 days readmission results analyzed by Logistic Regression before/ after the introduction of Tw-DRGs have Odd’s ratio 2.601(95% CI：1.516-4.462). The possibility of 14 days readmission with comobidity is higher than the one without comobidity. There is no significantly statistic distinction after introducing Tw-DRGs when CMI changes from 1.60 to 1.62 before and after the practice. Conclusion：The study shows this medical hospital still maintain the quality of medical services despite the improvement of medical efficiency due to the practice in Tw-DRGs.
關聯:	校內校外均不公開，學年度：99，106頁
顯示於類別:	[醫務管理系(所)] 博碩士論文

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