個案管理運用於Tw-DRGs支付制度之初探

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Title:	個案管理運用於Tw-DRGs支付制度之初探 An Exploratory Study of Case Management Implementation under the Tw-DRGs Payment System
Authors:	曾于庭
Contributors:	醫務管理系(所) 楊美雪
Keywords:	個案管理病歷書寫合併症或併發症病例組合指標醫療費用全民健保診斷關聯群(Tw-DRGs) case-mix index comorbidities/complication medical documentation case management Tw-DRGs medical costs
Date:	2012
Issue Date:	2013-04-22 14:58:49 (UTC+8)
Abstract:	中文摘要目的：本研究個案醫院從全民健保於2010年導入Tw-DRGs支付制度，即實施DRG個案管理。本研究旨在探討DRG個案管理介入後，是否能有效地改善病患醫療資源耗用以及病歷書寫之完整性。方法：採病歷回溯性研究設計，以南部某區域教學醫院之2009年至2011年Tw-DRGs第一階段導入的DRGs群組之3,665住院案例為研究對象。比較個案管理介入前後案例之平均年齡、住院天數、權重校正後醫療費用、醫療費用與給付費用之差額、CMI值與合併症或併發症編碼等之變化。結果：個案管理介入後之個案的平均醫療費用與住院天數比介入前高，平均年齡介入後之個案亦高於介入前。權重校正後醫療費用則是DRG個案管理介入後有顯著減少。DRG個案管理介入與個案之合併症或併發症編碼有顯著關聯，個案管理介入後第一年、第二年之CMI值分別為1.27與1.29都顯著高於介入前的1.03(p<.001)。介入後第一年與第二年比介入前個案的平均醫療費用差額增加分別為2,390.4點與2,151.1點，但都少於因CMI增加而增加的給付費用。結論：DRG個案管理介入有效地改善病歷書寫品質，使得合併症或併發症之編碼正確，醫院獲得合理的醫療給付，此外，有效地管控住院醫療費用的支出。因此，個案管理是Tw-DRGs支付制度下，為有效醫療照護與病歷書寫完整性的重要途徑，特別是在病歷書寫品質的提升上。 Abstract Objectives: DRG case management has been implemented in a teaching hospital in southern Taiwan since the introduction of the system of Tw-DRGs as a payment system in 2010. The aim of this study was to determine whether DRG case management intervention could effectively improve medical resources utilization and medical documentation. Methods: The study conducted a retrospective review of 3,665 medical records of discharges that were assigned to phase I Tw-DRGs for the years 2009 to 2011. Characteristics of average age, length of stay (LOS), hospital costs, DRG weight adjusted medical expenses, the differences between the hospital costs and the payment received, comorbidities and complications coding and hospital case-mix index of post-intervention discharges were compared to the prior year in detail. Results: Higher hospital costs and longer LOS of post-intervention discharges were noticed parallel to a significantly higher average age. Comparing the post-intervention to the pre-intervention period, medical records of discharges were with more comorbidities or complication coding (p< .001); hospital case-mix index was significantly greater (p< .001), pre-intervention (1.03) vs. one-year (1.27) and two-year post-intervention (1.29). During post-intervention period, mean hospital costs significantly decreased in an analysis that adjusted for DRG weight (p< .001). There was a significant increase (p< .001) in differences between the hospital costs and the payment received during both one-year and two-year post-intervention, average increase 2,390.4 RVUs and 2,151.1 RVUs respectively, which were lower than the payment increase due to the CMI rising during post-intervention periods. Conclusions: DRG case management that improves medical documentation can lead to improvements in coding of comorbidities and complications to reflect proper case-mix index and help improve payment; moreover, DRG case management can be an effective strategy to promote the appropriate use of health service resources. Under the DRGs payment system, DRG case management might be a worthwhile option to consider, especially in keeping comprehensive and complete medical documentation for every discharge.
Relation:	校內外完全公開，學年度：100，90頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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