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| 題名: | 探討影響Tw-DRGs案件結餘之相關因素_以MDC5循環系統之疾病為例
Impact of Taiwan Diagnosis Related Groups Payment System on Case Surplus and Related Factors
- The Case of MDC5 Circulatory Systems |
| 作者: | 江佳穗;Chia-Sui Chiang |
| 貢獻者: | 醫務管理學系碩士在職專班 |
| 關鍵詞: | Tw-DRGs,住院費用,MDC5循環系統疾病,DRG結餘;Tw-DRGs, hospital costs, MDC5 circulatory system diseases, DRG surplus |
| 日期: | 2013-07-30 |
| 上傳時間: | 2013-10-16 14:47:39 (UTC+8) |
| 出版者: | 中國醫藥大學 |
| 摘要: | 目標：2010年1月1日起健保局開始實施Tw-DRGs制度第一階段首先導入155項Tw-DRGs項目，本研究以第一階段導入項目最多的MDC5循環系統疾病之個案為對象探討影響個案結餘之相關因素。
方法：研究對象為MDC5循環系統疾病之個案共計47項;資料來源為2010年「全民健康保險學術研究資料庫」案件分類為5，且任一手術碼符合健保局公告第3.2版第一階段實施MDC 5之個案數為44,135，以描述性統計分析各變項的平均值、標準差;卡方檢定分析變項間之差異;運用羅吉斯迴歸模式分析影響Tw-DRGs案件MDC5之結餘相關因素。
結果：男性病患比女性病患結餘機率為1.08倍；年齡層方面60-69歲結餘機率是< 30歲的1.54倍(95%CI：1.33-1.78)為最高；有合併症、重大傷病及共病嚴重度愈高等特性之負結餘機率較高；健保局南區業務組相對其他業務組其結餘機率較高；醫院特性中地區醫院及私立醫院相對於其他層級醫院及公立醫院結餘機率較高；醫師年資大於10年(含)及服務量愈高其結餘機率也較高；DRG組別中以V組(DRG125,循環性疾病急性心肌梗塞除外有心導管無複雜診斷)當參考組，L組別(DRG10901,多條血管冠狀動脈繞道手術,無心導管)的結餘機率是V組的3.11倍(95%CI：2.30-4.21)為最高。Q組別(DRG11103-11105,重大心血管手術，無合併症或併發症)的結餘機率與V組相比是最低的為0.15倍(95%CI：0.12-0.20)。
結論：病患特性及健康情形、醫院特性及權屬別、醫師特性、健保局地區分布皆會影響Tw-DRGs案件的結餘。
Objectives: Bureau of National Health Insurance implemented Tw-DRGs system (Diagnosis Related Groups) on January 1st 2010. At first phase, it introduced into 155 items of Tw-DRGs. The purpose of this study is to investigate the related factors of the case balance, which is the first phase of the study to introduce the most MDC5 circulatory system diseases as a subject.
Methods: The subjects were the cases of MDC5 circulatory system diseases. Total was 47. The source is the 2010 "National Health Insurance Research Database" case type 5. In addition any surgical code was in accordance with NHI Announcements 3.2 version of the first phase of implementation of the MDC 5 Project Scope. The total of cases is 44,135.
It applied descriptive statistical to analyze the variables mean, standard deviation. chi-square test to show the differences between the variables. Using logistic regression models affected Tw-DRGs case MDC5 surplus related factors.
Results: It was found in the present study that the surplus probability of male patients than female patients was 1.08 times the probability; ages 60-69 surplus probability <30 years was 1.54 times (95% CI :1.33-1 .78) for the highest; there was higher probability of negative balance of complications, major injuries and higher severity of illness; relative to other Business Group, NHI Southern Business Group was higher probability of its surplus; hospital characteristics: related to other hospitals and public hospitals, district hospitals and private hospitals was higher probability of surplus; doctors years of service more than 10 years (including) and higher volume of services was also higher probability of surplus; DRG groups to group V(DRG125, circulatory disorders except acute myocardial infarction, cardiac catheterization without complex diagnosis) as the reference group; the surplus probability of L group than group was V 3.11 times (95% CI :2.30-4 .21) for the highest. DRG10901, multiple artery coronary bypass surgery, without cardiac catheterization; probability of balance Q group compared with the V (cardiovascular surgery, without complications or complications) is the lowest, which is 0.15 times (95% CI :0.12-0 .20).
Conclusion: Patient characteristics and health status, hospital characteristics and ownership, doctor’s characteristics, geographical distribution of NHI influenced the probability of balance of case Tw-DRGs. |
| 顯示於類別: | [醫務管理學系暨碩士班] 博碩士論文
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