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題名：Rasch測量計算DRG相對權數的應用研究
書刊名：健康保險雜誌
作者：錢才瑋／王文中／梁安億／林宏榮
作者(外文)：Chien, Tsair-wei／Wang, Wen-chung／Liang, On-yick／Lin, Hung-jung
出版日期：2005
卷期：2:1
頁次：頁73-86
主題關鍵詞：診斷關係群；Rasch分析；DRG相對權數；Facets軟體；主要診斷分類；DRGs；Rasch analysis；DRG relative weights；Many-facets；PPS
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(4) 博士論文(1) 專書(0) 專書論文(0)
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  • 共同引用共同引用:93
  • 點閱點閱:58
中央健康保險局計劃以DRGs作為醫院醫療費用給付上的依據，其中影響最大，也最受關注的就是DRG相對權數，其計算原理更是各醫療從業人員亟欲瞭解之處。美國自1982年實施DRGs支付制度，即有許多種計算DRG相對權數的作法與研究。本研究以2002年住院申報資料，用Rasch（1960）測量其DRG相對權數的計算，並與健保公佈的相對權數、CMS美國醫療服務組織及RPC研究規劃顧問組織、泰國清邁醫院等的相對權數做比較，亦以DRGs歸屬的26主要診斷分類做計算結果上的比較與分析。 DRGs歸判程式分析2002年17家醫學中心的899,573筆申報資料，分出495個DRGs碼，以醫療費用各項費用為指標，將各醫院的各個DRG的各項費用指標取其自然對數後，以1至15的計分方式，作為Rasch的Many-Facets軟體之分析，並計算出DRGs的相對權數成本。 與國際各國DRG相對權數比較後，本研究計算出的DRG相對權數甚富意義，在26主要診斷分類上，也較接近國際的相對水準，在CMI排名方面也較穩定。 本研究以全國醫學中心2002年的各項住院申報費用為評量指標，將各DRGs費用與其資源耗用上的相對比重作比較，可以作為以申報費用為基礎而計算出DRG相對權值方法上的參考。
Taiwan’s government plans to pay hospitals for their inpatient services at a predetermined rate (DRG price) for each discharge under the prospective payment system (PPS) and thus consider how to calculate diagnosis-related group (DRG) relative weights to better reflect the cost of care in an inpatient setting. There were many methods suggested to estimate DRG prices. Data analyses in this study were done with Rasch computer software, Many-Facets computer program, to estimate abilities with interval logits from which restored to original odds ratio state by utilizing exponential function and then produce a table of DRG relative costs with which four country’s relative weights were correlatively compared and statistically tested. Of 899,573 records of inpatient discharged from 17 medical centers in Taiwan, we grouped 495 DRGs matched up with 17 medical fees of claims data and developed a evaluation inventory on DRGs relative weights. Rasch modeling (1960) was applied to the 15 –point Likert score (1-lower to 15-higher) with natural logarithm on those 17 medical expenses across and within DRGs. The outcomes of this study were highly related with other national DRG relative weights. The correlation coefficient of Thailand’s Chiang Mai University’s RWs was the least inconsistent to that of this study. It also indicates that the RWs results of Many-Facets Rasch analysis are worthwhile being considered as a method of calculating DRG relative weights. We found that the DRG relative weights estimated by Rasch analysis in this study was most similar to the method with traditional average approach using 2002 data and most looked like as those of CMS in US. The calculation results of DRG relative cost weights through Many-Facets Rasch analysis to which were revealed worth paying attention and encouraging more researchers forward.
期刊論文
1.王文中(19970100)。評分客觀性與能力估計客觀性：傳統作法與試題反應理論作法之比較。測驗年刊，44(1)，29-52。new window  延伸查詢new window
2.林富滿(2005)。臺灣版DRGs支付制 度對醫界之影響與因應。健康保險雜誌，1(2)，63-67。new window  延伸查詢new window
3.陳琇玲、楊捷如、李宣緯、林秀美、林富滿(20041000)。到底CMS-DRGs如何支付醫院？其相對權值又是如何計算？。醫院，37(5)，57-66。  延伸查詢new window
4.Andrich, D.(1978)。A binomial latent trait model for the study of Likert-style attitude questionnaires。British Journal of Mathematical and Statistical Psychology，31，84-98。  new window
5.Carter, G. M.、Rogowski, J. A.(1992)。How recalibration method, pricing, and coding affect DRG weights。Health Care Financ Rev，14(2)，83-96。  new window
6.Cots, F.、Elvira, D.、Castells, X.、Dalmau, E.(2000)。Medicare's DRG-weights in a European environment: the Spanish experience。Health Policy，51(1)，31-47。  new window
7.Cots, F.、Mercade, L.、Castells, X.、Salvador, X.(2004)。Relationship between hospital structural level and length of stay outliers: Implications for hospital payment systems。Health Policy，68(2)，159-168。  new window
8.Cotterill, P.、Bobula, J.、Connerton, R.(1986)。Comparison of alternative relative weights for diagnosis-related groups。Health Care Financ Rev，7(3)，37-51。  new window
9.Fischer, G. H.、Ponocny, I.(1994)。An extension of the partial credit model with an application to the measurement of change。Psychometrika，59，177-192。  new window
10.Jackson, T.(2001)。Using computerised patient-level costing data for setting DRG weights: the Victorian (Australia) cost weight studies。Health Policy，56(2)，149-163。  new window
11.Master, G. N.(1982)。ARASH model for partial credit scoring。Psychometrika，47(2)，149-174。  new window
12.Myford, C. M.、Wolfe, E. W.(2004)。Detecting and measuring rater effects using many-facet Rasch measurement。Journal of Applied Measurement，5(2)，189-227。  new window
13.Pomplun, M.、Custer, M.(2004)。The equivalence of three data collection methods with field test data: a FACETS application。J Appl Meas，5(3)，319-327。  new window
14.Rogowski, J. R.、Byrne, D. J.(1990)。Comparison of alternative weight recalibration methods for diagnosis related groups。Health Care Financ Rev，12(2)，87-101。  new window
15.Vertrees, J. C.(2001)。Funding and future diagnosis related group development。Ann Acad Med Singapore，30(4)，13-16。  new window
16.Wright, B. D.、Mok, M.(2000)。Rasch models overview。Journal of Applied Measurement，1，83-106。  new window
17.梁安億、錢才瑋、林宏榮、王文中(20040300)。DRG在自主管理住院病歷抽樣審核上的應用研究。醫務管理期刊，5(1)，120-133。new window  延伸查詢new window
18.韓揆(20050300)。診斷組合制在臺推行問題(上)--DRGs之支付精神，支付邏輯及侷限。醫務管理期刊，6(1)，1-19。new window  延伸查詢new window
19.Fischer, G. H.(1973)。The linear logistic test model as an instrument in educational research。Acta Psychologica，37(6)，359-374。  new window
20.王文中(20041200)。Rasch測量理論與其在教育和心理之應用。教育與心理研究，27(4)，637-694。new window  延伸查詢new window
21.Fischer, Gerhard H.(1983)。Logistic Latent Trait Models with Linear Constraints。Psychometrika，48(1)，3-26。  new window
22.韓揆(20050300)。診斷組合在臺推行問題(下)--論病例計酬及實施準備。醫務管理期刊，6(1)，20-36。new window  延伸查詢new window
23.Adams, Raymond J.、Wilson, Mark R.、Wang, Wen-chung(1997)。The multidimensional random coefficients multinomial logit model。Applied Psychological Measurement，21(1)，1-23。  new window
24.王文中(19970400)。測驗的建構：因素分析還是Rasch分析？。調查研究，3，129-166。new window  延伸查詢new window
25.Wright, B. D.、Linacre, J. M.、Gustafson, J.-E.、Martin-Löf, P.(1994)。Reasonable mean-square fit values。Rasch Measurement Transactions，8(3)，370-371。  new window
會議論文
1.Chien, T. W.、Wang, W. C.(2005)。Rasch Analysis Answers the Question of How to Calculate DRG Relative Weights。International Conference of PROMS & ISME，(會議日期: 2005/06/20-23)。  new window
2.Wang, W. C.、Wilson, M.、Cheng, Y. Y.(1999)。Modeling local dependence across latent traits。Iinternational Conference of AARE-ANZRE。Melbourne。  new window
研究報告
1.林宏榮、錢才瑋、王文中(2004)。健保總額支付制度下各層級醫療院所醫療品質監控作業模式之建立與評估研究 (計畫編號：DOH93-TD-M-113-025)。  延伸查詢new window
圖書
1.Andersen, E. B.(1973)。Conditional Inference and Models for Measuring。Copenhagen：Mentalhygiejnisk Forlag。  new window
2.Linacre, J. M.(1989)。Many-faceted Rasch measurement。Chicago, IL：MESA Press。  new window
3.Wright, B. D.、Masters, G. N.(1982)。Rating scale analysis: Rasch measurement。Chicago：MESA Press。  new window
4.Rasch, G.(1960)。Probabilistic models for some Intelligence and attainment tests。University of Chicago Press。  new window
5.Lord, F. M.(1980)。Applications of item response theory to practical testing problems。Lawrence Erlbaum Associates。  new window
其他
1.Linacre, J. M.(1999)。WINSTEPS，Chicago, IL。，http://www.winsteps.com。  new window
2.RPC(2005)。DRG relative weight, Research and Planning Consultants, L. P.，http://www.rpcconsulting.com/drgweights.htm， 2005/02/16。  new window
3.健保局(2004)。二代醫療資訊服務系統住院病歷組合編審DRG應用程式下載，httP://210.69.214.156/med2portal/index.jsp。  延伸查詢new window
4.(2004)。健保局住院病例組合第一版權重--RW權值表，http://www.nih.gov.tw/20download/index-download.htm。  延伸查詢new window
5.BNHI(2005)。DRG relative weight table, Bureau of National Health Insurance, Taiwan，http:// www_nhi‘gov*tw/20download/index_ download.htm， 2005/02/16。  new window
6.Chiang Mai(2005)。DRG relative weight table, Faculty of Medicine of Chiang Mai University，http:// www.medxmu.ac.th/hospital/drg/ DRG.htm， 2005/02/16。  new window
7.CMS(2005)。DRG relative weight table, Centers of Medicare & Medicaid Services，http://www.cms. hhs.gov/ providers/hipps/default.asp， 2005/02/16。  new window
8.Wang, W. C.，Cheng, Y. Y.(1999)。A Multi-Facet Rasch Analysis of the College Teacher Evaluation Inventory，www.aare.edu.au/ 99papAvan99538.htm。  new window
圖書論文
1.Birnbaum, A. L.(1968)。Some latent trait models and their use in inferring an examinee's ability。Statistical theories of mental test scores。Addison-Wesley Publishing Company。  new window
 
 
 
 
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