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題名：DRG為基礎前瞻性支付制度對髖關節骨折／置換術的醫療利用與照護結果之影響
書刊名：臺灣公共衛生雜誌
作者：羅郁婷／張冠民／董鈺琪
作者(外文)：Lo, Yu-ting／Chang, Guann-ming／Tung, Yu-chi
出版日期：2015
卷期：34:2
頁次：頁180-192
主題關鍵詞：髖部骨折；髖關節置換術；診斷關聯群；照護結果；Hip fracture；Hip replacement surgery；Diagnosis related groups；Outcomes of care
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(5) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:5
  • 共同引用共同引用:7
  • 點閱點閱:66
目標：為了抑制上漲的健康照護費用，美國自1983年實施診斷關聯群（diagnosis related groups, DRG）為基礎的前瞻性支付制度，台灣於2010年1月實施以TW-DRG為基礎支付制度。很少研究探討實施DRG為基礎支付制度對於醫療利用及照護結果之影響，且研究結果並不一致。本研究目的係探討TW-DRG為基礎支付制度，對於髖部骨折與髖關節置換術之醫療利用與照護結果之影響。方法：資料取自2008年至2011年全民健康保險研究資料庫全國性樣本，選取主診斷為髖部骨折或主處置為髖關節置換術予以分析。本研究使用分段廣義估計方程式，控制趨勢、病人及醫院特性，以檢測實施TW-DRG為基礎支付制度，對於住院日數、30日再住院及30日死亡之影響。結果：實施TW-DRG為基礎支付制度與住院日數減少有關，及與30日再住院呈下降趨勢有關。結論：實施DRG為基礎支付制度，造成住院日數下降與30日再住院呈現下降趨勢。DRG為基礎支付制度的推行，可能促使醫療提供者建立較佳髖部骨折與髖關節置換術照護模式，以控制醫療利用，且改善再住院率。
Objectives: To reduce rising health care costs, prospective payment systems based on diagnosis-related groups (DRGs) were introduced in the United States in 1983. Taiwan implemented the TW-DRG-based payment system in January 2010. Few studies have examined the impact of DRG-based payment systems on medical utilization and outcomes of care, and the results have been inconsistent. The objective of this study was to determine the impact of the TW-DRG-based payment system on medical use and outcomes of care for patients with hip fractures and patients undergoing hip replacement surgery. Methods: Data were derived from the nationwide sample through the National Health Insurance Research Database between 2008 and 2011. Patients admitted with a primary diagnosis of hip fracture or patients who underwent primary hip replacement surgery were selected for analysis. Segmented generalized estimating equations were used to determine the impact of the TW-DRG-based payment system on the length of stay, 30-day readmission rate, and 30-day mortality rate when adjusted for trend, patient, and hospital characteristics. Results: The implementation of the TW-DRG-based payment system was associated with a decrease in the length of stay, and with a decreasing trend in the 30-day readmission rate. Conclusions: The implementation of a DRG-based payment system in Taiwan led to a decline in the length of stay and a declining trend in the 30-day readmission rate. DRG-based payment systems might facilitate the development of a better model by which to contain medical utilization and improve readmission rates for patients with hip fractures and patients undergoing hip replacement surgery.
期刊論文
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15.Beaupre, L. A.、Cinats, J. G.、Senthilselvan, A.(2006)。Reduced morbidity for elderly patients with a hip fracture after implementation of a perioperative evidence-based clinical pathway。Qual Saf Health Care，15(5)，375-379。  new window
16.Neuman, M. D.、Archan, S.、Karlawish, J. H.、Schwartz, J. S.、Fleisher, L. A.(2009)。The relationship between short-term mortality and quality of care for hip fracture: a metaanalysis of clinical pathways for hip fracture。J Am Geriatr Soc，57，2046-2054。  new window
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19.Fitzgerald, J. F.、Fagan, L. F.、Tierney, W. M.、Dittus, R. S.(1987)。Changing patterns of hip fracture care before and after implementation of the prospective payment system。JAMA，258，218-221。  new window
20.洪秀娟、楊榮森、曹昭懿(20050100)。臺灣髖部骨折之流行病學。臺灣醫學，9(1)，29-38。  延伸查詢new window
21.Holloway, J. J.、Thomas, J. W.(1989)。Factors Influencing Readmission Risk: Implications for Quality Monitoring。Health Care Financing Review，11(2)，19-32。  new window
22.Lien, H.-M.、Chou, S.-Y.、Liu, J.-T.(2008)。Hospital Ownership and Performance: Evidence from Stroke and Cardiac Treatment in Taiwan。Journal of Health Economics，27(5)，1208-1223。  new window
23.吳肖琪、簡麗年、吳義勇(20040400)。探討術前合併症指標與醫療利用及手術結果之關聯性--以全股(髖)關節置換健保申報資料為例。臺灣公共衛生雜誌，23(2)，121-129。new window  延伸查詢new window
24.Seagroatt, V.、Tan, H. S.、Goldacre, M.、Bulstrode, C.、Nugent, I.、Gill, L.(1991)。Elective Total Hip Replacement: Incidence, Emergency Readmission Rate, and Postoperative Mortality。British Medical Journal，303(6815)，1431-1435。  new window
25.Glickman, S. W.、Ou, F. S.、DeLong, E. R.(2007)。Pay for Performance, Quality of Care, and Outcomes in Acute Myocardial Infarction。JAMA: The Journal of the American Medical Association，297，2373-2380。  new window
圖書
1.Kahn, K. L.、Draper, D.、Keeler, E. B.(1991)。The Effects of the DRG-based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients: Executive Summary。Santa Monica, CA：RAND Corporation。  new window
2.Kisner, C.、Colby, L. A.(2002)。Therapeutic Exercise: Foundations and Techniques。Philadelphia：Davis。  new window
3.Mark, D.(2004)。Orthopaedic Examination, Evaluation, and Intervention。New York：McGraw-Hill。  new window
4.Mathauer, I.、Wittenbecher, F.(2012)。DRG-based Payment Systems in Low- and Middle-income Countries: Implementation Experiences and Challenges。Geneva：WHO。  new window
5.Hardin, J. W.、Hilbe, J. M.(2003)。Generalized Estimating Equations。Boca Raton, Fla：Chapman & Hall/CRC。  new window
其他
1.衛生福利部中央健康保險署(2015)。Tw-DRGs支付方案問答輯--管理面、支付通則、分類架構，http://goo.gl/WwVgrp， 2014/03/12。  延伸查詢new window
2.衛生福利部中央健康保險署(2013)。Tw-DRGs支付通則，http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&webdata_id=937&WD_ID=1036， 2013/04/03。  new window
3.衛生福利部中央健康保險署(2013)。DRGs支付制度，http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&webdata_id=937&WD_ID=1036， 2013/05/10。  new window
4.Agency for Healthcare Research and Quality(2013)。Inpatient quality indicators: technical specifications，http://www.qualityindicators.ahrq.gov/Modules/IQI_TechSpec.aspx.， 2013/04/06。  new window
 
 
 
 
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