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題名：論病例計酬實施前後冠狀動脈繞道手術病患死亡情形
書刊名：臺灣公共衛生雜誌
作者：李冬蜂／吳肖琪
作者(外文)：Lee, Tung-feng／Wu, Shiao-chi
出版日期：2004
卷期：23:4
頁次：頁305-315
主題關鍵詞：論病例計酬；冠狀動脈繞道手術；醫療品質；死亡率；Coronary artery bypass grafting surgery；CABGs；Case-based prospective payment system；CPS；Medical quality；Mortality rate
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(1) 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:3
  • 點閱點閱:253
　　　　　目標：為探討論病例計酬實施前後，冠狀動脈繞道手術病患死亡情形的變化及相關因素。方法：為介入前後自然實驗研究，以全民健保88年7月實施冠狀動脈繞道手術論病例計酬前18個月與後10個月中，接受冠狀動脈繞道手術患者為研究對象，共5,607人次；以住院期間死亡率與住院併出院後30日內死亡率作為測量指標。結果：論病例計酬實施後，冠狀動脈繞道手術之住院期間及住院併出院後30日內死亡率，在控制其他因素後並無統計上的顯著不同，顯示國內實施論病例計酬後，冠狀動脈繞道手術品質未顯著受到影響。在醫院特質方面，公立醫院雖住院期間死亡率較私立醫院高，然住院併出院後30日內死亡率則是私立醫院較高。而女性、年齡大於65歲、患有急性心肌梗塞、充血性心衰竭、週邊血管疾病、糖尿病或中風等病史，住院期間併發症、住院日較短，及由服務量較低之醫院或醫師執行手術之病患，其住院併出院後30日內死亡率較高。結論：住院併出院後30日內死亡率較適合用來監控CABGs手術品質之指標，且高服務量醫院及醫師的手術品質較佳。建議：健保局未來應加強低服務量醫院或醫師的審查與輔導，並持續監控醫療品質。此外，醫療供給者除應加強醫院低服務量醫師的手術訓練外，對於患有相關合併症之高危險群病患，亦應特別留意其照顧品質，以降低術後死亡的風險。
　　　　　Objective: To investigate the risk factors and changes in the mortality rate in patients with coronary artery bypass grafting surgery (CABGs) before and after the implementation of a case-based prospective payment system (CPS) in July 1999. Methods: The 5,607 patients who received CABGs from January 1998 (18 months before CPS) to April 2000 (10 months after CPS) were extracted from the National Health Insurance data. Their mortality rate of in-hospital and in-hospital plus within 30-days of discharge before and after the implementation of CPS was analyzed using a natural experiment study. The relative factors of mortality rate were also analyzed in this study. Results: After controlling for the confounding factors, the mortality rate of in-hospital and in-hospital plus within 30-days after discharge did not change significantly following the implementation of CPS for the patients received CABGs. It showed that CPS might not influence the medical quality of CABGs. The in-hospital mortality rate of public hospitals is higher than private hospitals. However, the mortality rate of in-hospital plus within 30-days of discharge was higher in the private hospitals. The factors such as female gender, being older than 65 year-old, acute myocardial infraction, congestive heart failure, cerebrovascular disease, diabetes, stroke, in-hospital complication, shorter length of stay, and hospitals or physicians with a lower volume of CABGs were related to a higher mortality rate. Conclusions: The mortality rate of in-hospital plus within 30-days of discharge could be used for monitoring medcial quality of CABGs. The Bureau of National Health Insurance should monitor the medical quality of low-volume hospitals or physicians. Health care providers should also pay attention to the surgery training for the low-volume physicians to reduce mortality rate.
期刊論文
1.Keeler, E.、Rubinstein, L.、Kahn, K.、Draper, David、Harrison, Ellen R.、McGinty, Michael J.、Rogers, William H.、Brook, Robert H.(199210)。Hospital Characteristics and Quality of Care。Journal of the American Medical Association，268(13)，1709-1714。  new window
2.Kahn, Katherine L.、Keeler, Emmett B.、Sherwood, Marjorie J.(1990)。Comparing Outcomes of Care before and after Implementation of the DRG-based Prospective Payment System。JAMA: The Journal of the American Medical Association，264(15)，1984-1988。  new window
3.錢慶文、黃三桂(2000)。論病例計酬制度對住院日數及醫療費用之影響：以痔瘡切除手術為例。公共衛生，26(4)，303-317。  延伸查詢new window
4.簡聰健(1994)。診斷關係群前瞻性給付制度（PPS/DRGS）之介紹，下。臺灣醫界，37(6)，105-108。  延伸查詢new window
5.吳敬堂、張香蘭、王文彥、侯毓昌(2000)。臨床路徑之介入對「論病例計酬」案件影響之初步探討－以急性闌尾炎為例。醫院：中華民國醫院協會雜誌，33，48-53。  延伸查詢new window
6.張慧朗、黃世聰、謝明里、王大民、崔克宏、賴榮豪(1999)。在論病例計酬制度下對於接受腹股溝疝氣修補術及經尿道前列腺切除術的病人施行臨床路徑可以改善醫療照顧的效率及品質？。長庚醫學，22，400-408。  延伸查詢new window
7.Jones, R. H.、Hannan, E. L.、Hammermeister, K. E.(1996)。Identification of preoperative variables needed for risk adjustment of short-term mortality after coronary artery bypass graft surgery。JACC，28，1478-1487。  new window
8.Stewart, R. D.、Campos, C. T.、Jennings, B.(2000)。Predictors of 30-day hospital readmission after coronary artery bypass。Ann Thorac Surg，70，169-174。  new window
9.Cowper, P. A.、Peterson, E. C.、DeLong, E. R.(1997)。Impact of early discharge after coronary artery bypass graft surgery on rates of hospital readmission and death。JACC，30，908-913。  new window
10.DesHarnais, S.、Chesney, J.、Fleming, S.(1988)。Trends and regional variations in hospital utilization and quality during the first two years of the prospective payment system。Inquiry，25，374-382。  new window
11.Louis, D. Z.、Yuen, E. J.、Braga, M.(1999)。Impact of a DRG-based hospital financing system on quality and outcomes of carein Italy。Health Services Research，34，405-415。  new window
12.Zhang, M.、Booth, B. M.、Smith, G. R.(1998)。Services utilization before and after the prospective payment system by patients with somatization disorder。J Behav Health Serv R，25，76-82。  new window
13.謝生蘭、陳益良、黃宗人、陳百薰、劉宏文、黃旭霖、林芳琴、戴玫瑰(2000)。急性闌尾炎切除術論病例計酬前後其醫療花費及臨床結果之比較。高雄醫學科學雜誌，16(6)，293-298。  延伸查詢new window
14.Hannan, E. L.、Kilburn, H.、Bernard, H.、O'Donnell, J. F.、Lukacik, G.、Shields, E. P.(1991)。Coronary artery bypass surgery: The relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors。Med Care，29，1094-1107。  new window
15.Hannan, E. L.、Racz, M. J.、Jollis, J. G.、Peterson, E. D.(1997)。Using medicare claims data to assess provider quality for CABG surgery: Dose it work well enough?。Health Services Research，31，659-677。  new window
16.Magovern, J. A.、Magovern, G. J.、Burkholder, J. A.(1996)。A model that predicts morbidity and mortality after coronary artery bypass graft surgery。JACC，28，1147-1153。  new window
17.蘇喜、黃月桂、李丞華(1997)。健保資料庫在醫療資源耗用及醫療品質偵測上之功用。中華公共衛生雜誌，16，527-537。new window  延伸查詢new window
18.Draper, D.、Kahn, K. L.、Reinisch, E. J.(1990)。Studying the effects of the DRG-based prospective payment system on quality of care - Design, sampling, and fieldwork。JAMA: The Journal of the American Medical Association，264，1956-1961。  new window
19.Romano, P. S.、Roos, L. L.、Luft, H. S.(1994)。A comparison of administrative versus clinical data: Coronary artery bypass surgery as an example。Journal of Clinical Epidemiology，47，249-260。  new window
20.Tu, J. V.、Sykora, K.、Naylor, D. C.(1997)。Assessing the outcomes of coronary artery bypass graft surgery: How many risk factors are enough?。JACC，30，1317-1323。  new window
21.黃正雄、賴曉亭、翁仁崇(2001)。接受首次單純性冠狀動脈繞道手術病人之死亡率的危險因素。臺灣醫學會雜誌，100(5)，299-303。  延伸查詢new window
會議論文
1.賴美淑(1999)。健保支付制度多元化研討會講稿集：全民健保支付制度之興革規劃。臺北：國家衛生研究院。  延伸查詢new window
圖書
1.康沛倫、郭樹民(2000)。冠狀動脈阻塞性病變之手術治療。冠狀動脈阻塞性病變之手術治療。高雄。  延伸查詢new window
其他
1.馬偕醫院(2000)。改良性冠狀動脈繞道術，沒有紀錄。  延伸查詢new window
2.莊佩璇(2000)。狹心症年輕化醫師提醒具危險因子者及早改善身體狀況，沒有紀錄。  延伸查詢new window
 
 
 
 
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