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引文資料
題名:
論質計酬對於思覺失調症患者急診及急性再住院的影響
書刊名:
臺灣公共衛生雜誌
作者:
陳麗尼
/
龔佩珍
/
張鏸云
/
蔡文正
作者(外文):
Chen, Li-ni
/
Kung, Pei-tseng
/
Chang, Hui-yun
/
Tsai, Wen-chen
出版日期:
2017
卷期:
36:2
頁次:
頁148-160
主題關鍵詞:
思覺失調症
;
論質計酬
;
差異中的差異法
;
急診
;
再住院
;
Schizophrenia
;
Pay-for-performance program
;
Difference-in-difference
;
Emergency department visits
;
Readmission utilization
原始連結:
連回原系統網址
相關次數:
被引用次數:期刊(
1
) 博士論文(0) 專書(0) 專書論文(0)
排除自我引用:
1
共同引用:
67
點閱:8
目標:全民健康保險2010年1月1日實施思覺失調症論質計酬方案,本研究旨在探討有無加入論質計酬方案,比較其急診及6個月內急性再住院發生的風險及其相關因素。方法:資料來源為全民健康保險研究資料庫,擷取2009年至2010年固定就診之思覺失調症重大傷病患者(6,713人),依其所屬院所分為有加入及未加入論質計酬方案兩組,採傾向分數(propensity score)1:1配對後,應用差異中的差異法(Difference-in-Difference)設計,以條件式羅吉斯迴歸模型(conditional logistic regression model)進行分析。結果:急診利用方面,加入論質計酬方案組在方案實施前為12.21%,方案後降為12.01%(p<0.05);未加入論質計酬方案組在方案前為13.3%,方案後降為11.80%(p<0.05)。6個月內急性再住院加入論質計酬方案組在方案前、後皆為1.71%(p>0.05);未加入論質計酬方案組在方案前為2.01%,方案後降為1.19% (p<0.05)。控制其他變項後,在條件式羅吉斯迴歸模型中之交互作用變項急診利用之勝算比(OR)為1.15倍(p>0.05)、急性再住院之勝算比(OR)為1.89(p>0.05),顯示加入論質計酬方案組在加入方案後急診利用及再住院下降幅度比未加入論質計酬方案組少。結論:患者經過配對後,院所加入思覺失調症論質計酬方案第一年,降低固定就診病患之急診利用及6個月內再住院之成效不佳。
以文找文
Objectives: On January 1, 2010, Taiwan began implementation of the Schizophrenia Payfor- Performance (P4P) program. The objective of this study was to investigate the impact of the P4P program on emergency department (ED) visits and acute readmissions within six months after discharge. Methods: The research data were obtained from the National Health Insurance Research Database. The study sample was made up of schizophrenic patients in the catastrophic illness registry for 2009-2010, whose regular visit institutions did or did not join the P4P program (n=6,713). The groups were matched using propensity scores in a ratio of 1:1. The conditional logistic regression model with difference-in-differences approach was then used. Results: For the P4P patients, the number of ED visits was 12.21% before the program and 12.01% after it (p < 0.05). For the non-P4P patients, the number of ED visits was 13.3% before the program and 11.80% after it (p < 0.05). Acute readmission utilization of the P4P patients both before and after the program was 1.71% (p > 0.05). In the non-P4P patients, acute readmission utilization was 2.01% before the program and 1.19% after it (p < 0.05). After adjustment for other variables, the interaction variable of ED visits in the conditional logistic regression model revealed that the odds ratio (OR) was 1.15 (p > 0.05) and that of acute readmission utilization was 1.89 (p>0.05). This finding showed that the reduction in the P4P patients was less than that in the non-P4P patients. Conclusions: When patients were matched, hospitals participating in the P4P program for patients with schizophrenia were ineffective in reducing emergency care and readmission within 6 months after discharge in the first year.
以文找文
期刊論文
1.
Deyo, R. A.、Cherkin, D. C.、Ciol, M. A.(1992)。Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases。Journal of Clinical Epidemiology,45(6),613-619。
2.
Prince, J. D.、Akincigil, A.、Kalay, E.(2008)。Psychiatric rehospitalization among elderly persons in the United States。Psychiatr Serv,59,1038-1045。
3.
Chien, I. C.、Chou, Y. J.、Lin, C. H.、Bih, S. H.、Chou, P.(2004)。Prevalence of psychiatric disorders among national health insurance enrollees in Taiwan。Psychiatric Services,55(6),691-697。
4.
Hwu, H. G.、Yeh, E. K.、Chang, L. Y.(1989)。Prevalence of psychiatric disorders in Taiwan defined by the Chinese Diagnostic Interview Schedule。Acta Psychiatrica Scandinavica,79(2),136-147。
5.
Lin, H. C.、Lee, H. C.(2009)。Psychiatrists' caseload volume, length of stay and mental healthcare readmission rates: a three-year population-based study。Psychiatry Res,166(1),15-23。
6.
Shrivastava, A.、Johnston, M. E.、Shah, N.(2010)。Persistent suicide risk in clinically improved schizophrenia patients: challenge of the suicidal dimension。Neuropsychiatric Disease and Treatment,6,633-638。
7.
Lindsey, M. A.、Joe, S.、Muroff, J.、Ford, B. E.(2010)。Social and clinical factors associated with psychiatric emergency service use and civil commitment among African-American youth。General Hospital Psychiatry,32,300-309。
8.
Chi, M. H.、Hsiao, C. Y.、Chen, K. C.(2016)。The readmission rate and medical cost of patients with schizophrenia after first hospitalization-a 10-year follow-up population-based study。Schizophrenia Research,170,184-190。
9.
Rosea, P.、Bauer, A.、Grinshpoon, A.、KhawaIed, R.、Meste, R.、Ponizovsky, A. M.(2006)。Rehospitalizations among psychiatric patients whose first admission was involuntary: a 10-year follow-up。Israel Journal of Psychiatry and Related Sciences,43,57-64。
10.
Silva, N. C.、Bassani, D. G.、Palazzo, L. S.(2009)。A case-control study of factors associated with multiple psychiatric readmissions。Psychiatric Services,60(6),786-791。
11.
DE Hert, M.、Correll, C. U.、Bobes, J.(2011)。Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care。World Psychiatry,10(1),52-77。
12.
Smith, D. J.、Langan, J.、McLean, G.、Guthrie, B.、Mercer, S. W.(2013)。Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study。BMJ Open,3(4),e002808。
13.
Shim, R. S.、Druss, B. G.、Zhang, S.(2014)。Emergency department utilization among Medicaid beneficiaries with schizophrenia and diabetes: the consequences of increasing medical complexity。Schizophrenia Research,152,490-497。
14.
Tseng, K. C.、Hemenway, D.、Kawachi, I.、Subramanian, S. V.、Chen, W. J.(2008)。Travel distance and the use of inpatient care among patients with schizophrenia。Administration and Policy in Mental Health,35,346-356。
15.
Kumar, G. S.、Klein, R.(2013)。Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review。Journal of Emergency Medicine,44,717-729。
16.
劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義(20060600)。臺灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊,4(1),1-22。
延伸查詢
其他
1.
衛生福利部中央健康保險署。全民健康保險思覺失調症醫療給付改善方案,http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=710&WD_ID=812&webdata_id=3862。
延伸查詢
2.
衛生福利部國民健康署。Schizophrenia; SCZD,https://gene.hpa.gov.tw/index.php?mo=DiseasePaper&action=paper1_show&cate=Set1&csn=77&sn=224。
3.
衛生福利部中央健康保險署。醫療給付改善方案,http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=659&WD_ID=897&webdata_id=4531。
延伸查詢
4.
Pomerantz, J. M.。Pay-for-Performance could better align incentives in behavioral health care,http://www.medscape.com/viewarticle/502399。
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