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

Impact of the Drg-Based Prospective Payment System on Medical Utilization and Outcomes of Care for Hip Fracture and Hip Replacement

羅郁婷(Yu-Ting Lo) ； 張冠民(Guann-Ming Chang) ； 董鈺琪(Yu-Chi Tung)

《台灣公共衛生雜誌》 34卷2期 (2015/04) Pp. 180-192

https://doi.org/10.6288/TJPH201534103115

摘要

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。

關鍵字

髖部骨折 ； 髖關節置換術 ； 診斷關聯群 ； 照護結果

並列摘要

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.

並列關鍵字

hip fracture ； hip replacement surgery ； diagnosis related groups ； outcomes of care

參考文獻

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衛生福利部中央健康保險署：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。引用2013/04/03。National Health Insurance Administration, Ministry of Health and Welfare, R.O.C. (Taiwan). Tw-DRGs payment principles. Available at: http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&webdata_id=937&WD_ID=1036. Accessed April 3, 2013. [In Chinese]