論病例計酬實施前後全股（髖）關節置換術病患出院後30日內的再住院情形

The Changes in Readmission Rate Within 30 Days After Total Hip Replacement before and After the Implementation of a Case-Based Prospective Payment System

簡麗年(Li-Nien Chien) ； 吳肖琪(Shiao-Chi Wu)

《台灣公共衛生雜誌》 22卷1期 (2003/02) Pp. 69-78

https://doi.org/10.6288/TJPH2003-22-01-08

摘要

目標：探論病例計酬實施後，全股(髖)關節置換術病患出院後30日內再住院的變化情形，及相關因素。方法：全股(髖)關節置換手術於民國86年11月實施論病例計酬支付制度，研究利用全國性健保申報次級資料，以86年1月至10月(實施前，2,550人次)與87年1月至89年11月(實施後，人11,884人次)進行單側置換者為研究對象。結果：論病例計酬實施前，病患30日內的再住院為每百人10.08人次，實施後為11.29人次，無統計上顯著增加。進一步以迴歸分析控制其他干擾因子後，發現制度實施後30日內的再住院顯著增加(OR=1.31)。其他相關因子方面，男性、年齡愈大、疾病嚴重度嚴重高者，發生機率愈高。位在東部地區、權屬別為公立、評鑑等級別為地區醫院、年服務量低的醫院與醫師，其病患發生再住院的危險性也較高。病患住院日愈長、住院期間發生併發症，30日內的再住院率較高，而住院期復健治療次數愈多反而愈低。結論：論病例計酬實施後，30日內的再住院率有顯著增加，相關單位在費用控制下應致力維持民眾就醫品質，如加強低服務量醫院與醫師品質監控，以減少病患出院後再住院的發生。

關鍵字

全股（髖）關節置換術,論病例計酬,醫療品質,再住院

並列摘要

Objectives: The goals of this study are to investigate the changes in readmission rate within30-day of THR (Total hip replacement) before and after the implementation of CPS (Case Payment System) and its related factors. Methods: The Bureau of National Health Insurance implemented the case payment for THR in November 1997. The outcome was analyzed according to the claimed database of national health insurance data of 2,550 patients with THR before CPS (from Jan 1997to Oct 1997), and 11,884 patients with THR after CPS (from Jan 1998 to Nov 2000). Results: The30-day readmission rates were 10.08% and 11.29% before and after CPS implementation. According to the logistic regression model, 30-day readmission rate increased significantly after the implementation of CPS (OR= 1.31). This study revealed that being male, older; having more seventy, LOS (length of stay) and in-hospital complications were found to be positively and significantly related to the 3D-day readmission rate after THR. However it was negatively influenced by the medical centers, hospital and physician volume, and inpatient rehabilitation. Conclusion: The study found that the 3D-day readmission rate significantly increased after implementing CPS. This effect should be noted. It is important to maintain medical quality when cost-control mechanisms are implemented. For example, NHI should monitor medical quality of hospitals and physicians with lower volumes.

並列關鍵字

THR(Total hip replacement), CPS(Case Payment System), medical quality, readmissionrate

參考文獻

林碧珠 Lin, Pi-Chu、 張蘇鈺 、 莊琴英(2000)。人工關節置換術患者生活品質及其相關因素之探討 Quality of Life and Its Related Factors for Patients after Total Joint Replacement。護理研究 The Journal of Nursing Research。8(2)

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