不同超長住院定義對急性住院病患之影響

目標：針對急性病患，探討不同超長住院定義下超長住院之情形。方法：以台灣地區2000年全民健保申報急性住院病患為對象，依超過住院日數30日、25日、90百分位、DRGs校正法及迴歸風險校正法定義超長住院；DRGs校正法及迴歸風險校正法皆是以校正後偏離常態分佈1.285個標準差（90百分位）定義超長住院，而迴歸風險校正法除校正病患疾病組合，亦校正病患性別及年齡。結果：超長住院率以超過30日定義為2.41%，超過25日定義為3.65%，超過住院日數90百分位定義為9.49%，以DRGs校正法定義為10.13%，以迴歸風險校正法定義為8.49%。各評鑑層級別醫院、公私立別醫院或不同科別之病患經由DRGs及迴歸風險校正法所計算出的超長住院率，均較傳統上超過30日或25日定義之超長住院率為高，顯示急性病患實際超長之住院情形嚴重。結論：將DRGs校正、或迴歸風險校正納入超長住院定義中有其重要性；DRGs校正或迴歸風險校正法能呈現病患超長住院的真實情形，建議健保局及醫院管理者可據以訂定可以改善超長住院的措施、提高急性病床之利用。

關鍵字

超長住院；住院日數；診斷關聯群；風險校正

並列摘要

Objectives: To investigate the condition of overstay in acute inpatients under the different definitions of overstay. Methods: The subjects were acute inpatients from the Taiwan National Health Insurance (NHI) databases in 2000. The five different definitions of overstay are: 1) over 30 hospital days, 2) over 25 hospital days, 3) over 90 percentile of hospital days, 4) over DRGs adjusted, and 5) over regression risk adjusted days of hospitalization. The DRGs adjusted and regression risk adjusted overstay are defined as being over the 1.285 standard deviation and standardized residual of normal distribution. Regression risk adjusted patients' case mix, age and sex. Results: According to the different definitions of overstay, the rate of overstay is 2.41% as defined by over 30 days, 3.65% as defined by over 25 days, 9.49% as defined by over 90 percentile of hospital days, 10.13% as defined by the DRGs adjusted method and 8.49% as defined by the regression risk adjusted method, respectively. The rate of overstay as defined by the DRGs and regression risk adjusted method is significantly higher than the traditional definition (over 30 or 25 days) used in different departments and levels of hospitals. It exposes the serious nature of overstay in acute patients. Conclusions: It is important to calculate overstay using the DRGs adjusted or regression risk adjusted methods. These adjusted methods could reveal the actuality of overstay for the administrators of NHI and hospitals, which could be applied to policy that would eliminate the problem of overstay and increase the utility of hospital beds for acute patients.

並列關鍵字

overstay ； length of stay ； DRGs ； risk adjustment

參考文獻

陳婉茗、朱慧凡、錢慶文、蘇喜、吳肖琪(2006)。醫院對即將全面實施DRGs支付制度之因應表現。醫務管理期刊。7，193-205。

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