- 學位論文
因應實施Tw-DRG,台灣醫療院所導入住院中ICD-10-CM/PCS編碼現況分析
Analysis of the status of ICD-10-CM/PCS coding in Taiwan inpatient hospital settings in response to the implementation of Tw-DRG
摘要
民國84年全民健康保險上路後，門、急、住院醫療費用申報診斷及處置，開始利用國際疾病分類代碼ICD-9-CM，民國105年起改用ICD-10-CM/PCS申報醫療費用；大多數醫院的門診疾病診斷由醫師自行點選國際疾病分類代碼，但住院病歷在病人出院後，由受訓過的專業疾病分類人員詳閱病歷後，編國際疾病分類的診斷和處置代碼來申報健保費用。中央健保署在有限的醫療經費之下，為控制龐大的醫療費用支出，於民國99年實施西醫基層醫療院所的Tw-DRG制度，醫療院所因應策略如下，例如實行臨床路徑並依據臨床診療指引照護病人、利用資訊系統在個案入院中立即判斷DRG落點、病歷書寫完整並提升品質、並加強醫院流程管理；政府未來將DRG第3-5階段上線，部份醫院已導入住院中ICD-10編碼，基於上述理由，本研究進行因應實施Tw-DRG，台灣醫療院所導入住院中ICD10-CM/PCS編碼現況分析。。針對目前已實施或曾實施住院中ICD-10-CM/PCS編碼的醫療院所發放問卷，問卷收集彙整後，以SPSS for windows軟體24.0版進行統計分析；將問項分為政策、人力、資訊、效益四大構面，提出假設政策、人力、資訊構面會影響效益構面，利用皮爾森(Pearson)相關係數、IPA、複回歸分析結果，發現四大構面組內相關性高、IPA二維矩陣圖顯示『推動住院中編碼，需要政府機關提供疾病分類諮詢管道以協助釐清編碼問題』此項需要優先改善、複回歸在重要性題項分析得到政策、人力、資訊構面會影響效益構面和在滿意度題項分析得到政策、人力構面影響效益構面較大，特別是在政策構面的影響最大。建議政府及相關學術醫療單位能在醫療院所實施住院中ICD-10-CM/PCS時，提供援手，能無縫接軌未來Tw-DRG第3-5階段全面上線。
並列摘要
The ICD-9-CM code set was adopted by hospital reimbursement systems for all inpatient and outpatient procedures and diagnoses since the implementation of the National Health Insurance (NHI) in Taiwan in 1995, and ICD-10-CM/PCS replaced ICD-9-CM in 2016 for reporting diagnosis and procedure codes on claims. In most hospitals, the diagnosis codes for outpatient services are selected by physicians, but the medical records of admitted patients are reviewed by trained clinical coders and a code for the diagnosis and procedure will be assigned according to the ICD coding system for NHI reimbursement after the patients are discharged. In 2010, due to the limited budget for health care, the National Health Insurance Administration (NHIA) implemented the Taiwan version of Diagnosis Related Groups (Tw-DRG) system for western medicine in primary health care institutions to control the extensive medical expenses, and the response measures undertaken by health care institutions include, for example, implementation of clinical pathways and offering care according to clinical diagnosis and treatment guidelines, instant determination of the DRG based on information systems at the time a case is admitted, completion and improvement of the quality of medical records, as well as enhancement of the business process management in hospitals. The government plans to launch the phases 3-5 of the DRG in the future and some hospitals have introduced the ICD-10 code set for their inpatient services. Therefore, this study analysis of the status of ICD-10-CM/PCS coding in Taiwan inpatient hospital settings in response to the implementation of Tw-DRG. Questionnaires were distributed to health care institutions that are currently using or had implemented the ICD-10-CM/PCS code set and the collected questionnaires were analyzed by the SPSS Statistics 24.0.0.2 for Windows. The questions were divided into four major facets: policy, manpower, information and benefits, and the hypothesis that the policy, manpower and information facets will affect the benefit facet was proposed. The results of the Pearson correlation coefficient, IPA and multiple regression analysis show a high intraclass correlation in the four major facets and the two-dimensional IPA matrix diagram demonstrates the issue of “promoting inpatient coding requires government agencies to provide counseling channels for disease classification to help clarify problems in coding” needs to be resolved promptly. In multiple regression analysis, the item analysis of importance suggests the policy, manpower and information facets will affect the benefit facet, and the item analysis of satisfaction indicates the policy and manpower facets have a greater effect on the benefit facet and the policy facet has the greatest impact. Hence, we recommend that the government and relevant academic medical centers to provide help in the implementation of ICD-10-CM/PCS in health care institutions for seamless integration of the phases 3-5 of the Tw-DRG in the future.