醫院自主管理對地區醫院進行醫院間轉診之影響：單一醫學中心之資料分析

Impact of a Hospital Self-management Project on Patient Referral from Local Hospitals: Data Analysis of a Medical Center

何婧嫙(Ching-Hsuan Ho) ； 黃正金(Cheng-Chin Huang) ； 張麗雅(Li-Ya Chang)

《Mid-Taiwan Journal of Medicine》 12卷3期 (2007/09) Pp. 151-156

https://doi.org/10.6558/MTJM.2007.12(3).4

摘要

目的　在醫院個別總額實施後，各級醬院為求內部成本及醬療費用之加強管控，對醫療人員採取不同之要求，這些措施對於醫療品質之提昇並不見得有正面之幫助，相對地亦將影響病患之權益。本研究希望藉由轉診病患之資料分析，以了解地區醬院在自主管理前後轉診行為之變化或影響。
方法　在本院轉診中心轉診資料庫中選取在92年及93年7至12月期間，加入自主管理之地區醫院轉院資料，分析並比較其轉至本院病患之數最變化、住院人次、比例、科別、及急診申報點數等之差異性。
結果　在符合研究條件之94家地區醫院中，轉院總人次由1281人次變為1456人次，增加13.7%，檢傷分級屬第一、二級者減少1.4%；須住進加護病房之比例增5.3%；住院病患所住科別順序雖有變動，但仍以內兒科重症及神經外科為主：在急診申報點數約6830及7128點，為同時期平均點數之二至三倍。統計分析顯示93年7至12月轉入病患年齡及住院須要加護病房病患比例上升而須要住院比例則下降，顯示轉診病患疾病嚴重度的增加，其他無顯著差異。
結論　並無明顯證據顯示自主管理方案實施後，地區醫院對重症病患之轉院行為有改變之現象。長期觀察地區醫院轉診病患型態有助於轉診制度之良性發展，並進而提昇病患在醫院間轉診之安全性。

關鍵字

醫院間轉診 ； 自主管理

並列摘要

Purpose. The Hospital Self-management Project proposed by the Bureau of National Health Insurance may influence the direction of management in local hospitals. This study analyzed the possible impact that the Hospital Self-management Project may have on patient referral from local hospitals.
Methods. Data regarding inter-hospital transfers were gathered from the China Medical University Hospital Department of Community Medicine transfer database. Data regarding patient transfers from local hospitals to our Emergency Department (ED) were included. Transfers from local hospitals that did not join the project were excluded from our analysis. Patient numbers, age, ratio of triage, admission to ICU or ward, use of high-cost examinations, and total ED expenses incurred from July to December, 2003 and 2004 were compared.
Results. The total number of referred patients who met the study criteria was 1281 in 2003 and 1456 in 2004. Patients who were classified into triage category I and II decreased by 1.4% from 2003 to 2004, while those who were admitted to the ICU or required high-cost examinations increased by 5.3% and 3.6%, respectively. The mean total ED expenses incurred by the study patients was NT$6830 in 2003 and NT$7128 in 2004. Statistical analysis revealed a significant increase in patient age and the ratio of ICU admission, but a significant decrease in the ratio of ward admission after the project.
Conclusion. No marked patient dumping by local hospitals was detected after the Hospital Self-management Project was implemented. Transfers of critically-ill patients who need intensive care are not influenced by this project.

並列關鍵字

interhospital transfer ； self-management project