DRGs權重公告對醫院代碼申報影響之研究－以束部醫院呼吸系統疾病群代碼申報變化之分析爲例

Impact of DRGs Weighting Announcement on Hospital Coding-Comparison of the Respiratory System Disease Coding Change among Hospitals in Eastern Taiwan

林玲珠(Ling-Chu Lin) ； 朱正一(Cheng-I Chu)

《醫護科技學刊》 10卷2期 (2008/04) Pp. 133-143

https://doi.org/10.6563/TJHS.2008.10(2).6

摘要

目標：分析中央健保局DRGs（diagnosis related groups；診斷關聯群）權重公告前後，台灣東部不同層級醫院呼吸系統疾病群之變化，以探討健保變革措施對醫院ICD-9-CM代碼申報之影響。方法：以2003-2004年東區健保局「住院醫療費用清單明細檔」資料，分析2004年2月台灣版DRGs權重公告前後，高風險DRGs、病例組合指標、診斷數、平均住院日於不同層級醫院之變化。結果：區域醫院於呼吸系統疾病的高風險DRGs87件數比值由00859上升到01516，病例組合指標值由13057上升到14305，次診斷數由336筆上升到36筆，平均住院日數由997日上升到1126日，區域醫院於DRG、權重公告前後比較呈顯著增加；醫學中心則無明顯變化。結論：東部區域醫院疾病群分布於DRGs權重公告前後有顯著變化，參照美國已實施多年的經驗，我國將實施DRGs支付制度前夕，宜儘早建立完整審查制度，以確保申報疾病分類代碼之品質，且對高風險DRGs指標應考量不同層級醫院之差異以進行長期監測。

關鍵字

診斷關聯群 ； 疾病分類 ； 高風險疾病群

並列摘要

Objectives: This study examines whether introducing DRG-based prospective payment systems influences the coding of hospital claims by comparing the coding of respiratory system diseases before and after the announcement of the DRGs weighting. Methods: Data were extracted from the 2003 and 2004 National Health Insurance Research Database. The sample included all in-patients treated for respiratory system diseases in hospitals and the only medical center in eastern Taiwan. The t test and chisquare test were performed to examine whether the high-risk DRGs, case-mix index, length of stay, number of diagnoses changed significantly between hospitals with different characteristics during these two years. Results: Regional hospitals exhibited significant changes in disease patterns. During the 2003-2004 study periods, their ratio of high-risk DRGs increased from 8.59 to 15.16; coding numbers increased from 3.36 to 3.60; case-mix indexes increased from 1.3057 to 1.4305, and length of stay increased from 9.97 to 11.26 days. No significant difference was observed for the medical center. Conclusion: The analytical results presented here imply that the DRGs weighting announcement of February 2004 influenced the change in respiratory system disease coding. The National Health Insurance Bureau should create a coding compliance plan before the introducing of DRG-based prospective payment systems and establish a mechanism for monitoring and verifying the claims. To reduce payment errors and maintain a high quality database, some high risk DRGs require regular monitoring.

並列關鍵字

DRGs ； ICD-9-CM ； high-risk DRGs

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