住院病例組合複雜性與出院狀況及住院日數間之相關性探討－以大臺北都會區六家醫院為例

本研究主要目的在探討不同醫院特質、科系別及病患特質與「住院病例組合」複雜性間的關係，並探討「住院病例組合」複雜性與住院病患出院狀況及住院日數之間的關聯性。本研究係一橫斷性研究，從大臺北都會區醫院中，立意挑選兩家公立地區級教學醫院、兩家公立區域級教學醫院，及兩家私立之地區級非教學醫院作為研究對象。在2002年11月起，共收集5,992筆住院病患資料，問卷資料採面訪方式取得。研究結果發現，隨著醫院別、醫院權屬別及醫院評鑑等級的不同，其所收治病患之病例組合複雜性皆有顯著性的差異。六家樣本醫院收治之病患依據住院病例組合複雜性構面之身心功能狀態、疾病嚴重度、合併症數目及合併症等級等變項之分佈分析，與醫院別有關；內科系病患之病例組合複雜性最高。住院病患特質除性別外，在年齡層、婚姻狀況、生活收入、住所、住院途徑等，均與住院病例組合複雜性有顯著的差異。病患特質（除性別外）、醫院特質在醫院別（除評鑑等級、權屬別外）、住院科別和住院病例組合複雜性等，與住院病患出院時狀況皆有顯著差異。身心功能狀態愈差者、疾病嚴重程度愈高者及疾病合併症愈多者，其平均住院日數愈長。本研究結果的初探可作為日後研究者研究各項病例組合之借鏡，同時可提供日後研究醫學中心層級時之對照；對未來研究的建議包括應繼續以縱貫性研究探討影響出院狀況及資源耗用的因素、考慮多面向評估的可能性、擴大研究對象範圍和設計合適的評估量表。

關鍵字

住院病例組合複雜性；出院狀況；住院日數

並列摘要

The purposes of this study are to examine whether the variations of hospitals' characteristics, admission departments, and in-patients' characteristics are different on in-patients case mix complexities; and to explore the relationships among case mix complexities, discharge status, and length of stay among in-patients of six hospitals in the Taipei Metropolitan Area. This cross-sectional study is evaluated by face-to-face interviewing 5992 in-patients from the six hospitals in the Taipei Metropolitan Area since November, year 2002. The six hospitals include two public local teaching hospitals, two private local nonteaching hospitals, and two public regional teaching hospitals. The independent variables in case mix complexities are functional status (for measuring physical and mental health, social and role functioning, and other general health concepts), severity of illness (staging of disease is the measurement scales of this study), co-morbidity numbers and its scales levels. The results support that there are significant differences among the six different hospitals in case mix complexities. Differences of the characteristics of hospitals (public/private, degree of hospital accreditation) lead to various case mix complexities. In discharge status and the length of stay, there are significant differences among admitted patient conditions, admission departments, the characteristics of the hospitals, and case mix complexities. The higher the case mix complexity, the longer the length of stay. Future research might focus on longitudinal study to explore the relationship among discharge status, resources consumption, multiple dimensions of evaluation, expanded sample hospitals and design appropriate evaluation instruments.