應用ACG病例組合系統評量榮民疾病負荷與校正醫療利用

Applying the Adjusted Clinical Groups System to Quantify Veterans' Morbidity Burdens and Adjust Their Medical Utilizations

李偉強(Wui-Chiang Lee) ； 楊昭恂(Jau-Shyun Yang) ； 洪世欣(Shih-Hsin Hung) ； 黃東波(Tong-Po Huang)

《醫務管理期刊》 8卷1期 (2007/03) Pp. 67-84

https://doi.org/10.6174/JHM2007.8(1).67

摘要

Objectives: Veterans have been reported to use more medical resources than the general populations, but their morbidity burdens have not been evaluated. The objective of this study is to assess veterans' morbidity burdens and to adjust their medical utilizations accordingly.
Methods: Johns Hopkins' Adjusted Clinical Groups (ACGs) system was used to group morbidity burdens based on individual's age, sex, and all ambulatory and inpatient ICD-9 codes in 2004. Veterans were limited to the retired soldiers who were eligible to the copayment waivers as defined by the National Health Insurance. Individual’s medical utilization parameters included the number of visits, ambulatory pharmacy expenditure, total ambulatory expenditure, length of inpatient stay, total inpatient expenditures, and total medical expenditures in 2004. Medical utilizations were compared between veterans and non-veterans by multivariate regression methods with and without adjustment for individual's age, sex, waiver status, and morbidity burdens modeled as dummy variables of unique Aggregated Diagnosis Groups (ADGs).
Results: Ninety-nine percent of populations could be appropriately assigned to ACGs. Ninety percent of veterans were assigned to 13 high-morbid ACGs. Veterans' had higher morbidity burdens than the general populations (9.0 vs. 5.5, p＜0.001), especially in chronic diseases, psychosocial disorders and malignancy. Before case-mix adjustment, veterans had significantly higher ambulatory and inpatient utilizations than the non-veterans. After adjustment, veterans had higher ambulatory expenditures but shorter lengths of stay, fewer inpatient and total expenditures than the non-veterans. Older age, waiver for copayment, and ADG-based morbidity burdens were associated with high medical utilizations. Among them, individual s morbidity burdens explained the largest share of variance in ambulatory and inpatient utilizations.
Conclusions: Individual's morbidity burdens could be appropriately grouped by the ACG system in Taiwan. Veterans had higher morbidity burdens than the general populations.

關鍵字

病例組合校正 ； 疾病負荷 ； 榮民 ； 醫療利用

並列摘要

Objectives: Veterans have been reported to use more medical resources than the general populations, but their morbidity burdens have not been evaluated. The objective of this study is to assess veterans' morbidity burdens and to adjust their medical utilizations accordingly.
Methods: Johns Hopkins' Adjusted Clinical Groups (ACGs) system was used to group morbidity burdens based on individual's age, sex, and all ambulatory and inpatient ICD-9 codes in 2004. Veterans were limited to the retired soldiers who were eligible to the copayment waivers as defined by the National Health Insurance. Individual’s medical utilization parameters included the number of visits, ambulatory pharmacy expenditure, total ambulatory expenditure, length of inpatient stay, total inpatient expenditures, and total medical expenditures in 2004. Medical utilizations were compared between veterans and non-veterans by multivariate regression methods with and without adjustment for individual's age, sex, waiver status, and morbidity burdens modeled as dummy variables of unique Aggregated Diagnosis Groups (ADGs).
Results: Ninety-nine percent of populations could be appropriately assigned to ACGs. Ninety percent of veterans were assigned to 13 high-morbid ACGs. Veterans' had higher morbidity burdens than the general populations (9.0 vs. 5.5, p＜0.001), especially in chronic diseases, psychosocial disorders and malignancy. Before case-mix adjustment, veterans had significantly higher ambulatory and inpatient utilizations than the non-veterans. After adjustment, veterans had higher ambulatory expenditures but shorter lengths of stay, fewer inpatient and total expenditures than the non-veterans. Older age, waiver for copayment, and ADG-based morbidity burdens were associated with high medical utilizations. Among them, individual s morbidity burdens explained the largest share of variance in ambulatory and inpatient utilizations.
Conclusions: Individual's morbidity burdens could be appropriately grouped by the ACG system in Taiwan. Veterans had higher morbidity burdens than the general populations.

並列關鍵字

ACG ； Case-Mix Adjustment ； Morbidity ； utilizations ； Veterans

參考文獻

Hornbrook, M. C.,Goodman, M. J.(1991).Health plan case mix: definition, measurement, and use.Adv Health Econ Health Serv Res.12,111-148.

Iezzoni, L. I.(1997).The risks of risk adjustment.JAMA.278(19),1600-1607.

Majeed, A.,Bindman, A. B.,Weiner, J.P.(2001).Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works.BMJ.323(7313),604-607.

Starfield, B.,Weiner, J.,Mumford, L.,Steinwachs, D.(1991).Ambulatory care groups: a categorization of diagnoses for research and management.Health Serv Res.26(1),53-74.

Wahls, T. L.,Barnett, M. J.,Rosenthal, G. E.(2004).Predicting resource utilization in a Veterans Health Administration primary care population: comparison of methods based on diagnoses and medications.Med Care.42(2),123-128.