- 期刊
臨床紀錄改善專業人員介入對ICD-10-CM/PCS編碼及台灣版診斷關聯群醫療給付制度影響之初探
An Exploratory Study on the Impact of CDIS Intervention on ICD-10-CM/PCS Coding and TW-DRGs Payment System
摘要
目的：本研究旨在探討南部某區域教學醫院DRG個管師介入病歷書寫完整性及即時性的管控前後之成效，進而評估醫院增聘在病歷書寫更專業的臨床紀錄改善專業人員（Clinical Documentation Improvement Specialist，CDIS）之可行性。方法：本文採回顧性研究設計，依本院一般消化外科現有導入DRG的住院案例為研究對象，DRG個案管理師介入後篩選符合本研究計畫的個案共621例。資料分析包括描述性統計分析及配對樣本t檢定，分析個案之DRG群組之分佈、定額、權重與幾何平均住院天數；用McNemar檢定分析DRG個案管理師介入前後與病歷書寫有無合併症或併發症是否有關聯存在。結果：DRG個案管理師介入後，個案的平均定額由介入前的53,225±12,762點，提升至54,318±13,302點，達統計上顯著差異（p＜.001）；介入前的權重為1.2007±0.2854，介入後權重升高至1.2253±0.2973，增加0.0119，達統計上顯著差異（p＜.001）；平均幾何平均住院天數由3.11±1.7天升至3.12±0.9天，雖略有增加，但未達統計上顯著差異，且DRG個案管理師介入後對於個案之住院天數仍能有效控制在可住院天數內。採用McNemar檢定分析DRG個案管理師介入與改善個案病歷書寫之合併症或併發症之關聯，結果顯示p值=.000（p＜.001），即DRG個案管理師介入後與改善個案病歷書寫之合併症或併發症有顯著關聯，DRG個案管理師介入病歷審查後，減少了病歷合併症或併發症之書寫遺漏情形，有效的改善病歷書寫品質。結論：本研究結果發現，DRG個案管理師介入後有效的改善一般消化外科住院個案的病歷書寫品質及合併症或併發症之書寫遺漏的情形，獲得真正較高的疾病權重值，相對也提升了醫院的CMI值以及提高了健保醫療費用的給付，另外還能有效的管控住院醫療費用的支出。然個案的幾何平均住院天數略有增加，可能與疾病嚴重度增加有關。因此，在Tw-DRGs支付制度下，醫院增聘臨床紀錄改善專業人員（CDIS）是可行的，能有效的為醫療照護品質與病歷書寫完整性做重要的把關者及溝通者，對醫院的整體效益是有幫助的。
並列摘要
Objectives: The aim of the study was to explore the effectiveness of DRG case manager's intervention to improve the completeness and timeliness of medical documentation, and to evaluate the feasibility to create the new job of ＂Clinical Documentation Improvement Specialist＂ (CDIS) for the hospital. Methods: In the study we conducted a retrospective review of 621 TW-DRGs cases in the general digestive surgery department. The informational analysis included descriptive statistical, paired sample t-tests and McNemar test to analyze the distribution, fixed fee, related weight (RW), length of stay (LOS), and whether the DRG case manager intervention was associated with medical documentation can lead to any improvements. Results: After the intervention of the DRG case manager, the average DRG fixed fee was increased from 53,225±12,762 to 54,318±13,302 (p＜.001); the RW increase of 0.0119 (p＜.001); the LOS increased by 0.01±0.8 days (p=.844), which showed no significant differences. The McNemar test results showed that p-value = .000 (p＜.001), it means that after DRGs case manager intervention the record missing situation did cut down and the quality of clinical documentation improved. Conclusion: The results of this study showed that the quality of clinical documentation of general digestive surgery department did improve effectively, lack writing of comorbidity or complications decreased, RW increased, and the average DRG fixed fee increased after the DRG case managers intervention. However, the LOS increased was related to the increase in disease severity. Moreover, DRG case manager can be an effective strategy to promote the appropriate use of health service resources. Under the DRGs payment system, it is feasible for the hospital to hire more CDIS, which might be an important gatekeeper and communicator for better quality of medical documentation.
延伸閱讀
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