個案管理師介入運用於支付自然生產及剖腹生產Tw-DRG制度之探討

Case Manager Implementation on the Spontaneous and Cesarean Delivery under the Tw-DRG Payment System

曾于庭(Yu-Ting Tseng) ； 楊美雪(Mei-Hseuh Yang) ； 施驊真(Hua-Zen Shi) ； 簡婉儀(Yuen-Yee Kan) ； 吳錦明(Jing-Ming Wu)

《南臺灣醫學雜誌》 9卷1期 (2013/06) Pp. 32-39

https://doi.org/10.6726/MJST.201306_9(1).0004

摘要

目的：本研究旨在探討當個案管理師介入後，在管控自然生產及剖腹生產病患的醫療資源耗用以及改善病歷書寫完整性之成效。方法：採病歷回溯性研究設計，以本醫院之2009年至2011年導入Tw-DRGs之自然生產及剖腹生產住院案例為研究對象，個案管理師介入前為116例、介入後第一年為131例與第二年有123例。資料分析包括描述性統計分析及單因子變異數分析（one-way ANOVA）檢定與卡方等推論性統計分析。結果：個案管理師介入後第一年與介入後第二年，剖腹生產個案的平均住院天數分別為5.26±0.69天及5.36±0.66天，皆低於介入前的5.57±1.16天。介入後第一年剖腹生產個案之平均醫療費用比介入前低。DRG個案管理師介入與個案病歷之合併症或併發症書寫有顯著關聯，個案管理師介入後第一、二年之CMI值也都顯著高於介入前。結論：本研究結果發現，DRG個案管理師介入後有效的改善自然生產及剖腹生產個案的病歷書寫完整性，改善了合併症或併發症之書寫遺漏情形，提升了醫院的CMI值，相對的提高了健保醫療費用的給付。另有效的管控住院醫療費用的支出。因此，個案管理師介入是Tw-DRGs支付制度下，為有效醫療照護與病歷書寫完整性的重要途徑之一。

關鍵字

全民健保診斷關聯群 ； 個案管理師 ； 病歷書寫 ； 生產

並列摘要

Objective: DRG case manager has been implemented in a teaching hospital in southern Taiwan since the introduction of the system of Tw-DRGs as a payment system in 2010. The aim of this study was to determine whether DRG case manager intervention could effectively improve medical resources utilization and medical documentation.Methods: The study conducted a retrospective review of 370 medical record of discharge were assigned to phase I Tw-DRGs for the years 2009 to 2011. Characteristics of average age, length of stay (LOS), hospital costs, DRG weight adjusted medical expenses, the differences between the hospital costs and the payment received, comorbidities and complications record and hospital case-mix index of post-intervention discharges were compared to the prior year in detail.Results: Lower hospital costs and shorter LOS of post-intervention. Comparing the post-intervention to the pre-intervention period, medical records of discharges were with more comorbidities or complication coding (p＜0.001); hospital case-mix index was significantly greater (p＜0.001).Conclusions: DRG case manager that improves medical documentation can lead to improvements in coding of comorbidities and complications to reflect proper case-mix index and help improve payment moreover, DRG case manager can be an effective strategy to promote the appropriate use of health service resources. Under the DRGs payment system, DRG case manager intervention might be a worthwhile option to consider, especially in keeping comprehensive and complete medical documentation for every discharge.

並列關鍵字

Tw-DRGs ； case manager ； medical documentation ； delivery