結合診斷與資源耗用之護理照護成本系統初探

A Pilot Study of Nursing Care Cost System Integrated Diagnosis and Resources Utilization

李明純(Ming-Chun Lee)

指導教授 ： 張睿詒

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.01457

摘要

隨著國內醫療產業環境的變化，醫院在面臨競爭日益激烈的生存壓力下，成本的分析與控制愈來愈受到重視，尤其在總額預算下，醫院間競爭的決勝關鍵將在於對品質的要求以及對成本的瞭解。而醫院經營最主要的目的之一，即在於提供病患住院之照護，因此，瞭解住院部門的資源耗用情形，將有助於拓展組織生存空間。由於在病患接受住院照護的過程中，除一般醫療診察、檢查、手術外，護理照護服務亦扮演著舉足輕重的角色，故使護理照護成本分析成為成本管理中不可或缺的一環。因此，本研究最主要的目的在於參考國外病人分類系統以及成本分析模式之發展，研擬一套結合診斷與住院病程之前瞻性成本分析模式，並利用研究所得之成本資訊，提供護理部門進行成本管理之參考。
本研究係參考Fischer（1998）所發展的多重面向分類模式之概念，將病人日依不同面向進行分類，並建構其分類矩陣模型，建立步驟分為三大階段，第一階段首先建立各項護理活動資源耗用模式，第二階段建立病人分類並進行成本分析，第三階段則利用第二組資料驗證所建立之成本分析模式。分析之樣本資料收集自個案醫院五個一般內外科病房，資料收集期間自92年2月至4月，經過初步分析後，利用18個診斷，132種病人日類別，共2,884病人日之資料進行模式之建立。
研究結果發現以診斷與住院病程兩面向分析病人日之平均資源耗用，不同診斷病程之病人日其護理照護成本不同；而各診斷病程日可依據資源耗用之模式分為16個相似的群組，當以第二組資料驗證模式之預測能力，總體樣本估計誤差為-0.34%，相較於其他研究，本研究整體預測能力相當準確。
本研究以結合診斷與住院病程為基礎之成本分析模式可提供護理部門進行成本管理以及護理人力之配置，並能結合病例組合之資訊，同時進行護理短、中、長期的人力資源規劃，滿足管理之需求。

關鍵字

護理照護 ； 資源耗用 ； 成本分析 ； 護理成本 ； 診斷群組

並列摘要

With the continuously changing of medical industrial environment, hospitals in Taiwan face more and more fierce competition. Cost control and quality enhancement become the key factors in organization’s survival, especially when the global budget mechanism has been implemented. However, one of the major functions of hospitals is to provide inpatient services, which consume most of hospital resources. Understanding the resources utilization of hospitalization department will facilitate hospital to extend viability. In the process of providing patient care, nursing care plays a vital role as well as medical care, examination, and operation do. Nursing cost analysis therefore becomes an essential part of cost management. Thus, the purpose of this research is to develop a prototypical model of nursing care cost analysis which integrates diagnosis, patient day in order of stay, and resource utilization. Moreover, we wish to provide the useful information for nurse managers and support them to perform cost management efficiently.
The study adopts the concept of multiple dimensional classification model presented by Fischer (1998). In our model, we classify patient days into several groups by different dimensions and establish a patient day classification matrix. The establishing process was divided into three stages: 1. Develop resource consumption patterns for individual nursing care activities. 2. Establish patient day classification system and nursing care costing model. 3. Validate the nursing care costing model by the second set of data.
The data of cost and nursing care activities collected form five sample wards each patient day in a certain medical center from February to April in 2003 are analyzed in this study. We use 18 diagnoses and 132 patient day types from 2,884 patient days to build the final model.
The results of this research are as follows. When we classified the patient days into groups by these two dimensions of diagnosis and patient stay process, different resources utilization patterns are found. Each patient day can be classified into 16 clusters based on their resources utilization patterns. The overall estimation error is -0.34%. Comparing with earlier researches, predictability of our model is superior.
Through this study, it can be concluded that the nursing care costing model integrated diagnosis, patient day in order of stay, and resource utilization is applicable. Moreover, it can provide valuable information for nurse managers from the combining of case-mix not only for short- term cost control and nurse staffing but also for long-term human resource planning to meet the various management needs.

並列關鍵字

costing system ； nursing care ； nursing cost ； resources utilization

參考文獻

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