目標:為更深入了解Tw-DRGs制度對醫療利用所造成的影響,本研究選擇第二階段導入的DRG23402來研究。分析在同一家醫院中的不同醫療專科(有無TW-DRGs相關經驗),在照護相同的疾病之病人上,醫療耗用是否有差異。 方法:研究個案資料來源為南部某區域教學醫院,取2014年7月至2015年9月區間送核之Tw-DRGs案件病人資料明細表中,針對落入DRG23402的住院病人,排除申報科別非歸入骨科及腦神經外科之個案,統計總樣本數為550筆(骨科445筆,腦神經外科105筆)。 結果:本研究統計結果以「女性」為大宗,佔總個案數69%。在控制影響因素之後,腦神經外科的病人住院天數較骨科多出0.9天;僅有主處置之病人相對於多項處置之病人住院天數減少1.6天,醫療費用合計減少4,003元;主處置ICD-9碼為7849 (其他部位骨其他修補或整形手術)之病人較其他主處置碼之病人醫療費用合計增加6,821元,其中放射線診斷費就高出18,479元;而醫療資源耗用與年齡、性別以及醫師年資無關。 結論:主處置為ICD-9碼7849 (其他部位骨其他修補或整形手術)者,主要為執行椎體成型術(Vertebroplasty)之病人,其放射線診斷費較其他主處置高,故這類病人歸於同一支DRG是否合理值得再做檢討。
Objective: This research will be focused on DRG23402 implemented in stage 2 in order to analyze the difference in the medical resource consumption on the patient with the same disease from the different medical specialties with/ without Tw-DRGs experience in a hospital and to deeply explore the influence on medical care utilization in Tw-DRGs system. Materials and methods: The case study data, excluding the other specialties, was collected among the approved TW-DRGs records of orthopedics and neurosurgery in a teaching hospital in the southern part of Taiwan from July 2014 to September 2015. 550 hospitalized patients with DRG23402 in total were chosen for the observations including 445 cases of orthopedics and 105 cases of neurosurgery. Results: The result indicates that the female patients are the majority of the observation and accounts for about 69%. After the variable adjustment, the patients of neurosurgery are admitted 0.9 day more than those of orthopedics. Compared to the patients under multiple treatments, those under main treatment are admitted/ hospitalized 1.6 day less and spend 4,003 NTD less on medical care fee. Besides, the medical care fee total for patients with ICD-9 codes 7849 (bone reconstructive surgery or plastic surgery in other body region) increase more than the one for the other patients by 6,821 NTD, which the radiation treatment charges for patients with ICD-9 codes 7849 are also more than those for the others by 18,479 NTD. However, the medical resources consumption is not even relevant to age, sex, and seniority of the doctor. Conclusions: Most of the patients with ICD-9 codes 7849(Other repair or plastic operations on bone, other site) are those under vertebroplasty and the radiation treatment charges relatively higher than those under main treatment. Therefore, it is worth more research and discussion whether it is reasonable to classify these patients into the same DRG.