| Summary: | 碩士 === 長庚大學 === 醫務管理學研究所 === 93 === The implementation of Global Budget payment system restrains the healthcare resources of hospitals. Especially, the emergency department became vulnerable to the shifting of patients among health care providers. There are increasing needs for hospital administrators to pay more attention in manage as to maintain quality of services and to keep costs in reasonable range. Decision makers of a hospital should be well informed by the changes of ER patient structure in order to plan ahead.
This study analyzed data from the ER department of a Medical Center in Northern Taiwan in 2004. Total sample size was 99,231 while variables including age, gender, triage scale, disease type, procedures/treatments and examinations items, and medical fee. The analysis used factor analysis together with experts’ opinions to identify major procedures/treatments and examinations so as to get component of distinguish procedures. Cluster analysis was performed to categorize patients into groups of similar patient profiles or similar major medical procedures. Findings are summarized as follows.
1.The study found that there were three major disease categories as regards to procedure base analysis. While after conducting a more detail procedure base analysis, the ER patients were further divided into 56 subgroups.
2.Patients in each subgroup are highly predictable in the subsequent medical utilization. Therefore, administrators can use this information to predict the consequence of medical consumption during the whole hospital stay. Resource allocation was herein to be adjusted according to the previous information by decision makers.
3.The analyses of this study have demonstrated that patients with characteristics of male, younger than 10 years old, and at level-3 triage scale are frequent users of ER resources.
4.The characteristics of high medical consumption among ER patients are male, older, decreasing level of triage, and some specific disease patterns such as neoplasms, diseases of blood or blood-forming organs, and circulatory system diseases.
The results of this study provides information and models for healthcare providers to predict and manage limited resources in order to accommodate health insurance changes such as global budget, individual hospital global budget, and integrated delivery system.
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