Analysis on Trends for Medical Utilization and Outcome of Orthopedic before and after the Implementation of the Tw-DRGs Payment Systems at a Regional Hospital

• Main Authors: Ya-Wen Lin, 林雅雯
• Other Authors: Hui-Fang Su
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/84852597546682670976

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 103 === Objectives：The purposes of this study were to compare the trend of medical utilization and care outcomes among orthopedic inpatients between the case payment system (2006-2009) and the Tw-DRGs payment system (2010-2013) and explore factors contributing to the differences. Methods：From the national health insurance claims data of a regional hospital in Taipei City, data of orthopedic inpatients in the top 10 DRGs of MDC08 musculoskeletal system and connective tissue during the first phase of Tw-DRGs implementation were selected. Comprising 1202 cases under case payment and 1762 cases under Tw-DRGs, the data were analyzed using SAS 9.3. t-test, Chi-square test, multiple regression, and Logistic regression analysis were applied for comparison between the two groups of data. Results：After implementation of Tw-DRGs, the average length of stay and the medical cost declined significantly with related factors controlled. More specifically, patient’s age, CMI (case mixed index), and disease classification codes were positively related to length of stay, and length of stay also varied across physicians. As to factors affecting medical costs, it was found that inpatient’s age, gender, CMI, and disease classification codes were all related to medical costs of orthopedic inpatients. More specifically, in eight DRGs (including codes of 20904, 21103, 21904, 22302, 22404, 22504, 22902, and 47103), inpatient’s age, CMI, and disease classification codes were positively related to medical costs, and medical costs also varied across physicians. After implementation of Tw-DRGs, the medical costs of DRG20903 total hip replacement and DRG20905 total knee replacement were smaller for male inpatients than for female ones, but differences between physicians were insignificant. In terms of care outcomes, both hospital readmission within 14 days after discharge and emergency(ER) revisit within 3 days after discharge slightly increased, but not to the degree of statistical significance. Physician and disease classification codes were factors affecting hospital readmission within 14 days after discharge. Due to the small sample size, factors affecting ER revisit within 3 days after discharge were not analyzed. Conclusions：The tendency found in this study shows a gradual increase in the number of inpatients, stable medical care quality, and an improvement in service inefficiency after the first phase of Tw-DRGs implementation. While in pursuit of revenue, hospital administrators should encourage their physicians to get hold of the clinical characteristics of patients and continuously endeavor to improve the integrity of medical records, increase physicians’ understanding of DRGs, and deploy effective monitoring measures. Future researchers are advised to include use a national health database or self-pay treatment items or connect with the personnel database to consider more variables or conduct a retrospective study to have an in-depth analysis of clinical quality. The results will be helpful for staged implementation of Tw-DRGs.