以指標 14 天非計畫再住院率和三天內急診重返率探討在臺灣實行診斷相關群組的影響

Abstract

為有效控制醫療費用增長,國家健康保險署 (NHIA) 實施了臺灣住院診斷相關群組支付制度 (Tw-DRGs),以提高住院治療的品質並減少不必要的住院。本研究旨在探討 Tw-DRGs的實施是否會對住院治療品質產生負面影響? 因此,本研究評估了 2014 年 Tw-DRGs 第二階段實施 (Tw-DRGs-II) 對住院護理品質的影響;使用獨立樣本 t 檢定和邏輯回歸方法來分析每個醫院層級 (從 2007 年至 2017 年第三季度)的醫療指標。研究結果顯示,Tw-DRGs-II 對住院治療品質產生了負面影響。根據獨立樣本 t 檢定,Tw-DRGs-II 實施後在所有醫院層級中,均對 14 天非計畫再住院率 (URA-14) 產生了顯著負面影響。但三天內急診室重返率 (RES-3)沒有顯示相符的結果,且學術醫療中心和區域醫院的品質水平在 Tw-DRGs-II 實施後有明顯下降。根據邏輯回歸的結果,兩個指標顯示 Tw-DRGs-II 對不同級別的醫院的住院治療品質產生了顯著負面影響,包括全院群、醫療中心和區域醫院,但地區醫院除外。此外本研究也使用廣義估計方程式 (GEE) 做為分析比較的參考。總之,Tw-DRGs-II 對住院治療品質產生了負面影響。因此,建議行政部門在 Tw-DRGs-II 實施後加強監督,防止數據欺詐,並提供更大的激勵措施以提高住院治療的品質。

To effectively control the growth of medical expenses, the National Health Insurance Administration (NHIA) has implemented the Taiwan inpatient diagnosis-related groups payment system (Tw-DRGs) to improve the quality of inpatient care and reduce unnecessary hospitalization. This study aims to explore the implementation of Tw-DRGs would adversely affect the quality of inpatient care? Therefore, the impact of Tw-DRGs second phase implementation (Tw-DRGs-II) in 2014 on the quality of inpatient care is assessed

independent t-test and logistic regression methods are used to analyze the medical indicators at each level of hospitals (from 2007 to the third quarter of 2017). We found that Tw-DRGs-II has a negative impact on the quality of inpatient care. Based on independent t-test, a significant effect on increasing the 14-day unplanned readmission rate (URA-14) at all levels of hospitals after the Tw-DRGs-II implementation is found. However, the three-day emergency room (ER) revisit rate (RES-3) did not show matching results, and the quality level of academic medical centers and metropolitan hospitals decreased significantly after the Tw-DRGs-II implementation. Based on the results of logistic regression, two indicators show that the Tw-DRGs-II significantly affects the quality of inpatient services in hospitals at different levels, including the all-hospital group, academic medical centers, and metropolitan hospitals, except local community hospitals. Furthermore, this study also employed Generalized Estimating Equations (GEE) as a reference for comparative analysis. In conclusion, Tw-DRGs-II adversely affects the quality of inpatient care. Therefore, we recommend that the executive branch strengthen supervision after the implementation of Tw-DRGs-II to prevent data fraud and provide greater incentives to improve the quality of inpatient care.