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題 名 | 提供醫師訊息對醫療費用及住院日數影響的研究--利用試題反應理論為訊息提供的程式基礎=Effects on Costs of Medical Care and Length of Stay with IRT Computer-generated Informational Messages Directed to Physicians |
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作 者 | 錢才瑋; 梁安億; 王文中; 林宏榮; | 書刊名 | 健康保險雜誌 |
卷 期 | 2:1 民94.08 |
頁 次 | 頁87-102 |
分類號 | 412.56 |
關鍵詞 | 醫療費用基準率; 三參數洛基模式; 病例組合指標; 試題反應理論; Base rate; Three-parameter logistic model; DRG; CMI; Item response theory; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:健保總額預算制度的實施,以DRG作為住院病歷抽樣審核及醫療費用與病歷診斷碼的查驗,逐漸成為健保的重要工具。醫院面臨DRG檔案分析抽樣費用審查的糾正與核減影響,勢必需有一套因應的策略與措施。 方法:利用試題反應理論三參數洛基模式的特徵曲線,在醫師巡房單上提供醫師住院期間醫療費用及住院日數異常的訊息。 結果:發現對個案醫院2001年至2004年第一季比較分析,CMI由1.33昇至1.57(+18%);平均醫療費用由47,607昇至62,909(+32%);平均住院日數由63.96昇至7.57(+8.76%);費用基準率由41,580昇至52,285(+26%);費用基準率的變異係數由1.00昇至1.39(+39%)。皆呈顯著性的差異(p<0.05)。 結論:健保預計2006年推行住院DRG支付制度,住院期間費用訊息的提供、出院後醫師參與DRG碼的編製、出院至申報前診斷碼的調整、及申報後統計分析與CMI的改善措施和檢討等系列研究,將是醫院管理階層所關注的事項。俟國家衛生研究院發行各醫院健保2003年及2004年申報資料後,本研究個案醫院與其他醫院再相比較,俾可更加應證「提供醫師訊息」的涵義與目的。 |
英文摘要 | The medical expense and patient’s diagnosis have been fully examined through DRGs assessment as global budget system putting into effects in Taiwan. How to deal with DRG file analyses implemented in reimbursement is to challenge all the mangers in hospitals. The research adopted item characteristic curves in Item Response Theory to provide physicians with messages generated by computer to release the abnormal status on costs of medical care and length of stay in hospital. Not only to reasonably reactivate the amount of reimbursement on the patient and the figure of Case Mixed Index in the experimental hospital as offering messages to physicians in the past 2 years, but also to reduce the coefficient of variation (CV) on Base Rate dividing medical expense by CMI and the number of unusual cases screened by Insurance insititute’s computer system on DRGs assessment. We found that all the researched subjects of CMI, averaged medical fees and length of stay on inpatients, Based-Rates and those CV values were increased at. 18,. 23,. .0876, .26 and .39 respectively. All of them were statistically significant (P<0.05). Owing to many factors to affect the effects on costs of medical carte and length of stay in hospital, the message offering to physicians, is one of the feasible and simplified ways to contain expenditures and to shorten the length of stay in an effort to obtain the max profits under global budgeting. Research time is too limited and constrained to implement the other strategies in a moment. We suggested that the following research could compare the results with effects on ether on-job statistical analysis or diagnoses coding adjustment before reimbursement improve CMI outcomes. In addition, another case study using hospitals’ reimbursement data in year 2003 and/or 2004 would be appreciated to compare again with this one to know whether messages directed to physicians significantly meet the expectation. |
本系統中英文摘要資訊取自各篇刊載內容。