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題 名 | Rasch測量計算DRG相對權數的應用研究=Rasch Analysis Answers the Question of How to Calculate DRG Relative Weights |
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作 者 | 錢才瑋; 王文中; 梁安億; 林宏榮; | 書刊名 | 健康保險雜誌 |
卷 期 | 2:1 民94.08 |
頁 次 | 頁73-86 |
分類號 | 412.56 |
關鍵詞 | 診斷關係群; Rasch分析; DRG相對權數; Facets軟體; 主要診斷分類; DRGs; Rasch analysis; DRG relative weights; Many-facets; PPS; |
語 文 | 中文(Chinese) |
中文摘要 | 中央健康保險局計劃以DRGs作為醫院醫療費用給付上的依據,其中影響最大,也最受關注的就是DRG相對權數,其計算原理更是各醫療從業人員亟欲瞭解之處。美國自1982年實施DRGs支付制度,即有許多種計算DRG相對權數的作法與研究。本研究以2002年住院申報資料,用Rasch(1960)測量其DRG相對權數的計算,並與健保公佈的相對權數、CMS美國醫療服務組織及RPC研究規劃顧問組織、泰國清邁醫院等的相對權數做比較,亦以DRGs歸屬的26主要診斷分類做計算結果上的比較與分析。 DRGs歸判程式分析2002年17家醫學中心的899,573筆申報資料,分出495個DRGs碼,以醫療費用各項費用為指標,將各醫院的各個DRG的各項費用指標取其自然對數後,以1至15的計分方式,作為Rasch的Many-Facets軟體之分析,並計算出DRGs的相對權數成本。 與國際各國DRG相對權數比較後,本研究計算出的DRG相對權數甚富意義,在26主要診斷分類上,也較接近國際的相對水準,在CMI排名方面也較穩定。 本研究以全國醫學中心2002年的各項住院申報費用為評量指標,將各DRGs費用與其資源耗用上的相對比重作比較,可以作為以申報費用為基礎而計算出DRG相對權值方法上的參考。 |
英文摘要 | Taiwan’s government plans to pay hospitals for their inpatient services at a predetermined rate (DRG price) for each discharge under the prospective payment system (PPS) and thus consider how to calculate diagnosis-related group (DRG) relative weights to better reflect the cost of care in an inpatient setting. There were many methods suggested to estimate DRG prices. Data analyses in this study were done with Rasch computer software, Many-Facets computer program, to estimate abilities with interval logits from which restored to original odds ratio state by utilizing exponential function and then produce a table of DRG relative costs with which four country’s relative weights were correlatively compared and statistically tested. Of 899,573 records of inpatient discharged from 17 medical centers in Taiwan, we grouped 495 DRGs matched up with 17 medical fees of claims data and developed a evaluation inventory on DRGs relative weights. Rasch modeling (1960) was applied to the 15 –point Likert score (1-lower to 15-higher) with natural logarithm on those 17 medical expenses across and within DRGs. The outcomes of this study were highly related with other national DRG relative weights. The correlation coefficient of Thailand’s Chiang Mai University’s RWs was the least inconsistent to that of this study. It also indicates that the RWs results of Many-Facets Rasch analysis are worthwhile being considered as a method of calculating DRG relative weights. We found that the DRG relative weights estimated by Rasch analysis in this study was most similar to the method with traditional average approach using 2002 data and most looked like as those of CMS in US. The calculation results of DRG relative cost weights through Many-Facets Rasch analysis to which were revealed worth paying attention and encouraging more researchers forward. |
本系統中英文摘要資訊取自各篇刊載內容。