| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 90 === Total Hip Replacement (THR) had been adapted in Case Payment System (CPS) in November 1997. THR is one of the highly safety and cost effective surgical interventions. It’s worth of being concerned with quality of care because of high utilization rate and medical expenditure. A low preventable complication could affect a large number of patients. The goals of this study are to investigate the utilization rate, quality of care, and factors of hospital and post-hospital care of THR after the implementation of CPS. The outcome was analyzed according to the claim database of national health insurance data of 15292 patients with THR from January 1997 to December 2000. The data was divided into patient, physician and hospital profile.
According to the patient profile analysis, length of stay (LOS), medical cost, times of rehabilitation, hospital mortality and complication of THR have decreased after the implementation of CPS. The post-hospital quality indexes: readmission, orthopedic and rehabilitation outpatient utilization within 30-day and 90-day have increased quite obviously. Only post-hospital mortality hasn’t been changed before and after CPS implementation. Further, we found that LOS, medical cost and times of rehabilitation utilization also have decreased via hospital and physician profile analysis. Conversely, the hospital and post-hospital mortality, readmission and rehabilitation outpatient utilization rate within 30-day and 90-day have increased after CPS implementation via the hospital and physician profile analysis.
This study revealed that female gender, age, and the severity of illness were found to be positive significantly related to the probability of post-hospital mortality after THR, but hospital and physician volume of THR were negative. However, the readmission was positively influenced by male gender, the age of the patient, the severity of illness and LOS instead of being negatively influenced by medical center, hospital and physician volume. Besides, orthopedic and rehabilitation outpatient utilization were positive significantly affected by female gender and the age of the patient.
In conclusion, the quality care of THR was not mainly changed except the low-volume hospitals and physicians after CPS implementation. So, the Bureau of National Health Insurance (NHIB) should intensify to inspect and audit the quality of care in low-volume hospitals and physicians in order to maintain quality of care. NHIB have to monitor them with the abnormal quality of care indexes. The rehabilitation utilization during hospitalization could decrease in post-hospital medical services. The rehabilitation should be included into minimum requirements standard items. In order to avoid cost-shifting happening, NHIB have to pay more attention to the phenomenon, which hospital medical services might be shifting to post-hospital ones. Department of Health should establish the clinical database, which is helpful in following the patient’s quality of care.
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