| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 93 === Abstract
Objective:
The purpose of this study is to investigate the current status of medical resources utilization of patients with proliferative diabetic retinopathy and its influencing factors in Taiwan.
Design: Retrospective analysis of secondary data obtained from a medical center in Taiwan.
Methods:
Patients with proliferative diabetic retinopathy who underwent vitrectomy operation were identified from the database of a medical center during the period of 2003 to 2004. The medical expenditure database was from the Bureau of National Health Insurance (BNHI) claimed data. Stepwise regression was used for statistical analysis.
Results:
There were total 328 patients enrolled in this study, including 200 male and 128 female. There were 478 admission records studied. The average in-patient length of stay was 5.67 days, and the average admission times were 1.44. The medical expenditure of first admission was NT$55,123, the total admission cost within the period of one year was NT$ 75,655. The one-year total medical cost, including in-patient and out-patient medical expenditure, was NT$ 84,232. The reasons of admission more than one time were bilateral eyes retinopathy (63.74%), recurrent vitreous hemorrhage (20.88%), cataract (35.16%), retinal detachment (13.19%) and glaucoma (15.38%). The stepwise regression model analysis showed that health care resource consumption of patients with diabetic retinopathy was influenced by the age of patients, but not gender. Our study also demonstrated that medical expenditure of patients with sub-diagnostic code of tractional retinal detachment was statistically higher than that of patients with vitreous hemorrhage alone.
Conclusion: The medical resource utilization of patients with proliferative diabetic retinopathy was influenced by the age and different sub-diagnostic codes of patients, and postoperative ocular complications.
Recommendation:
1). The BNHI should revise the Diagnosis-related Groups (DRG 03601, Retinal procedure with vitreous operation procedure) so that the payment can be adjusted in the subgroups of patients with different characteristics and sub-diagnostic codes.
2). To improve the quality of eye care, in the diabetes pay-by-quality experimental project of BNHI, the fundus examination procedure should be referred to the eye specialists to perform indirect ophthalmoscopy after pupil dilatation.
3). The identification of lesion side (right or left eye) should be added to the NHI claimed dataset.
4). For hospital manager, the clinical pathway of vitrectomy operation for diabetic retinopathy should be established, the associated medical expenditure should be monitored and controlled without sacrifying the therapeutic quality.
Key words: proliferative diabetic retinopathy, medical resources utilization, retinal detachment, vitreous hemorrhage, vitrectomy
|
|---|
