| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 95 === Objectives: The various countries' acute length of stay (LOS) drop year by year, but prolonged length of stay was increasing; prolonged length of stay possibly causes to need to be hospitalized patients to be unable into, also increases the possibilities of the nosocomial infection, which is an important indictor for medical. The analyses were adjusted by DRGs to control the patients’ individual differences, but domestic studies rarely of prolong length of stay via DRGs rarely. This study will to investigate the effect of market’, patients’ and the hospital’ characteristics in 2000 on the patients’ prolonged conditions in 2000, the hospitals’ prolonged rate in 2002 and the change of hospitals’ prolonged rate during 2000-2002.
Method: The population was the inpatients in 2000 and 2002 from the NHI databases in Taiwan, differentiates for the acute beds, the acute psychiatry beds and the chronic psychiatry beds. The expected value of LOS was adjusted by DRGs, sex, age and the interaction of sex and age, subtract the expected value from LOS to obtain the standardized residual error, which is larger than 1.15 defined prolonged length of stay.
Results: According to the study, the patients’ and the hospital’ characteristics are associated with the inpatients’ prolonged conditions in 2000. The market centralized degrees are associated with the inpatients’ prolonged conditions in 2000 and the hospitals’ prolonged rate in 2002 in acute beds and chronic psychiatry beds especially. The hospitals’ prolonged rate in 2000 are associated with the change of hospitals’ prolonged rate during 2000-2002.
Conclusions: It is important to defined prolonged length of stay by DRGs. The market’, patients’ and the hospital’ characteristics are associated with the prolonged length of stay. The hospital prolonged conditions this year can use to expect in the future. We suggest the medical providers should strengthen the internal management, apply the clinical paths, the norms for LOS and the discharge planning. The Bureau of Nation Health Insurance should pay attention to the performance of hospital which influenced by the market centralism degree, and control the performances of psychiatry beds and the hospitals high readmission rate or prolonged rates to reduce the possibilities of prolonged conditions in the future.
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