| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 101 === Background:
Since January 2010, the Bureau of National Health Insurance started the Taiwan Version of Diagnosis Related Groups (Taiwan Diagnosis Related Groups, Tw-DRGs), to improve the efficiency of medical services, the quality of patient care, and its efficacy. Previously implementation of DRGs in other countries, hospitals became more cost-oriented. To save medical costs, hospitals may decrease the average length of stay or reduce the use of medical supplies, and these strategies may cause early discharge, saving medical cost but affect medical care quality. Therefore, the quality of medical care is one of the most important issues under Tw-DRGs.
Objective:
To explore changes in hospital mortality and 14-day readmission rates before and after the implementation of Tw-DRGs to present the impacts on medical care quality.
Methods:
This study used longitudinal secondary data analysis and a before–after study design, analyzing 97 cases of DRGs in the first year of the first stage implementation of Tw-DRGs and hospitals as the unit of analysis. The independent variable is the implementation of Tw-DRGs and the dependent variables are indicators of medical quality, including hospital mortality and 14-day readmission rate. 14-day readmission rate referred to the same individuals under the same MDC, including cross-hospital ones within 14-days after discharge. This study compares the medical care quality of the same hospital before and after Tw-DRGs by paired t-test. Controlling hospital characteristics, assess changes in medical care quality before and after Tw-DRGs by Probit analysis. Secondary data comes from the National Health Insurance Research Database (NHI).
Results:
1. Hospital mortality: The hospital mortality was 0.11% before Tw-DRGs in 2009, and 0.18% after Tw-DRGs in 2010. Hospital mortality increased after Tw-DRGs, but not significant p=0.11 by paired t-test. Controlling hospital characteristics, the result of Probit analysis after Tw-DRGs was 0.094, and the P=0.309 that not significant.
2. 14-day readmission rate: The 14-day readmission rate was 0.25% before Tw-DRGs in 2009 and 0.97% after Tw-DRGs in 2010. The 14-day readmission rate increased significantly p=.025 by t-test after Tw-DRGs. Controlling hospital characteristics, the Probit analysis for the 14-day readmission rate was 0.349 and the p<0.001 after Tw-DRGs.
Conclusion:
There was significant increase in 14-day readmission rate and no significant change in hospital mortality after Tw-DRGs. However, indicating a decrease on the medical care quality after the implementation of Tw-DRGs.
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