| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 101 === The Quality Assurance Retention Program under a hospital global budgeting scheme had been carried out on January 1st, 2011. Did the program can promote the quality of healthcare ? The purpose of the study was using the total hip replacements (THR) as samples to compare the differences of health care utilization and outcome before and after the implementation of Quality Assurance Retention Program. The ambulatory visit file of the first 5000-person cohort database from the National Health Research Database in 2010 and 2011 were analyzed. The one of dependent variable were health care utilization, including inpatient length of stays (LOS) and medical expenses, which were discussed from the hospitalization, merging with 14-day and 30-day readmissions. The other dependent variable was quality of care, including readmission rate within 14-day and 30-day, and emergency visit rate within 3-day.
Health care utilization：(A) LOS：after controlling the confounding factors, the analysis of patient profile showed negative association with program and LOS, but no significant. Bivariate analysis data showed after program implementing LOS decreased to 7 days, but LOS merging with 14-day and 30-day readmissions increased to 7.64 days and 8.32 days. The age≧80 years, many comorbidities, insured in provincial cities, and the east depart had more LOS. There were lower LOS in regional hospital, north and south depart and high volume hospital. (B) medical expenses：after program implementing the medical expenses had significant decreased. The age≧80 years, more comorbidities, medical center, low volume hospital had more medical expenses.
Quality of care：(A) readmission rate：after program implementing, bivariate and logistic analysis showed the increasing of readmission rate, but no significant. Median volume hospital had higher readmission rate, and hospital belonging to east depart had lower readmission rate. (B) emergency visit rate within 3-day：there was no association between program implementing and emergency visit.
This study suggests that Bureau of National Health Insurance (NHIB) should enhance strictly review of readmission rate, and monitor the abnormal indicators to keep the health care quality. In order to avoid cost-shifting happening, NHIB have to pay more attention to the effects of the quality assurance retention program. Hospital medical services might take more care to those patients who have more comorbidities, no matter inpatient or outpatient care. They should keep monitoring between hospital volume and its quality.
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