Risk Factors and Resource Utilization of unplanned readmission of elderly patients in a Medicine Center

• Main Authors: Hsiao Wen Chen, 鄭小文
• Other Authors: H. M. Tseng
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/zbnzg8

碩士 === 長庚大學 === 商管專業學院碩士學位學程在職專班醫務管理組 === 106 === Background: In Taiwan, elderly population over the age of 65 exceeds 14% in 2018, and Taiwan has entered an aged society. The health problems of the elderly will also affect the financial problems of national health insurance. Finding out the risk factors for the elderly readmission and effectively reducing the medical expenditure of the elderly is a topic of concern for the health providers and the medical community professions. The purpose of this study was to investigate the influencing factors of unplanned rehospitalization frequency and inpatient medical expenditures of elders in medical wards of a medical center. Methods: Retrospective medical records were used. The study sample consisted of 1,069 unplanned hospitalized patients aged over 65 who were admitted to the elderly medical wards from January 1, 2013 to December 31, 2015. The patients were categorized according to their diagnoses of multiple chronic diseases using poLCA (Polytomous Variable Latent Class Analysis) statistical analysis, and then the hierarchical linear regression analysis to examine the associated risk factors of readmission frequency, length of stay, medical costs, and DRG payment deviation. Results: The PoLCA analyses resulted in four groups of patients which showed the best grouping effect. The disease pattern of the third group is more complex and diverse, including hypertension, diabetes and stroke, chronic kidney disease, blood disorders, the geriatric syndrome, and gastrointestinal disorder. The results showed that older, DRG Diversity indicates the multiplicity of underlying diseases, and prescription of feeding or other treatments (ventilator use/hemodialysis/blood transfusion) are significant risks of readmission frequency, rehospitalization days, medical expenses, and DRG payment. Conclusion: The characteristics of disease patterns for the elderly are more complicated than other populations, which resulted in cares from different hospitals or specialties to treat the individual elderly. This affects the frequency of rehospitalization, length of stay, and thus increases the medical expenses and the negative-profit of DRG payment for the elderly. The results suggested that hospital preparations for the elderly discharge should be made earlier, and the case management model should be followed to reduce the chance of readmission. The government should strengthen the long-term care system to seamlessly integrate the care of discharged patients to reduce hospitalization expenditures.