Analysis the Correlation Between Quality of Care, Medical Resource Utilization and Medical Care Expenses after Implementation of TW-DRGs－Using Fusion Surgery of a Regional Teaching Hospital in Central Taiwan as an Example.

• Main Authors: ZHENG, XU-SHEN, 鄭旭伸
• Other Authors: HSU, CHE-HAN
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/qzsx9z

碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 107 === Objective: This study aims to explore expenses of medical resource utilization and differences of reimbursement of National Health Insurance (NHI) to spinal fusion surgeries (DRG coding 496, 497, and 498 respectively) after the second phase of DRG version 3.4 was implemented in a regional teaching hospital from central Taiwan. The analyzed factors included: 1) patient characteristics (gender, age, BMI, comorbidities or complications), 2) physician characteristics (department, years of experience, surgery cases), 3) disease characteristics (admission information, number of diagnoses, number of treatments), and 4) healthcare quality (post-operative infection, lengths of inpatient hospitalization, returning back to hospital within 14 days after being discharged). After resulting, we attempts to propose better strategies and improvement solutions in response to this newer version of TW-DRGs payment system for target hospital in this case study. Methods: This research employed a retrospective method by secondary data. After eliminating some inadequate or unsuitable cases, there were 954 patients were selected for analysis by payments of DRG496, DRG497 and DRG498 during 2016 to 2018 from "Inpatient Medical Expenses List Details and Reporting Fee" in this study. Besides, a total of 15 physicians were selected to discuss from human resource management data bank according to the target hospital. The analysis themes were then compared the selected data for medical resources consumption, healthcare quality, and healthcare expenses. Research data were first collected and analyzed by using Microsoft EXCEL. Then SPSS 22.0 was in turn employed to analyze descriptive statistics and inferential statistics, including chi-square test, t-test, ANOVA and logistic regression to compare differences and relevance among respective variables. Results: The results showed that there were: 1)significant correlations among postoperative infections and variables of patients gender (p＜0.05), comorbidities or complications (p＜0.01), and treatment numbers of disease (p＜0.01); 2) significant correlation among lengths of inpatient hospitalization and variables of patients gender (p＜0.01), age (p＜0.05), comorbidities or complications (p＜0.001), departments of physician (p＜0.001), experience years of physician (p＜0.001), surgical operation loading (p＜0.001), numbers of disease diagnoses (p＜0.01), and treatment numbers of disease (p＜0.01); 3) significant correlation between returning back to hospital within 14 days after being discharged and surgical operation loading (p＜0.05). 4) The older patients, higher BMI numbers, with comorbidities or complications, more diagnoses and treatment, longer lengths of inpatient hospitalization tend to cause higher average healthcare expenses. 5) By logistic regression analysis, there were significant correlation among postoperative infections, medication fee (p＜0.05), and injection technical fee (p＜0.05). Besides, there were significant correlation among lengths of inpatient hospitalization, diagnoses fee (p＜0.001), ward fee (p＜0.001), disease treatment fee (p＜0.01), surgery fee (p＜0.01), and blood plasma fee (p＜0.05). In addition, there were significant correlation among returning back to hospital within 14 days after being discharged, ward fee (p＜0.05), and inspection fee (p＜0.05). Conclusions: The implementation of newer version of TW-DRGs payment system had substantially impacted financial and operational strategies of hospitals. The study results disclosed many potential factors of impacting the financial issues in the target hospital. In order to maintain or even better to improve operational performance of the hospital, we proposed following suggestions which including clinical paths need to be revised immediately, a proportional physician fee (PPF) be established, and a connected function for paying the difference of TW-DRGs payment system be implemented, cost control and target operational management be implemented and etc.