探討急診論質計酬對於介入性心導管治療費用與結果之影響

Abstract

研究背景：心臟疾病為台灣2014年十大死因第二名，為引導醫療服務提供者提供整體性醫療照護，論質計酬逐漸受到重視。台灣於2012年5月實施全民健康保險急診品質提升方案，期望藉財務獎勵提升急診急性心肌梗塞病患照護品質。目前國內針對該方案研究較少，且尚未探討對於急診急性心肌梗塞且接受介入性心導管治療病患的醫療費用與照護結果之影響。 研究目的：探討全民健康保險急診品質提升方案對於急診急性心肌梗塞且接受介入性心導管治療病患醫療費用與照護結果之影響。 研究方法：本研究利用全民健康保險研究資料庫2005年承保抽樣百萬歸人檔進行次級資料分析，擷取2008年至2013年第三季期間資料，以急診急性心肌梗塞接受介入性心導管治療病患做為研究對象。使用分段廣義估計方程式(Generalized estimating equations, GEE)，探討全民健康保險急診品質提升方案對於急診急性心肌梗塞且接受介入性心導管治療病患醫療費用與照護結果之影響。 研究結果：全民健康保險急診品質提升方案實施後，急診急性心肌梗塞且接受介入性心導管治療病患住院期間醫療費用、30天死亡及30天再入院表現均無顯著差異。 結論：全民健康保險急診品質提升方案對於急診急性心肌梗塞且接受介入性心導管治療病患醫療費用及照護結果於研究期間可能影響不顯著。

Background：Heart disease was ranked second in the top ten leading causes of death in Taiwan in 2014. To encourage medical service providers in providing holistic medical care, hospital administrators have increasingly emphasized pay for performance. Taiwan implemented a project in May 2012, aiming to elevate the quality of emergency department (ED) care covered by the National Health Insurance. Specifically, financial incentives were formulated in an attempt to enhance ED quality of care for patients with acute myocardial infarction (AMI). Currently, few studies have examined the project, and no study has explored the project’s influence on the medical costs and care outcomes of patients with AMI who have received percutaneous coronary intervention(PCI). Objective：To research the impact of the P4P program in the ED on costs and outcomes of PCI. Method：This study used the 2005 claim data of the National Health Insurance Research Database of 1 million beneficiaries for secondary data analyses. The data of patients with AMI who have received PCI between 2008 and the third quarter of 2013 were retrieved. A segmented generalized estimating equation was used to investigate the influence of the project aimed at enhancing ED care quality on the medical costs and care outcomes of patients with AMI who have received PCI. Results：There are no significant improvements in hospitalization cost, 30-day mortality and all cause 30-day readmission after implementing P4P program in the ED. Conclusion：There are no significant improvements after the implementation of P4P program in the ED on costs and outcomes of PCI.