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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏 | |
dc.contributor.author | Chen-Yang Wang | en |
dc.contributor.author | 汪辰陽 | zh_TW |
dc.date.accessioned | 2021-06-15T13:37:06Z | - |
dc.date.available | 2018-02-24 | |
dc.date.copyright | 2016-02-24 | |
dc.date.issued | 2016 | |
dc.date.submitted | 2016-01-26 | |
dc.identifier.citation | 中央健康保險署。DRG 住院診斷關聯群支付制度。取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&webdata_id=937&WD_ID=1036
中央健康保險署。Tw-DRG 支付通則。取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1036&webdata_id=937&WD_ID=1036 中央健康保險署。論病例計酬支付代碼點數 DRG 參考對照表(104722)。取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=879&webdata_id=3633 中央健康保險署(無日期)。何謂急性心肌梗塞。2016 年1 月18 日,取自http://www.nhi.gov.tw/mqinfo/Content.aspx?Type=AMI&List=1 中央健康保險署台北分局。Tw-DRGs 支付方案介紹。2016 年1 月20 日。取自http://dha.esis.com.tw/Faq/Tw-DRGs%A4%E4%A5I%A4%E8%AE%D7%BB%A1%A9%FA%B7%7C_%A4%E4%A5I%A4%E8%AE%D7.ppt 王淑蕙(2011)。合併症及併發症對台灣版診斷關聯群解釋力之影響-以DRG127 為例(未出版之碩士論文)。長榮大學,臺南市。 王維吟、張燕良、王拔群、陳雅惠(2006)。兒童扁桃腺切除手術論病例計酬制實施之影響評估。輔仁醫學期刊,4(2),73- 81。 朱樹勳(1992)。心臟病與開心手術。臺北市:健康世界。 朱澤民、廖慧娟(2007)。住院診斷關聯群政策說明(Diagnosis Related Groups,DRGs)。醫療品質雜誌,1(5),38-42。 李曉伶、吳肖琪(2013)。台灣慢性病人醫療利用之探討-以慢性腎臟病、糖尿病及高血壓為例。臺灣公共衛生雜誌,32(3),231-239。 李冬蜂、吳肖琪(2004)。論病例計酬實施前後冠狀動脈繞道道手術病患死亡情形。臺灣公共衛生雜誌,23(4),305-315。 李玉春(1998)。健康保險支付制度。於楊志良編健康保險(第三版)。臺北市:巨流。 林詠蓉、曾家琳、湯澡薰(2008)。疾病分類人員對診斷編碼的建議對健保支付費用與DRG 點數之初探性研究-以台某市某區域醫院爲例。醫務管理期刊,9(2),83- 87。 胡月娟、陳敏麗、胡秀媛、賴豐美、馮清淳、顧家恬、陳夏蓮、方月、王琤、趙莉芬、陳佩英、古淑玉、李滿梅、郭青萍、賴美信、蔡碧藍(2005)。慢性病護理學。臺北市:華杏。 郭奎妙(2012)。台灣診斷關聯群支付制度實施前後對醫療利用、醫療行為及醫療品質之影響-以冠狀動脈繞道手術為例(未出版之碩士論文)。國立臺灣大學,臺北市。 國民健康署。民國 98 年國民健康訪問調。取自http://www.hpa.gov.tw/Bhpnet/Web/HealthTopic/TopicArticle.aspx?No=201203210001&parentid=200712270001 甘宗達(無日期)。什麼是冠狀動脈繞道手術(CABG)。2016 年1 月18日,取自http://surgery.hosp.ncku.edu.tw/cvs_new/service/service11.htm 張美蓉、楊美雪、蘇秀玉、施驊真(2013)。Tw-DRGs 潛在可預防併發症次診斷醫療費用之病例對照研究。若瑟醫護雜誌,7(1),18 - 32。 張煥禎、廖慧娟(2001)。全民健康保險下疾病分類編碼品質與相關影響因素研究。醫療品質雜誌,2(3),27-46。 張芝綺(2010)。整合式照護模式對65 歲以上慢性病患醫療利用之可能影響(未出版之碩士論文)。國立臺灣大學,臺北市。 黃瑞典、柯成國、藍守仁、嚴雅音(2011)。疾病分類編碼品質對外科住院醫療給付影響之研究。南臺灣醫學雜誌,7(2),94 - 103。 楊志良、趙海倫、黃偉堯、林文德、黃光華、賴美淑、龐一鳴、林秀碧、蔡文正、李菱菱、吳淑慧、洪錦墩(2012)。健康保險。臺北市:華格那。 楊錦豐(2001)。論病例計酬實施對醫療費用及品質之影響─以冠狀動脈繞道手術為例(未出版之碩士論文)。高雄醫學大學,高雄市 楊美雪、吳蕙玲、錢慶文、吳聰慧(2010)。Tw-DRGs 潛在可預防併發症次診斷醫療費用之病例對照研究。醫務管理期刊,11(3),43- 58。 衛生福利部統計處。死因統計。取自http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=1610 蔡惠芳(2008)。台灣第三版DRGs 的變異性與解釋力之研究(未出版之碩士論文)。亞洲大學,臺中市。 韓揆、許欣怡(2010)。論病例計酬DRG 原理。臺北市:合記。 韓揆(2005)。診斷組合制在台推行問題(上)-DRGs 之支付精神,支付邏輯及侷限。醫務管理期刊,6(1),1- 19。 韓揆(2001)。全民健康保險下疾病分類編碼品質與相關影響因素研究。醫務管理期刊,2(3),1- 19。 藍忠孚(1990)。勞保實施診斷關係群(DRGs)制度之研究。臺北市:行政院勞工委員會。 簡麗年、吳肖琪(2003)。論病例計酬實施前後全股(髖)關節置換術病患出院後30 日內的再住院情形。臺灣公共衛生雜誌,22(1),69-78。 魏秀美、張慧如、錢慶文(2006)。某醫學中心醫師和疾病分類人員ICD-9-CM編碼一致性之分析。醫務管理期刊,7(3),229- 243。 顏文榮(2011)。疾病嚴重度對台灣特定性腦血管疾患住院診斷關聯群之解釋力分析(未出版之碩士論文)。長榮大學,臺南市。 蕭淑珍、王郁青、陳一伶、李浩銓、許茜甯(2014)。資訊科技應用於改善多重慢性病人門診重複處方之分析。臺灣公共衛生雜誌,33(6),663 - 673。 羅郁婷、張冠民、董鈺琪(2015)。DRG 為基礎前瞻性支付制度對髖關節骨折�置換術的醫療利用與照護結果之影響。臺灣公共衛生雜誌,34(2),180 -192。 Assaf, A. R., Lapane, K. L., McKenney, J. L., & Carleton, R. A. (1993). Possible influence of the prospective payment system on the assignment of discharge diagnoses for coronary heart disease. New England Journal of Medicine, 329(13), 931-935. Anderson, G., & Knickman, J. R. (2001). Changing the chronic care system to meet people’s needs. Health Affairs, 20(6),146-160. Busato, A., & von Below, G. (2010). The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health Research Policy and Systems, 8, 31. Busse, R., Geissler, A., & Quentin, W. (2011). Diagnosis-Related Groups in Europe: Moving towards transparency, efficiency and quality in hospitals. United Kingdom. Center for Medicase & Medcicaid Services. Chronic Condiions. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trendsand-Reports/Chronic-Conditions/CC_Main.html Cheng, S. H., Chen, C. C., & Tsai, S. L. (2012). The impacts of DRG-based payments on health care provider behaviors under a universal coverage system: A population-based study. Health Policy, 107(2), 202-208. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373-383. Coulam, R. F., & Gaumer, G. L. (1992). Medicare's prospective payment system: a critical appraisal. Health Care Financing Review, 1991(Suppl), 45. Cutler, D. M. (1993). The incidence of adverse medical outcomes under prospective payments (No. w4300). National Bureau of Economic Research. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of Clinical Epidemiology, 45(6), 613-619. Donaldson, C., & Magnussen, J. (1992). DRGs: The road to hospital efficiency. Health Policy, 21(1), 47-64. Endrei, D., Zemplényi, A., Molics, B., Ágoston, I., & Boncz, I. (2014). The effect of performance-volume limit on the DRG based acute care hospital financing in Hungary. Health Policy, 115(2), 152-156. Fitzgerald, J. F., Moore, P. S., & Dittus, R. S. (1988). The care of elderly patients with hip fracture. New England Journal of Medicine, 319(21), 1392-1397. Fu, S., Huang, N., Chou, Y. J. (2014) Trends in the prevalence of multiple chronic conditions in Taiwan from 2000 to 2010: A Population-based study. Preventing Chronic Disease. 11(E187), 1-10. Feinglass, J., & Holloway, J. J. (1991). The initial impact of the Medicare prospective payment system on US health care: A review of the literature. Medical Care Research and Review, 48(1), 91-115. Gay, E. G., & Kronenfeld, J. J. (1990). Regulation, retrenchment—The DRG experience: Problems from changing reimbursemwnt practice. Social Science & Medicine, 31(10), 1103-1118. Hamada, H., Sekimoto, M., & Imanaka, Y. (2012). Effects of the per diem prospective payment system with DRG-like grouping system (DPC/PDPS) on resource usage and healthcare quality in Japan. Health Policy, 107(2), 194-201. Kahn, K. L., Keeler, E. B., Sherwood, M. J., Rogers, W. H., Draper, D., Bentow, S. S.,& Brook, R. H. (1990). Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. Journal of the American Medical Association, 264(15), 1984-1988. Louis, D. Z., Yuen, E. J., Braga, M., Cicchetti, A., Rabinowitz, C., Laine, C., & Gonnella, J. S. (1999). Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy. Health Services Research, 34(1 Pt 2), 405. Librero, J., Peiró, S., & Ordiñana, R. (1999). Chronic comorbidity and outcomes of hospital care: Length of stay, mortality, and readmission at 30 and 365 days. Journal of Clinical Epidemiology, 52(3), 171-179. MacKenzie, E. J., Morris Jr, J. A., & Edelstein, S. L. (1989). Effect of pre-existing disease on length of hospital stay in trauma patients. Journal of Trauma and Acute Care Surgery, 29(6), 757-765. Mo, F., Morrison, H., & Liepold, H. (2011). Drug utilization in Canadian patients with major chronic diseases. American Journal of Pharmacy Benefits, 3(3), e42-50. Mushlin, A. I., Black, E. R., Connolly, C. A., Buonaccorso, K. M., & Eberly, S. W. (1991). The necessary length of hospital stay for chronic pulmonary disease. Journal of the American Medical Associaition, 266(1), 80-83. National Heart, Lung, and Blood Institute. What Is Percutaneous Coronary Intervention?(n.d.). 2016/1/18, Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty Palmer, R. M., Saywell, R. M., Zollinger, T. W., Erner, B. K., LaBov, A. D., Freund,D. A.,& Throop, F. B. (1989). The impact of the prospective payment system on the treatment of hip fractures in the elderly. Archives of Internal Medicine, 149(10), 2237-2241. Rosenberg, M. A., & Browne, M. J. (2001). The impact of the inpatient prospective payment system and diagnosis-related groups: a survey of the literature. North American Actuarial Journal, 5(4), 84-94. Rogers, W. H., Draper, D., Kahn, K. L., Keeler, E. B., Rubenstein, L. V., Kosecoff, J., & Brook, R. H. (1990). Quality of care before and after implementation of the DRG-based prospective payment system: a summary of effects. Journal of the American Medical Association, 264(15), 1989-1994. Rochon, P. A., Katz, J. N., Morrow, L. A., McGlinchey-Berroth, R., Ahlquist, M. M., Sarkarati, M., & Minaker, K. L. (1996). Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability: A prospective comparison of three comorbidity indices. Medical Care, 34(11), 1093-1101. Sloan, F. A., Morrisey, M. A., & Valvona, J. (1988). Medicare prospective payment and the use of medical technologies in hospitals. Medical Care, 26(9), 837-853. Steiner, C. A., Barrett, M. L., Weiss, A. J., & Andrews, R. M. (2006). Trends and projections in hospital stays for adults with multiple chronic conditions, 2003–2014: Statistical Brief# 183. Shmueli, A., Intrator, O., & Israeli, A. (2002). The effects of introducing prospective payments to general hospitals on length of stay, quality of care, and hospitals' income: The early experience of Israel. Social Science & Medicine, 55(6), 981-989. Tierney, W. M., Fitzgerald, J. F., Miller, M. E., James, M. K., & McDonald, C. J. (1995). Predicting inpatient costs with admitting clinical data. Medical Care, 1-14. Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269-2276. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51515 | - |
dc.description.abstract | 背景:自1995 年我國健保開辦以來,實行過多次支付制度的改革,其中包含2010 年臺灣住院診斷關聯群(Tw-DRGs)的實施。由於此項制度為一種前瞻性支付制度,預先訂定支付標準,因此醫療院所有傾向減少處置亦或選擇病人。而多重慢性病經常使用較多醫療資源,目前尚未有研究探討DRG制度實施對於有無多重慢性病的病患是否有不同影響。
目的:本研究旨在探討臺灣住院診斷關聯群實施後,對於多重慢性病患之醫療利用與照護結果的影響。 方法:本研究以冠狀動脈繞道手術及經皮內冠狀動脈形成術的病人為介入組,尚未納入DRG之同大類MDC5項目手術的病人為對照組,資料來源為2008 年至2011 年全民健康保險資料庫。研究中利用傾向分數配對法(PSM)增加DRG實施前後個案的可比較性,並利用廣義估計方程式(GEE)與差異中的差異法(DID)進行分析。 結果:DRG實施後,相較於對照組,介入組在住院天數、用藥醫令數、總醫療費用皆顯著下降,照護結果則無差異;然而,介入組中有無多重慢性病相比,醫療利用與照護結果皆無統計上顯著差異。 結論:本研究的心臟病手術病人,在Tw-DRGs實施後並不會因為多重慢性病狀態的不同在醫療資源耗用與照護結果上有所差異。建議未來應針對其他疾病類別進行分析,以做為未來健保署繼續推行DRG制度之參考。 | zh_TW |
dc.description.abstract | Background: The National Health Insurance has been introduced since 1995, and several payment reforms have been implemented, including Taiwan diagnosis related group (Tw-DRGs). Under the prospective payment system with a pre-determined payment standard, hospitals tend to reduce medical service or select patients. Patients with multiple chronic conditions (MCCs) usually consume more medical resource than others. However, the impact of DRG payment on patients with multiple chronic conditions has not been examined.
Object: This study was to examine the impacts of implementing Tw-DRGs systems on medical resource usage and health care outcomes for patients with MCCs. Methods: Patients who underwent coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty were included as the intervention group, and the comparison group consisted of patients who underwent the MDC5 surgeries which were not yet included in the Tw-DRGs. The data used was from National Health Insurance Research Database, from 2008 to 2010. Propensity score matching was used to enhance the comparability between subjects before and after the implementation of DRG, and the generalized estimating equations model and difference-in-difference analysis was also used in this study. Result: The introduction of DRG payment resulted in decrease in patient’s length of stay, the number of medication orders, and total inpatient expenses in the intervention group in relation to the comparison group, yet no significant changes were found concerning health care outcomes. However, in the intervention group, we found no significant difference between MCC patients and non-MCC patients in medical resource use and health care outcomes. Conclusion: For the patients underwent cardiac surgery, the implementation of Tw-DRGs did not result in the differences in medical resources consumption or health care outcome between MCC patients and non-MCC patients. We suggest that more analysis on various kinds of diagnosis groups should be conducted and the findings may be useful for the National Health Insurance Administration DRG payment system. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T13:37:06Z (GMT). No. of bitstreams: 1 ntu-105-R03848007-1.pdf: 2346133 bytes, checksum: d142f5c2c253206011ecf045ddfe4d28 (MD5) Previous issue date: 2016 | en |
dc.description.tableofcontents | 致謝…………………………………………………………i
中文摘要…………………………………………………ii 英文摘要…………………………………………………iii 第一章 緒論……………………………………………1 第一節 研究背景與動機………………………………1 第二節 研究目的………………………………………4 第三節 研究重要性……………………………………5 第二章 文獻回顧………………………………………6 第一節 冠狀動脈繞道手術與經皮內冠狀動脈形成術……………6 第二節 我國慢性病回顧……………………………………………8 第三節 住院診斷關聯群之介紹……………………………………11 第四節 前瞻性支付制度實證研究…………………………………22 第五節 小結…………………………………………………………28 第三章 研究方法……………………………………………………35 第一節 研究設計……………………………………………………35 第二節 研究假說……………………………………………………36 第三節 研究架構……………………………………………………37 第四節 研究材料與對象……………………………………………39 第五節 研究變項定義………………………………………………40 第六節 統計分析方法………………………………………………46 第四章 研究結果……………………………………………………48 第一節 描述性統計…………………………………………………48 第二節 雙變項分析…………………………………………………55 第三節 多變項分析…………………………………………………83 第四節 研究假說驗證………………………………………………121 第五章 研究討論……………………………………………………124 第一節 研究方法討論.……………………………………………124 第二節 研究結果討論.……………………………………………126 第六章 結論………………………………………………………...131 參考文獻………………………………………………………………132 附錄……………………………………………………………………138 | |
dc.language.iso | zh-TW | |
dc.title | 臺灣住院診斷關聯群(Tw-DRGs)對多重慢性病患資源耗用及照護結果的影響 | zh_TW |
dc.title | The Impact of Tw-DRGs Payments on Resource Use and Care Outcomes for Patients with Multiple Chronic Conditions | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 楊長興,董鈺琪 | |
dc.subject.keyword | 診斷關聯群,多重慢性病,冠狀動脈繞道手術,經皮內冠狀動脈形成術,醫療資源利用,照護結果, | zh_TW |
dc.subject.keyword | diagnosis related groups,multiple chronic conditions,coronary artery bypass graft surgery,percutaneous transluminal coronary angioplasty,meducal resource use,health care outcome, | en |
dc.relation.page | 140 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2016-01-27 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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