請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69936
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏(Shou-Hsia Cheng) | |
dc.contributor.author | Lan Lin | en |
dc.contributor.author | 林蘭 | zh_TW |
dc.date.accessioned | 2021-06-17T03:34:56Z | - |
dc.date.available | 2021-03-07 | |
dc.date.copyright | 2018-03-07 | |
dc.date.issued | 2018 | |
dc.date.submitted | 2018-02-12 | |
dc.identifier.citation | 中文部分
衛生福利部中央健康保險署中區業務組與中區醫院代表聯繫會第38次會議。 2016年6月7日。取自http://www.nhi.gov.tw/Resource/webdata/22682_4_NO38_NHICB_HOSP_report_1011204_1.pdf 衛生福利部中央健康保險署高屏業務組。全民健保TW-DRGs申報與審查規劃。2016年9月13日。取自 http://www.areahp.org.tw/upload/event_source/970702B-2.pdf 衛生福利部中央健康保險署。DRGs實施一年之成效報告。2016年9月13日。取自https://www.nhi.gov.tw/Content_List.aspx?n=CE79D02312754D55&topn=CA428784F9ED78C9 衛生福利部中央健康保險署。3.4版1,062項Tw-DRGs適用權重表。2016年9月13日。取自https://www.nhi.gov.tw/Content_List.aspx?n=CE79D02312754D55&topn=CA428784F9ED78C9 衛生福利部中央健康保險署。4.0版Tw-DRGs問答集。2017年11月13日。取自 https://www.nhi.gov.tw/Content_List.aspx?n=8790770CE116449A&topn=CA428784F9ED78C9&upn=03F9B653D3B01DEE 衛生福利部中央健康保險署。TW-DRGs住院診斷關聯群 提高醫療品質、效率及公平性。2016年9月13日。取自http://www.nhi.gov.tw/epaperN/ItemDetail.aspx?DataID=3703&IsWebData=0&ItemTypeID=5&PapersID=326&PicID= 衛生福利部中央健康保險署。Tw-DRG支付通則修正文字(103.07.04更新)。取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=17&menu_id=1027&webdata_id=4966 衛生福利部中央健康保險署(2014,2014/6/6)。Tw-DRGs住院診斷關聯群第二階段自103年7月1日施行。2016年12月1日。取自https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&sms=587F1A3D9A03E2AD&s=F9A067CA647C51AD 衛生福利部中央健康保險署(2014)。2014-2015年全民健康保險年報。台北市:衛生福利部衛生福利部。103年國人死因統計結果。2016年9月1日。取自http://www.mohw.gov.tw/news/531349778 衛生福利部中央健康保險署(2016)。1月份(提衛生福利部全民健康保險會第3屆106年第1次委員會議報告)。台北市:衛生福利部衛生福利部。全民健康保險_慢性/非慢性病醫療點數統計_西醫門診總表。2016年2月1日。取自https://www.nhi.gov.tw/Content_List.aspx?n=E13DFC9EA4B8083B&topn=CDA985A80C0DE710 衛生福利部中央健康保險署(2017)。DRG住院診斷關聯群支付制度。2017年2月1日。取自https://www.nhi.gov.tw/Content_List.aspx?n=DCCBE9C48349FFF0&topn=CA428784F9ED78C9 衛生福利部國民健康署。2007年台灣地區高血壓、高血糖、高血脂之追蹤調查 研究。2016年9月1日。取自http://www.hpa.gov.tw/BHPNet/Portal/File/ThemeDocFile/201410031153463091/%e6%85%a2%e6%80%a7%e7%97%85%e7%9b%9b%e8%a1%8c%e7%8e%87.csv 衛生福利部國民健康署(2015)。2015國民健康署年報中文版。 李冬蜂、吳肖琪(2004)。論病計酬實施前後冠狀動脈繞道手術病患死亡情形。台灣衛誌 23,305-15。 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。 汪辰陽(2016)。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。台北: 臺灣大學臺灣大學健康政策與管理研究所碩士論文。 林宜柏、吳昇容、 許仲偉、許華書、 蘇秉淵(2011)。高血壓病人服藥遵從性及其相關因素之探討。亞東學報。31,81-86。 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.。台北: 臺灣大學臺灣大學健康政策與管理研究所碩士論文。 廖惠華、李偉強、張偉斌、魏秀美(2014)。台灣導入診斷關聯群對醫療利用之影響—以內科系心導管診斷及治療為例。15(2),111-127。 臺北醫學大學生物統計研究中心(2017)。傾向分數配對–淺談馬哈蘭距離之應用。eNews。17。 高憲立(2004)。奪命性胸痛之一,急性冠狀動脈症候群。醫生,我的胸口痛。健康世界(219),59-80。 朱樹勳(1983)。淺談心臟開刀①。健康世界(90),3-7。 劉秉彥、陳志鴻(2002)。冠狀動脈疾病。科學發展(352),48-53。 劉慧玲、傅玲、余白妃、高秋惠、詹明珊、邱艷芬(2003).冠狀動脈繞道手術臨床路徑之建立與成效評值.護理雜誌,50(6),33-42。 李冠偉(2004)。認識冠心病和心導管介入性治療。彰基院訊,21(6),6-9。 盧美秀、林秋芬、魏玲玲(1997).個案管理與臨床路徑.護理雜誌,44(5),23-27。 英文部分 André Busato and Georg von Below.(2010) The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective. Health Research Policy and Systems,8(31),1-6. Averill R.F., M.S., Muldoon J.H., Vertrees J.C.,Goldfield N.I., Mullin R.L.,Fineran E.C,Zhang M.Z., Barbara Steinbeck,Thelma Grant(1998) The Evolution of Casemix Measurement. Using Diagnosis Related Groups (DRGs). 3M HIS Research Reprot. Baek S., Park S. H., Won E., Park Y. R. & Kim H. J. (2015). Propensity score matching: a conceptual review for radiology researchers. Korean journal of radiology.(16), 286–296. Centers for Medicare & Medicaid Services.(2015). County Level Multiple Chronic Conditions (MCC) Table: Prevalence, Medicare Utilization and Spending. Retrieved from: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/MCC_Main.html Centers for Medicare & Medicaid Services.(2015). Chronic Conditions. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-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. Condelius A, Edberg A.K., Jakobsson U., Hallberg I.R. (2008). Hospital admissions among people 65+ related to multimorbidity, municipal and outpatient care. Arch Gerontol Geriatr. 46(1):41-55. Friedman B, Jiang HJ, Elixhauser A, Segal A.(2006) Hospital inpatient costs for adults with multiple chronic conditions. Med Care Res Rev,63(3),327-46. Fetter, R.B., Thompson, J.D. and Millis, R. (1976) A system for cost and eimbursement control in hospitals. Yale J. Biol. Med., 49, 123 134. Fitzgerald J.F., Moore P.S., Dittus R.S. (1988) The care of elderly patients with hip fracture. Changes since implementation of the prospective payment system. N Engl J Med,319(21),1392-7. Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, Basu J. (2014). Multiple Chronic Conditions Chartbook. AHRQ Publications No, Q14-0038. Rockville, MD: Agency for Healthcare Research and Quality. Grotz M, Schwermann T, Lefering R, Ruchholtz S, Graf v d Schulenburg JM, Krettek C, Pape HC.(2004). DRG reimbursement for multiple trauma patients -- a comparison with the comprehensive hospital costs using the German trauma registry. Unfallchirurg, 107(1):68-75. 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(2-3),194-201. Hwang, W., Weller, W., Ireys, H., & Anderson, G. (2001). Out-of-pocket medical spending for care of chronic conditions. Health Affairs, 20(6), 267-278. Hoffman, C., Rice, D., & Sung, H. Y. (1996). Persons with chronic conditions. Their prevalence and costs. JAMA, 276(18), 1473-1479. Kondo A., Kawabuchi K.(2012)Evaluation of the introduction of a diagnosis procedure combination system for patient outcome and hospitalisation charges for patients with hip fracture or lung cancer in Japan.Health Policy, 107 , 184-193. Kahn K.L., Keeler E.B., Sherwood M.J., Rogers W.H., Draper D, Bentow S.S., Reinisch E.J., Rubenstein L.V., Kosecoff J, Brook RHKahn KL, Keeler E.B., Sherwood M.J., Rogers W.H., Draper D, Bentow S.S.(1990). Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. Journal of the American Medical Association . 264,1984–8. Kane, R. L., Priester, R., & Totten, A. M. (2005). Meeting the Challenge of Chronic Illness: Johns Hopkins University Press. Larsen, P. D. (2009). Chronic Illness: Jones & Bartlett Learning, 5-6. 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. J Clin Epidemiol. 52(3):171-9. Linden V. D.,Wim J. Ronald K. Hambleton .(1997). Handbook of Modern Item Response Theory. Mant J, McManus,R.J. (2006).Does it matter whether patients take their antihypertensive medication as prescribed? The complex relationship between adherence and blood pressure control. Journal of Human Hypertension (20), 551–553. National Heart, Lung and Blood Institute. Who Is at Risk for Atherosclerosis? (n.d.) 2016/06/22, Retrieved from: https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/atrisk Perrin, E. C., Newacheck, P., Pless, I. B., Drotar, D., Gortmaker, S. L., Leventhal, J., Weitzman, M. (1993). Issues involved in the definition and classification of chronic health conditions. Pediatrics, 91(4), 787-793. Schneider K. M., Brian E O'Donnell, and Debbie Dean(2009). Prevalence of multiple chronic conditions in the United States' Medicare population. Health Qual Life Outcomes. 7: 82. Starfield B, Leiyu Shi, and James Macinko.(2005).Contribution of Primary Care to Health Systems and Health. Health Qual Life Outcomes.7: 82. Van den Akker, M., Buntinx, F., & Knottnerus, J. A. (1996). Comorbidity or multimorbidity. European Journal of General Practice, 2(2), 65-70. Vogeli C., Shields A.E.,Lee T. A.,Gibson T. B.,Marder W. D.,Weiss K. B.,David Blumenthal, (2007). Multiple Chronic Conditions: Prevalence, Health Consequences and Implications for Quality, Care Management, and Costs.J Gen Intern Med.22(3): 391–395. Warshaw G.(2006). Introduction: advances and challenges in care of older people with chronic illness. Generation, 30,5-10. Wolff J. L.,Barbara Starfield,Gerard Anderson(2002). Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly. Arch Intern Med.162(20):2269-76. WHO(2014).Noncommunicable diseases. Retrieved from:http://www.who.int/topics/noncommunicable_diseases/en/ | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69936 | - |
dc.description.abstract | 研究背景:為有效提升管理效率與合理分配醫療資源,使民眾能獲得更完善的醫療照護,中央健康保險署於2010年起分階段導入臺灣住院診斷關聯群(Tw-DRGs)支付制度。該項支付制度屬於前瞻式支付方式,以住院病患之診斷、手術或處置及其他條件分成不同的群組,以達到醫療資源耗用相似的分類,再參考過去之醫療費用訂定預先支付醫院之費用標準。然而多重慢性病患的醫療資源耗用通常較高,醫事機構是否會為了有效控制成本,而在醫療處置上有所改變,進而影響多重慢性病病患之住院醫療利用情形及照護結果,鮮有研究加以探討。
研究目的:本研究以Tw-DRGs實施前後,比較心導管診斷與治療之病人有無多重慢性病,探討其住院醫療利用及照護品質之影響。 研究方法:研究資料使用「全民健康保險資料庫」原始檔,降低樣本代表性之限制及增加樣本數擷取,並以「審核結果DRG」之欄位擷取申報正確之案件作為研究樣本,降低資料因錯誤分組而導致的偏誤。本研究以MDC5為研究對象,介入組為第一階段導入Tw-DRGs接受心導管診斷與治療之病患,對照組為未納入第一階段Tw-DRGs之同類MDC5,使用傾向分數配對法增加導入Tw-DRGs前後之可比較性,並以廣義估計方程式(GEE)統計方法,進行差異法之差異法之差異法(Difference-in-difference-in-differences ,DDD)探討Tw-DRGs實施前後多重慢性病在醫療利用與照護結果的影響。 研究結果:Tw-DRGs實施對於多重慢性病之病人在住院總醫療費用、住院天數、住院前一週門診醫療費用、藥費占率、醫令數等醫療利用皆無顯著差異;照護結果亦顯示30日內死亡率、30日內再入院率及3日再急診率無顯著差異。若以整體政策效應分析,Tw-DRGs實施,相較於對照組,介入組住院總醫療費用、住院天數及住院前一週門診醫療費用、處置醫令皆有顯著差異。照護結果的部分,30日內死亡率無顯著差異、30日內再入院率顯著增加及3日再急診率無顯著差異。 結論與建議:本研究中進行心導管處置之病人,在Tw-DRGs實施後並不會影響多重慢性病人之醫療利用與照護結果,建議未來的研究設計,可以利用敏感度分析,將多重慢性病個數以不同切點進行分析,做為政策建議之參考。 | zh_TW |
dc.description.abstract | Background: In order to effectively enhance the quality and efficiency of care, Taiwan’s version of diagnosis related groups (Tw-DRGs) launched in 2010. Under the prospective system, patients within each category are clinically similar and are expected to use the same level of medical resources and health care costs. However, patients with multiple chronic conditions usually needed more medical resources. Tw-DRGs was implemented eight years ago, many studies have examined whether Tw-DRGs contributes to reduced resource usage, as does its effects on healthcare quality. Few studies have been conducted to investigate the impact of Tw-DRGs payment system on patients with multiple chronic conditions.
Objectives: The purpose of this study was to determine the impact of the Taiwan Diagnosis Related Groups (Tw-DRGs) payment system treating patients with Cardiac Catheterization and examine medical expenses and quality of care for patients with multiple chronic conditions. Methods: Patient-related data were obtained from the National Health Insurance data warehouse during the study period (2008-2011). To eliminated sample bias and misclassification, we select the representative sample from population and patients are assigned to DRG with EXM_RESULT_DRG in claim data. Patients who underwent Cardiac Catheterization as the intervention group and the comparsion group who underwent MDC5 intervention which were not phased in study period. Propensity score matching (PSM) was used to divide the subjects into DRG and non-DRG groups. The difference-in-difference-in-difference approach and the generalized estimating equation (GEE) model were used to compare the DRG and non-DRG groups with multiple chronic conditions on their medical usage and health outcome. Results: After Tw-DRGs were implemented, we found no significant difference between patients with multiple chronic conditions and patients without multiple chronic conditions in medical usage and health outcome. However, after Tw-DRGs was initiated, the DRG group had lower medical expenses, lower length of stay, higher medical expense shifting outpatient and lower number of orders for diagnosis or treatment. The mortality rate within 30 days after discharge and ED visits within 3 days after discharge compared to the non-DRG group were not significant. In contrast, after Tw-DRGs were implemented, the DRG group had a higher readmission rate within 30 days after discharge compared to the non-DRG group. Conclusions: After implementing the Tw-DRGs payment system, the medical usage and health outcome did not lead to the difference in patients with multiple chronic conditions and patients without multiple chronic conditions. We suggest that a sensitivity analysis used to determine how different values of an independent variable impact dependent variables under a given set of MCC assumptions. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T03:34:56Z (GMT). No. of bitstreams: 1 ntu-107-R02848024-1.pdf: 2955287 bytes, checksum: 5c80ce6dca3780a2acec632bb8c72d4c (MD5) Previous issue date: 2018 | en |
dc.description.tableofcontents | 口試委員會審定書 i
致謝 ii 中文摘要 iii Abstract v 目錄 vii 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第三節 研究重要性 4 第二章 文獻回顧 5 第一節 心導管檢查與治療之介紹 5 第二節 住院診斷關聯群介紹 7 第三節 多重慢性病之醫療利用 21 第四節 小結 25 第三章 研究方法 27 第一節 研究設計 27 第二節 研究假說 28 第三節 研究架構 29 第四節 資料來源與研究對象 31 第五節 研究變項與操作型定義 33 第六節 統計分析方法 44 第四章 研究結果 47 第一節 描述性統計 47 第二節 雙變項分析 56 第三節 多變項分析 88 第五章 討論 122 第一節 研究方法討論 122 第二節 研究結果討論 123 第三節 研究假說之驗證 129 第四節 研究限制 130 第六章 結論 131 參考文獻 133 中文部分 133 英文部分 136 | |
dc.language.iso | zh-TW | |
dc.title | 多重慢性病在DRGs對醫療資源耗用與照護結果影響中所扮演的角色 | zh_TW |
dc.title | The role of multiple chronic conditions in the impact of DRGs on health care resources usage and outcome | en |
dc.type | Thesis | |
dc.date.schoolyear | 106-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 蔡淑鈴(Shu-LingTsai),郭年真(Raymond Nien-Chen Kuo) | |
dc.subject.keyword | 住院診斷關聯群,多重慢性病,差異法之差異法之差異法(Difference-in-difference-in-differences ,DDD),醫療資源利用,照護結果, | zh_TW |
dc.subject.keyword | Diagnosis related groups,Multiple chronic conditions,Difference-in-difference-in-differences,Medical resources usage,Health care outcome, | en |
dc.relation.page | 139 | |
dc.identifier.doi | 10.6342/NTU201800485 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2018-02-13 | |
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 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-107-1.pdf 目前未授權公開取用 | 2.89 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。