Asia unversity:item 310904400/3220

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鍵詞: 日期: 2006上傳 2009-11-17 19:12:12 (UTC+8) Abstract Introdution: Hospital Global Budget Payment System has been executed since July, 2002. Although the execution of Hospital Global BudgetPayment System can efficiently control the medical expenditures, hospitals and clinics might become the cause of lowering thehealthcare quality by control ing costs further. Therefore, it is necessary to study and comprehend the changes of healthcare quality ofhospitals and analyze the related factors before and after the execution of Hospital Global Budget Payment System. Purpose: Be aware of the changes of healthcare quality of hospitals and the related factors before and after the execution of Hospital GlobalBudget Payment System based on the quality indicators of hospital global budget healthcare and of evidence-based medicine diseasemanagement. Methods: The research proceeds the secondary information analysis according to the National Health Insurance Research Database provided byNational Health Research Institutes, analyzing healthcare quality with two hundred thousand people sampling from the enrol ment filesmaintained by the Bureau of National Health Insurance based on the health insurance data from 2000 to 2004. The objects of study arethe 510 hospitals appointed by the Bureau of National Health Insurance, which wil be gathered statistics from and analyzed about qualityindicators of hospital global budget healthcare and of evidence-based medicine disease management by the means of statistics suchas Pair-t examination, regression, and so on. Results: After other variables are control ed, there is an obvious change of some items of quality indicators of healthcare after the execution ofhospital global budget in this research, which includes utilization rate of injections in outpatient services and its revised version, utilizationrate of antibiotics in outpatient services, repeated utilization rate of antacid from the same prescription in outpatient services (the revised 摘要: version), rate of re-admission within 14 days after discharging from the same hospital (the revised version), rate of emergency treatment within 3 days after discharging from the hospital and its revised version, utilization rate of antibiotics for the infection of the upperrespiratory tract, and utilization rate of Metformin for the diabetics with a complication of kidney disease ICD-9-CM 585. The qualityindicators for the above mentioned items al descend obviously, which mark great significance in statistics. On the other hand, the itemssuch as rate of prescribing chronic continuous prescriptions in outpatient services, rate of inappropriate days of medicine taking in thesame hospital in outpatient services, rate of inappropriate days of medicine taking in outpatient services and its revised version, andrate of overlong hospitalization for more than 30 days have the quality indicators ascend obviously which mark great significance instatistics. In the comparison of the performance of 17 medical centers on the quality indicators of hospital global budget healthcare in outpatientand inpatient services and of evidence-based medicine disease management, 6 medical centers achieve more than 50% of theindicators in the part of hospital global budget healthcare quality in outpatient and inpatient services. However, two of the six hospitalsdoesn?t reach 50% or above in the part of quality indicator of evidence-based medicine disease management. Conclusion: The quality indicators of healthcare that have an obvious change after the execution of hospital global budget include utilization rate ofinjections in outpatient services and its revised version, utilization rate of antibiotics in outpatient services, repeated utilization rate ofantacid from the same prescription in outpatient services (the revised version), rate of re-admission within 14 days after dischargingfrom the same hospital (the revised version), rate of emergency treatment within 3 days after discharging from the hospital and itsrevised version, rate of prescribing chronic continuous prescriptions in outpatient services, rate of inappropriate days of medicine takingin the same hospital in outpatient services, rate of inappropriate days of medicine taking in outpatient services and its revised version,rate of overlong hospitalization for more than 30 days, utilization rate of antibiotics for the infection of the upper respiratory tract, andutilization rate of Metformin for the diabetics with a complication of kidney disease ICD-9-CM 585. Since the revised version of qualityindicator of hospital global budget healthcare can be more significant as an indicator, we suggest using the revised version to monitorcontinuously and reinforcement the monitor of quality indicator of disease management toward hospitals in additional y.
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Source: http://wr.asia.edu.tw/file/Health/Health-2689.pdf