Department of Health Services Administration, China Medical University, Taichung, Taiwan, R.O.C.
Department of Superintendent, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan, R.O.C.
PLoS One. 2020 Dec 9;15(12):e0243373. doi: 10.1371/journal.pone.0243373. eCollection 2020.
Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC).
We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System.
In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69-9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32-31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals.
The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.
台湾自 2010 年起实施疾病诊断相关分组（DRGs），关注 DRG 支付制度下的医疗质量。本研究旨在探讨每个主要诊断类别（MDC）下，DRG 支付制度下住院患者急诊就诊、再入院和医院转科的特征、相关因素和时间分布。
我们使用来自台湾 2012 年至 2013 年的国家健康保险研究数据库（NHIRD）进行回顾性队列研究。多水平逻辑回归分析用于检验 DRG 支付制度下患者急诊就诊、再入院和医院转科的相关因素。
本研究中，103779 名住院患者采用 DRG 支付制度。其中，4.66%的患者在出院后 14 天内就诊于急诊。14 天内就诊于急诊的风险增加因素包括年龄、月收入较低、居住地城市化程度、合并症指数、MDCs 和医院所有制（p<0.05）。就 MDCs 而言，肾脏和泌尿道疾病（MDC11）导致 14 天内就诊于急诊的风险最高（OR=4.95，95%CI：2.69-9.10）。在这些住院患者中，6.97%在 30 天内再次入院。与再入院风险增加相关的因素包括性别、年龄、月收入较低、合并症指数、MDCs 和医院所有制（p<0.05）。就 MDCs 而言，妊娠、分娩和产褥期（MDC14）患者 30 天内再入院的风险最高（OR=20.43，95%CI：13.32-31.34）。在 30 天内再次入院的患者中，75.05%的患者在 14 天内再次入院。只有 0.16%的患者转至其他医院。
研究表明，手术中的主要诊断类别与急诊就诊、再入院和医院转科之间存在显著相关性。结果表明，对于 ED 就诊、再入院和医院转科的高风险的主要原因，可能需要对 MDCs 进行进一步调查。
