1998 1993
Mainz, 2003; Rubin et al, 2001
Kazandjian et al, 2003; Dimick et al 2004; Rogowski et al, 2004; Grandjour et al, 2003; Epstein, 2002
Peterson et al 2004 Pintor et al, 2002
Horn et al., 1985; Kravitz et al., 1992; Stein et al., 1987; Stewart, Hays, & Ware, 1988; Tarlov et al., 1989 Medicare
Diagno-sis Related Groups, DRGs
Horn et al., 1985; Horn, Horn, & Sharkey, 1986
Goldfarb & Coffey, 1987
Listing, Klindworth, & Zeidler, 2001 Greenfield, et al., 1988 1. 2. 3. 4. 5. 6. 1. 2. 3. 1. 2. 3. 4. 1. 2. 3. 4.
1. Stewart et al. 1981 Health Insurance Study HIS
Stewart 1988 MOS short-form General Health Survey
Health Scales 22 0 = 14 1 =22-43 2 =44-63 3 =64 2.
Gonnella, et al. 1984 The SysteMetrics Disease Staging System
1 2 3 4
3.
Kravitz 1992
4.
11 12 11 12 1 2 22 5 Cronbach 50 0.81 0.85 C D A B E F 5,992 C 505 1,470 24.5% A D
23.4% 20.6% F 100 219 3.7% ??????????????? ?O)Xg? ?@@@@@@@@@@@@@@@@@@@@)g???????????????????? 14 64 51.1% 65 79 23.2% 14 9.0% 53% 47% 55.3% 28.0% 12.0% 65.0% 24.4% 2.6% 5 5 . 4 % 44.0% 0.6% 48.3% 32.8% 6.3% 91.2% 3 2 1 1 2 3 3.8% 0 2 3 B 53.2% E 46.9% F 45.7% D 32.3% 2 E 59.8% F 57.3% C 3 1 . 4 % D 100% 100% ᚂտ ᠌឴տ ຟᠦ้ ᖂחኵ ӱԝ୰ڢኵ ԤਝԻϷШ Aᚂ ϴҳ ӴୢఀᏰ 200 1404 23.4 Bᚂ ϴҳ ӴୢఀᏰ 220 980 16.4 Cᚂ ϴҳ ୢఀᏰ 505 1470 24.5 Dᚂ ϴҳ ୢఀᏰ 855 1235 20.6 Eᚂ ؽҳ Ӵୢᚂ 158 684 11.4 Fᚂ ؽҳ Ӵୢᚂ 100 219 3.7 ᖂॎ 2138 5992 100.0
ᡐ ԩኵ ԤਝԻϷШ ੫፴ ԑឭቹ >=80ྑ 712 11.9 >=65~<80ྑ 1388 23.2 >=14~<65ྑ 3053 51.1 >=2~<14ྑ 539 9.0 >=1Т~<2 ྑ 190 3.2 <1এТ 88 1.5 ᒸᅓ 22 ܒտ ظ 3132 53.0 τ 2778 47.0 ᒸᅓ 82 ஔࡅޑݷ Ґஔ 1646 28.0 ӣۨ 72 1.2 ᚔஔ 88 1.5 ϐஔ 3316 55.3 ៶ᄀ 718 12.0 Ϸۨ 49 0.8 ᒸᅓ 103 ҡࣀԝΣ ড়Ρඪټ 3871 65.0 ھۡώհԝΣ 1452 24.4 ߨھۡԝΣ 266 4.5 ଝӄߜ 212 3.6 ޥོᔼߜ 153 2.6 ᒸᅓ 38 ՞ܚ ড় 5450 91.0 ԊᎴϛЖ 335 5.6 ၽҕ 16 0.3 ڏт 113 1.9 ᒸᅓ 78 ՞ഊ৷ ငߞຨ 3310 55.4 ငࡨຨ 2625 44.0 ငᙽ 37 0.6 ᒸᅓ 20
՞ऋفտȞN=5992ȟ ϱऋف 2878 48.3 Ѵऋف 1955 32.8 ωڋऋ 750 12.5 ஏऋ 375 6.3 ᒸᅓ 34 0.6 юޑݷ ౹ᘾȃܖᙽю 5453 1.2 ሯᙽтݽᕛ 185 3.1 ߨґՌଢ଼ю 188 3.1 ґՌଢ଼ю 48 0.8 ԫι 106 1.8 ᒸᅓ 11 ٽಢӫፒᚕܒ ٘Жђޑᄘ 0 1082 18.2 1 22-43 Ϸ 281 4.7 2 44-63 Ϸ 2013 33.9 3 64 Ϸоΰ 2564 43.2 ᒸᅓ ᝒ१࡙ 0ȈؠԤᑯȞ՞ᔮȟ 287 4.8 1ȈຨᘞጂۡؠԤځี 3990 66.9 2Ȉࠁ३ӵ࢚ΙᏢۢȂ࡞џ ЕีځีȇȞϚݽᕛ൷ོЕี ځีȟ 1354 22.7 3ȈШ 2 ᝒ१ȂݰЅӻ ᆍᏢۢȂႱࡣϚԁȇȞᑖྃݽᕛϫ ฒݲԤਝȟ 225 3.8 4Ȉԫι 106 1.8 ᒸᅓ 30 Ԥฒӫځ Ԥӫځ 1192 20.0 ฒӫځ 4772 80.0 ᖂڷ 5964 100.0 ᒸᅓ 28 ӫځ้ 0 4743 80.2 1 352 6.0 2 602 10.2 3 213 3.6 ᒸᅓ 81
9.2% E 43% B 24.8% C 21.7% D 11.1% 1 E D 1.8% 2.35% B C F 288 1 8 . 3 2 =10.447 p<0.01 Scheffe 1 80 11.23 14~ 65 2~ 14 1 ~ 2 2 65~ 80 11.03 14~ 65 2~ 14 1 ~ 2 3 14~ 65 7.29 2~ 14 80 11.23 65~<80 11.03 2~ 14 4.73 Scheffe 1 A 6.80 ᚂտ A B C D E F ٘Жђޑᄘ 3 оΰϞШٽ 43.8% 53.2% 41.4% 32.3% 46.9% 45.7% ᝒ१࡙ 2 оΰ ϞШٽ 25.1% 24.5% 31.4% 9.2% 59.8% 57.3% ԤӫځϞШٽ 11.8% 24.8% 21.7% 11.1% 43.0% 18.0% ӫځ้ 1 оΰ ϞШٽ 11.8% 24.9% 22.1% 11.1% 43.0% 17.8% ԫι 1.6% 3.5% 3.5% 1.6% 3.0% 0.9%
C 11.44 D 8.53 2 B 7.43 C 3 C 11.44 D 8.53 E 6.59 F 5.24 4 D E F C 11.44 D 8.53 F 5.24 8.68 6.26 10.11 7.06 6.26 Scheffe 10.15 7.47 5.19 5.10 Scheffe 14~ 65 8 0 O R = ᡐ Ȥ2 p ᡐ Ȥ2 p ੫፴ ՞ऋտ 213.814 <0.001 ԑឭቹ 191.753 <0.001 ܒտ 4.758 0.313 ٽಢӫፒᚕܒ ஔࡅޑݷ 99.255 <0.001 ٘Жђޑᄘ 151.494 <0.001 ҡࣀԝΣ 53.355 <0.001 ᝒ१࡙ 6409.642 <0.001 ՞ܚ 61.278 <0.001 ӫځኵҬ 64.840 <0.001 ՞ഊ৷ 139.754 <0.001 ӫځ้ 57.370 <0.001 ᚂ੫፴ ᚂտ 101.060 <0.001 ᠌឴տ 5.754 0.218 ᚂຟᠦ้ 54.628 <0.001
՞Рኵ ᡐ এኵ ҁ֯ኵ ྥ৯ F Scheffe ٱࡣᔮۡ ੫፴ ܒտ 1.400 ظ 3129 8.50 10.235 τ 2778 8.18 10.775 ԑឭቹ 54.964ɎɎɎ 80Њ ྑ 711 11.23 10.912 65~Њ ɴ80 1388 11.03 14.239 14~Њ ɴ65 ྑ 3052 7.29 9.027 2~Њ ɴ14 ྑ 539 4.73 2.548 1 Њ এТ~ɴ2 ྑ 190 4.82 2.415 ɴ1 এТ 88 7.55 7.722 1-3, 1-4, 1-5 2-3, 2-4, 2-5 3-4 ஔࡅޑݷ 30.543ɎɎɎ Ґஔ 1646 6.15 7.954 ӣۨ 72 11.07 14.373 ᚔஔ 88 8.95 10.508 ϐஔ 3314 8.65 10.629 ៶ᄀ 718 11.56 13.008 Ϸۨ 49 7.82 5.769 1-2, 1-4,1-5 4-5 ԝΣ 28.938ɎɎɎ ড়Ρඪټ 3870 8.63 11.134 ھۡώհԝΣ 1452 6.35 6.775 ߨھۡώհԝΣ 266 8.92 8.678 ଝӄߜ 212 11.31 13.705 ޥོᔼߜ 15333 13.70 14.590 1-2, 1-4, 1-5 2-3, 2-4, 2-5 3-5 ՞ܚ 33.790ɎɎɎ ড় 5448 7.96 9.406 ԊᎴϛЖ 334 13.42 19.108 ၽҕ 16 8.31 5.735 ڏт 113 11.92 16.383 1-2, 1-4 ՞ഊ৷ 10.238ɎɎɎ ငߞຨ 3309 7.85 9.52 ငࡨຨ 2623 8.87 11.46 ငᙽ 37 12.73 12.90 1-2, 1-3 ᚂ੫፴ ᚂտ 42.710ɎɎɎ A 1404 6.80 6.297 B 980 7.43 7.931 C 1470 11.44 14.210 1-3, 1-4 2-3 3-4, 3-5, 3-6
᠌឴տ 41.406ɎɎɎ ϴҳ 5089 8.68 10.255 1-2 ؽҳ 900 6.26 11.260 ᚂຟᠦ้ 76.487ɎɎɎ ӴୢఀᏰ 2384 7.06 7.020 ୢఀᏰ 2705 10.11 12.251 Ӵୢ 900 6.26 11.260 1-2 2-3 ՞ऋտ 71.538ɎɎɎ ϱऋف 2877 10.15 12.112 Ѵऋف 1954 7.47 9.788 ωڋऋ 750 5.10 3.545 ஏऋ 375 5.19 3.390 1-2, 1-3, 1-4 2-3, 2-4 ٽಢӫፒᚕܒ ٘Жђޑᄘ 197.550ɎɎɎ 1 22-43 Ϸ 285 16.58 18.000 2 44-63 Ϸ 2013 10.39 11.734 3 64 Ϸоΰ 2563 6.35 6.022 1-2, 1-3 2-3 ᝒ१࡙ 77.094ɎɎɎ 0 287 4.59 3.579 1 3988 7.48 8.066 2 1354 9.88 12.421 3 225 13.10 12.607 4 106 20.92 32.724 1-2, 1-3, 1-4, 1-5 2-3, 2-4, 2-5 3-4, 3-5 4-5 ӫځኵҬ 24.172ɎɎɎ 0 4769 7.69 9.489 1 907 10.55 12.311 2 258 10.03 10.665 3 27 10.81 10.941 1-2, 1-3 ӫځ้ 4.515Ɏ 1 362 10.00 11.566 2 617 10.25 11.982 3 226 13.08 18.198 1-2 2-3 3-1 D 1235 8.53 9.157 E 682 6.59 12.762 F 218 5.24 3.575 4-5, 4-6 p<0.05 p<0.01 p<0.001
2.047 OR=3.635 OR=0.14 B C A 0.436 0.499 0 2 OR=0.322 3 2 OR=4.094 14.3% 14 64 53% 47% 11.4 1.8% 2.35% 1992 1995 2% 1998 1.2% 1998 1998 2-4
՞юਢԆݣޑݷ (Ԇࣀ=1ȇݣ=0) ᡐӪᆎ Ճಢ ଟᘪ߽ኵ ྥᇲ p ഽᆗШ (95%߬ᒦୢ) லኵ 10.264 14.487 0.479 0.8831 ੫፴ ܒտ ظ τ -0.185 0.223 0.407 -0.831 (0.537~1.287 ) ԑឭ 65~Њ ɴ80 ྑ 80Њ ྑ 0.293 0.256 0.252 1.340 (0.812~2.214 ) 14~Њ ɴ65 ྑ 0.716 0.344 0.037 2.047 (1.042~4.019 ) 2~Њ ɴ14 ྑ 6.652 16.599 0.689 774.216 (0.000~0.010 ) 1 Њ Т~ɴ2 ྑ 5.474 27.035 0.840 238.395 (0.000~0.024 ) ɴ1 এТ 3.223 49.183 0.948 25.113 (0.000~ฒ३σ) ஔࡅޑݷ Ґஔ Ϸۨ 0.206 1.107 0.852 1.229 (0.140~10.756 ) ӣۨ 0.433 1.287 0.736 0.648 (0.052 ~ 8.080 ) ᚔஔ 7.851 42.757 0.854 2568.484 (0.000~0.0637 ) ϐஔ 0.460 1.058 0.663 1.585 (0.199~12.597 ) ៶ᄀ 0.293 1.076 0.785 1.341 (0.163~11.052 ) ҡࣀԝΣ ড়Ρඪټ -0.784 0.506 0.122 0.457 (0.169~1.232 ) ߨھۡώհԝΣ -1.086 0.691 0.116 0.337 (0.087~1.308 ) ଝӄߜ -0.916 0.656 0.162 0.400 (0.111~1.446 ) ޥོᔼߜ ھۡώհ ԝΣ 0.966 0.781 0.216 0.381 (0.082~1.759 ) ՞ܚ ԊᎴϛЖ ড় 0.686 0.362 0.058 1.986 (0.977~4.038 ) ၽҕ 9.059 104.461 0.931 8593.082 (0.000~ฒ३σ) ڏт 8.979 36.466 0.806 7934.275 (0.000~0.086 ) ՞ഊ৷ ငߞຨ ငࡨຨ 1.291 0.272 <0.001 3.635 (2.135~6.190 ) ငᙽຨ -1.965 0.612 0.001 0.140 (0.042~0.465 ) ᚂտ Bᚂ Aᚂ -0.830 0.360 0.021 0.436 (0.215~0.883) Cᚂ -0.695 0.349 0.046 0.499 (0.252~0.988) Dᚂ -0.292 0.410 0.477 0.747 (0.334~1.670) Eᚂ -0.483 0.484 0.318 0.617 (0.239~1.593) Fᚂ 0.391 1.066 0.714 1.478 (0.183~11.944)
66.9% 22.7% Kravitz et al., 1992 80% 66.9% 80% 3 2 96.2% ՞ऋտ ϱऋف ωڋऋ -6.996 14.435 0.628 0.628 (0.000~0.017) Ѵऋف -5.657 14.439 0.695 0.695 (0.000~0.068) ஏऋ 0.235 26.079 0.933 0.993 (0.000~0.020) ٽಢӫፒᚕܒ ٘Жђޑᄘ 0 -1.134 0.359 0.002 0.322 (0.159~0.650) 1 22-43 Ϸ -0.473 0.306 0.122 0.623 (0.342~1.135) 3 64 Ϸоΰ 2 44-63Ϸ 1.410 0.366 <0.001 4.094 (2.000~8..382) ӫځኵҬ 0.256 0.175 0.144 0.144 (0.916~1.823)
՞Рኵ ᡐӪᆎ Ճಢ ଟᘪ߽ኵ ྥ৯ t P லኵ 5.499 1.741 3.159 0.002 ੫፴ ԑឭ 65~ Њ ɴ80 ྑ 80Њ ྑ 0.795 0.466 1.706 0.088 14~ Њ ɴ65 ྑ 0.290 0.512 0.567 0.571 2~ Њ ɴ14 ྑ -2.434 0.973 -2.501 0.012 1 Њ Т~ɴ2 ྑ -2.313 1.172 -1.974 0.048 ɴ1 এТ -0.924 1.399 -0.660 0.509 ஔࡅޑݷ Ґஔ Ϸۨ -0.601 1.389 -0.433 0.665 ӣۨ 2.308 1.748 1.321 0.187 ᚔஔ 0.216 1.689 0.128 0.898 ϐஔ 0.567 1.361 0.417 0.677 ៶ᄀ 1.176 1.417 0.830 0.407 ҡࣀԝΣ ড়Ρඪټ 0.667 0.354 1.884 0.060 ߨھۡώհԝΣ 1.457 0.641 2.274 0.023 ଝӄߜ 1.338 0.746 1.795 0.073 ޥོᔼߜ ھۡώհ ԝΣ 1.694 0.927 1.828 0.068 ՞ܚ ԊᎴϛЖ ড় 2.042 0.669 3.052 0.002 ၽҕ -1.917 2.401 -0.798 0.425 ڏт 2.686 0.953 2.818 0.005 ՞ഊ৷ ငߞຨ ငࡨຨ -0.733 0.266 -2.758 0.006 ငᙽຨ 1.517 1.566 0.969 0.333 ᚂ੫፴ Bᚂ Aᚂ -0.576 0.411 -1.403 0.161 Cᚂ 3.152 0.379 8.311 <0.001 Dᚂ 1.832 0.380 4.815 <0.001 Eᚂ -2.567 0.524 -4.903 <0.001 Fᚂ -2.345 0.787 -2.978 0.003 ՞ऋտ ϱऋف ωڋऋ 2.566 0.898 2.858 0.004 Ѵऋف 2.529 0.873 2.898 0.004 ஏऋ 2.750 1.111 2.475 0.013
B C A Adj- R2=14.3% C 11.44 D 8.53 80 11.23 65~ 80 11.03 1 7.55 U
Bradbury, Golec & Steen 2000
ٽಢӫፒᚕܒ ٘Жђޑᄘ 0 2.146 0.647 3.317 0.001 1 22-43 Ϸ 2 44-63 Ϸ 4.238 0.625 6.778 <0.001 3 64 Ϸоΰ -2.133 0.316 -6.757 <0.001 ᝒ१࡙ 0 -3.246 0.795 -4.081 <0.001 1 2 -1.424 0.344 -4.138 <0.001 3 1.681 0.728 2.309 0.021 4 8.484 0.991 8.555 <0.001 ӫځኵҬ 0.410 0.259 1.582 0.114 ኺҏኵ=5992 F =26.618 P <0.01 ր߽ۡኵ Adj R2=0.143
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12. 1991
DRGs
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Hsiu-Wei Chang, Nai-Wen Kuo, Kuo-Cherh Huang, Yaw-Ching Chen, Kuo-Piao Chung*
The purposes of this study are to examine whether the variations of hospi-tals ?????? ?@@?e? ?@@?e? ?@@?e? ?@@?e? ?@@?e? ?@@?e?????????????????????????
characteristics, admission departments, and in-patients
?????? ?@@?e? ?@@?e? ?@@?e? ?@@?e? ?@@?e? ?@@?e????????????????????????? characteristics are different on in-patients case mix complexities; and to explore the relationships among case mix complexities, discharge status, and length of stay among in-pa-tients of six hospitals in the Taipei Metropolitan Area. This cross-sectional study is evaluated by face-to-face interviewing 5992 in-patients from the six hospitals in the Taipei Metropolitan Area since November, year 2002. The six hospitals include two public local teaching hospitals, two private local nonteaching hospi-tals, and two public regional teaching hospitals. The independent variables in case mix complexities are functional status (for measuring physical and mental health, social and role functioning, and other general health concepts), severity of illness (staging of disease is the measurement scales of this study), co-mor-bidity numbers and its scales levels. The results support that there are significant differences among the six different hospitals in case mix complexities. Differ-ences of the characteristics of hospitals (public/private, degree of hospital ac-creditation) lead to various case mix complexities. In discharge status and the length of stay, there are significant differences among admitted patient condi-tions, admission departments, the characteristics of the hospitals, and case mix
complexities. The higher the case mix complexity, the longer the length of stay. Future research might focus on longitudinal study to explore the relationship among discharge status, resources consumption, multiple dimensions of evalua-tion, expanded sample hospitals and design appropriate evaluation instruments.
