DOI QR코드

DOI QR Code

Estimation of cost by unnecessary readmission of the tertiary hospitals

불필요한 재입원 비용 추정에 관한 연구

  • Shin, Min Sun (Department of Healthcare Management, Gachon University) ;
  • Lee, Won Jae (Department of Healthcare Management, Gachon University)
  • 신민선 (가천대학교 헬스케어경영학과) ;
  • 이원재 (가천대학교 헬스케어경영학과)
  • Received : 2017.10.11
  • Accepted : 2017.12.20
  • Published : 2017.12.28

Abstract

Unnecessary readmissions could be the result of the inadequate and unnecessary treatments. Adequate quality indicators for readmission are important because they can identify inadequate spending by inpatients as well as quality screening. This study attempted to estimate the cost incurred by unnecessary readmissions. The Health Insurance Claims Data of 18 years or older who were admitted in the tertiary hospitals in 2014 were analyzed. Admissions and readmissions were sorted and readmissions were classified into planned and unplanned readmissions. We adopted 28 days as a criteria for the classification of the readmission. Proportion of the patients were higher in readmissions among cancer, accompanied diseases, and special rehabilitation patients. Cost of the readmissions were 50% of the total cost of the admission among the patients of same diseases, same departments, and same hospitals. Almost 1,000billion Won were used by the unnecessary readmissions. We need to reduce the readmissions in regions, departments, and diseases studying the pattern of the readmissions. National level efforts are required to improve quality of care and reduce cost by the unnecessary readmissions.

입원기간동안 적절하지 않거나 불필요한 처치로 발생될 수 있는 재입원관련 질지표는 질스크리닝 뿐만 아니라 입원환자의 적절하지 못한 지출을 파악할 수 있어서 중요하다. 이 연구는 예방할 수 있는 재입원으로 인해 발생되는 진료비 규모를 파악하고자 한다. 건강보험심사평가원의 2014년도 청구 데이터를 활용하여 종합병원이상 의료기관에 입원한 18세 이상 성인을 대상으로 분석하였다. 입원 유형을 1회 입원군과 재입원군으로 분류하였고, 재입원군은 다시 계획된 재입원과 계획되지 않은 재입원으로 분류하였다. 재입원 간격은 28일 이내로 설정하였다. 암질환, 동반질환, 전문재활 환자의 경우 1회 입원군보다 재입원군의 분포가 더 많았다. 계획되지 않은 재입원 유형 중 동일 기관, 동일 진료과목, 동일 질병군 입원의 경우 재입원에 지출된 총 진료비가 전체 재입원 진료비의 50%가량을 차지하였다. 불필요한 재입원으로 인해 발생되는 진료비는 2014년 1년간 9,990억원 정도였다. 재입원이 잦은 지역, 진료과목, 질병군 등의 패턴을 활용하여 재입원을 줄이려는 노력이 필요하다.

References

  1. C. M. Ashton, D. J. Del Junco, J. Soucheck, N. P. Wrey, C. L. Mansyur, "The Association Between the Quality of Inpatient Care and Early Readmission: A Meta-Analysis of the Evidence", Medical Care, Vol. 35, No. 10, pp. 1044-1045, 1997. https://doi.org/10.1097/00005650-199710000-00006
  2. E. L. Hannon, M. J. Racz, G. Walford, et al., "Redictors of Readmission for Complications of Coronary Artery Bypass Graft Surgery", JAMA, Vol. 290, No. 6, pp. 773-780, 2003. https://doi.org/10.1001/jama.290.6.773
  3. N. I. Goldfield, E. C. McCullough, J. S. Hughes, A. M. Tang , Beth Eastman, L. K. Rawlins, and R. F. Averill, "Identifying Potentially Preventable Readmissions", Health Care Financing Review Vol. 30, No. 1, pp. 75-91, 2008.
  4. Centers for Medicare & Medicaid Services(CMS), Hospital-wide all-cause unplanned readmission measure(final technical report), CMS&YNHHSC/CORE, 2012.
  5. M. H. Kim, H. S. Kim, S. H. Hwang, "Original Articles : Developing a Hospital-Wide All-Cause Risk-Standardized Readmission Measure Using Administrative Claims Data in Korea: Methodological Explorations and Implications", Health Policy and Management, Vol. 25, No. 3, pp. 197-206, 2015. https://doi.org/10.4332/KJHPA.2015.25.3.197
  6. E. W. Lee, S. H. Yu, H. J. Lee, S. I. Kim, "Original Articles : Factors Associated with Unplanned Hospital Readmission", Korean journal of hospital management, Vol 15, No. 4, pp. 125-142, 2010.
  7. J. H. Hong, "A Study of the Characteristics of Readmitted Patients in an University Hospital in Korea", Journal of Korean Society of Quality Assurance in Health Care, Vol. 2, No. 2, pp. 56-71, 1995.
  8. J. H. Hwang, S. J. Rhee, "A Study on the Identification of Risk Factors for unplanned Readmissions in a University Hospital", Journal of Korean Public Health Nursing, Vol. 16, No. 11, pp. 201-212, 2002.
  9. S. A. Lee, Y. J. Ju, J. Y. Shin, E. C. Park, H. Y. Lee, "Readmission Rate: Experience in USA, Canada and UK", Quality improvement in health care, Vol. 22, No. 1, pp. 29-37, 2016. https://doi.org/10.14371/QIH.2016.22.1.29
  10. E. Y. Choi, M. S. Ock, S. I. Lee, "Is the Risk-Standardized Readmission Rate Appropriate for a Generic Quality Indicator of Hospital Care?", Health Policy and Management, Vol. 26, No. 2, pp. 148-152, 2016. https://doi.org/10.4332/KJHPA.2016.26.2.148
  11. HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE, Study of readmission model categorize and standard development, HEALTH INSURANCE REVIEW & ASSESSMENT SERVICE&Dankuk University, 2016.
  12. https://hcup-us.ahrq.gov/toolssoftware/ccs10/ccs10.jsp#download.
  13. Quan H, Li B, Couris CM et al. "Updating and Validating the Charlson Comorbidity Index and Score for Risk Adjustment in Hospital Discharge Abstracts Using Data from 6 Countries", AM J Epidemiol, Vol. 173, No. 6, pp. 676-282, 2011. https://doi.org/10.1093/aje/kwq433
  14. H. W. Yoo, Inpatient care focused strategy and convergence performance in hospitals, Journal of the Korea Convergence Society, Vol. 7. No. 4, pp. 59-66, 2016. https://doi.org/10.15207/JKCS.2016.7.4.059
  15. J. H. Lee, Y. M. Kim, S. H. Kang, "Original Article : A study patient management for both planned and unplanned readmission in a medium-size hospital", Health Service Management Review, Vol. 2, No. 1, pp. 11-17, 2008.
  16. Silvestein MD, Qin H, Mercer SQ, Fong J, Haydar Z, "Risk Factors for 30-day Hospital readmission in Patients ${\geq}$65 year of age", Baylor University Medical Center, Vol. 21, No. 4, pp. 363-372, 2008. https://doi.org/10.1080/08998280.2008.11928429
  17. Eun Whan Lee, "Selecting the Best Prediction Model for Readmission", J prev Med Public Health, Vol. 45, pp. 259-266, 2012. https://doi.org/10.3961/jpmph.2012.45.4.259
  18. J. Y. Moon, An empirical study of the Strategy Development and Deployment effects on the Hospital Management and Hospital Performance, Journal of the Korea Convergence Society, Vol. 6. No. 6, pp. 57-63, 2015. https://doi.org/10.15207/JKCS.2015.6.6.057
  19. Stephen F. Jencks, Mark V. Williams, and Eric A. Coleman, "Rehospitalizations among Patients in the Medicare Fee-for-Service Program", The New England Journal of Medicine, Vol. 360, pp. 1418-28, 2009. https://doi.org/10.1056/NEJMsa0803563