Journal of Preventive Medicine and Public Health

  • 제43권6호
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  • Pages.523-534
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  • 2010
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  • 1975-8375(pISSN)
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  • 2233-4521(eISSN)
대한예방의학회 (The Korean Society for Preventive Medicine)
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고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty

  • 장원모 (서울대학교 의과대학 의료관리학교실) ;
  • 은상준 (계명대학교 의과대학 예방의학교실) ;
  • 사공필용 (서울대학교 의과대학 의료관리학교실) ;
  • 이채은 (서울대학교 의학연구원 의료관리학연구소) ;
  • 오무경 (서울대학교 의과대학 의료관리학교실) ;
  • 오주환 (서울대학교 의학연구원 의료관리학연구소) ;
  • 김윤 (서울대학교 의과대학 의료관리학교실)
  • Jang, Won-Mo (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Eun, Sang-Jun (Department of Preventive Medicine, Keimyoung University College of Medicine) ;
  • SaGong, Pil-Young (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Lee, Chae-Eun (Institute of Health Policy and Management, Medical Research Center, Seoul National University) ;
  • Oh, Moo-Kyung (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Oh, Ju-Hwan (Institute of Health Policy and Management, Medical Research Center, Seoul National University) ;
  • Kim, Yoon (Department of Health Policy and Management, Seoul National University College of Medicine)
  • 투고 : 2010.07.26
  • 심사 : 2010.10.12
  • 발행 : 2010.11.30
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초록

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

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참고문헌

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