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研究生(外文):Hsiu-Hsiu Fan
論文名稱(外文):A Study of Surveillance Mechanism of Medical Care Expenses– An Exemplified of DRG 20904 the Partial Hip Arthroplasty
指導教授(外文):Wen-Hsiang Wu
外文關鍵詞:Taiwan Diagnosis Related GroupsDecision TreeControl chart
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The payment system of Diagnosis Related Groups (DRGs) has been implemented since 2010 in Taiwan. How to effectively monitor the medical expenses for DRGs constrained from the defined payment is an important impact to the hospital. According to the information from the Ministry of Internal and the Department of Health, the population aging results in the higher rate in surgical joint operation. Exemplified by partial hip arthroplasty, this study aims to help the hospitals and the Ministry of Health and Welfare to monitor the medical expenses and to establish a feasible method to observe the profit and deficit in Taiwan.
Cases of the partial hip arthroplasty in three medical centers from 2008 to 2010 from database of the Ministry of Health and Welfare are chosen for this study. Age has been decided as the potential parameter related to the expenses by exploration of the data. After the removal of the stray values, the ages are subdivided into subgroups and then the target of this study is the average age value of each subgroup. Therefore, the control chart can be determined and schemed to monitoring the profit and deficit simultaneously. Because of the difficulties of the calculation of the individual target and the coincidence with the regulation of the Ministry of Health and Welfare, this standardized pre-control chart well combines the upper and lower formats with the upper and lower limits defined by the Ministry of Health and Welfare and are feasible for staffs to learn and judge the profit and deficit. Furthermore, this study suggests that the Nonparametric Control Charts is available for the Ministry of Health and Welfare to decide whether the declared expenses are oversubscribed by different hospitals with the same payments. A customized system to monitor the details of the profit and deficit could be implemented by the Multiple Control Charts. Furthermore, the other control charts might be suitable to monitor the expenses depending on the characteristics of different medical centers, regional hospitals, or our own hospitals.
目錄 I
圖目錄 III
表目錄 IV
第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究流程 4
1.4 研究結構 6
第二章 文獻探討 7
2.1 診斷關係群支付制度探討 7
2.1.1診斷關係群之沿革與發展 7
2.1.2各國實施診斷關係群概況 10
2.1.3台灣實施診斷關係群之發展 14
2.1.4診斷關係群支付制度之衝擊與影響 16
2.1.5 疾病分類之簡介 17
2.2 部分髖關節置換術與治療方式 20
2.2.1髖關節的構造 20
2.2.2執行部分髖關節置換術的病因 20
2.2.3部分髖關節置換術治療方式 21
2.3 資料探勘研究探討 23
2.4 管制圖運用與相關研究 25
2.5 目標個別值移動全距管制圖 27
2.6 預控圖與管制圖之差異 28
2.6.1 傳統預控圖 29
2.6.2 兩階段預控圖 30
2.7無母數修瓦特管制圖 32
2.8多層級修華特管制圖 33
第三章 研究方法 34
3.1 研究限制 35
3.2 研究範圍與對象 35
3.3 個別值移動全距管制圖 36
3.4 決策樹分析 37
3.5目標個別值移動全距管制圖 38
3.6 兩階段預控圖 39
3.7 無母數修瓦特管制圖 40
3.8多層級修華特管制圖 41
第四章 研究結果 43
4.1個別值移動全距管制圖監控結果 43
4.2資料探勘之決策樹分析結果 44
4.3 個案醫院目標個別值移動全距管制圖 45
4.4 標準化預控圖監控之結果 51
4.5無母數管制圖 55
4.6多層級修華特管制圖監控之結果 58
第五章結論與建議 62
5.1建議 65

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