DPC hospital management with ADL evaluation in elderly patients
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概要
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[Purpose] The administrative reform in 2006 cut down on payments to care hospitals and as a result might increase dropouts from the long-term care insurance (LTCI) system for the elderly in Japan. The capacity reduction of the LTCI is believed to extend the length of stay in DPC (Diagnosis Procedure Combination) managed hospitals for the medical care of disabled patients, who commonly have additional complications that increase medical costs. This study analyzes how ADL (Activities of Daily Living) affect the management parameters adjusted with DPC.<BR>[Methods] This study was conducted between July and November 2006, and included 2058 patients aged 15 or more who had been discharged from the Ureshino Medical Center. ADL scores of the DPC evaluation were converted to the Barthel Index (BI) in 0 to 100 points. We defined "disabled" as BI 60 or less, and correlated disability with the length of hospital stay and financial DPC ratio.<BR>[Results] The studied elderly patients rated frequently as disabled. Disabled at discharge were 2.9% in the age group 15 to 64 years, 10.3% in age group 65 to 74 years, and 26.5% in age group 75 years or more, which correlated with the frequency of cannot-go-home in 4.4%, 9.4%, and 24.6%, respectively. Within the same DPC category, the disabled patients at admission had longer hospital stays and a lower DPC ratio. Multivariate analysis revealed that disability prolongs hospital stay by 2.57 days (95%CI 1.30-3.84), and reduces the DPC ratio by 0.047 (95% CI 0.020-0.067) after adjustments.<BR>[Conclusion] Patients' ADL profoundly affects the parameters of hospital management. However, the DPC system does not properly compensate for profit and loss dependent on ADL. To avoid financial risks due to disability, DPC hospitals should make correct assessments and introduce strict ADL management for elderly patients.
- 特定非営利活動法人 日本医療マネジメント学会の論文
特定非営利活動法人 日本医療マネジメント学会 | 論文
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