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Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

Huang, Pei-Fang ; Kung, Pei-Tseng ; Chou, Wen-Yu ; Tsai, Wen-Chen Remuzzi, Giuseppe

PloS one, 2020-12, Vol.15 (12), p.e0243373-e0243373 [Periódico revisado por pares]

United States: Public Library of Science

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Título:
Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study
Autor: Huang, Pei-Fang ; Kung, Pei-Tseng ; Chou, Wen-Yu ; Tsai, Wen-Chen
Remuzzi, Giuseppe
Assuntos: Adult ; Age ; Aged ; Childbirth & labor ; Cohort analysis ; Comorbidity ; Correlation analysis ; Demographic aspects ; Diagnosis related groups ; Diagnosis-Related Groups - economics ; Diagnosis-Related Groups - standards ; Diagnostic systems ; DRGs ; Earth Sciences ; Economics, Hospital ; Emergency medical care ; Emergency medical services ; Emergency service ; Emergency Service, Hospital - economics ; Emergency Service, Hospital - standards ; Female ; Gender ; Health care industry ; Health care policy ; Health insurance ; Health risks ; Health services ; Hospital emergency services ; Hospital patients ; Hospitalization ; Hospitals ; Hospitals - standards ; Humans ; Inpatients ; Length of Stay - economics ; Male ; Medical diagnosis ; Medicine and Health Sciences ; Middle Aged ; Ownership ; Patient Discharge - economics ; Patient transfer ; Patients ; Payment systems ; Payments ; Prospective payment systems ; Puerperium ; Regression analysis ; Risk ; Risk Factors ; Social Sciences ; Statistics ; Surgery ; Taiwan - epidemiology ; Time Factors ; Urbanization ; Urinary tract ; Young Adult
É parte de: PloS one, 2020-12, Vol.15 (12), p.e0243373-e0243373
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
Competing Interests: The authors have declared that no competing interests exist.
Descrição: Taiwan has implemented the Diagnosis Related Groups (DRGs) since 2010, and the quality of care under the DRG-Based Payment System is concerned. This study aimed to examine the characteristics, related factors, and time distribution of emergency department (ED) visits, readmission, and hospital transfers of inpatients under the DRG-Based Payment System for each Major Diagnostic Category (MDC). We conducted a retrospective cohort study using data from the National Health Insurance Research Database (NHIRD) from 2012 to 2013 in Taiwan. Multilevel logistic regression analysis was used to examine the factors related to ED visits, readmissions, and hospital transfers of patients under the DRG-Based Payment System. In this study, 103,779 inpatients were under the DRG-Based Payment System. Among these inpatients, 4.66% visited the ED within 14 days after their discharge. The factors associated with the increased risk of ED visits within 14 days included age, lower monthly salary, urbanization of residence area, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, Diseases and Disorders of the Kidney and Urinary Tract (MDC11) conferred the highest risk of ED visits within 14 days (OR = 4.95, 95% CI: 2.69-9.10). Of the inpatients, 6.97% were readmitted within 30 days. The factors associated with the increased risk of readmission included gender, age, lower monthly salary, comorbidity index, MDCs, and hospital ownership (p < 0.05). In terms of MDCs, the inpatients with Pregnancy, Childbirth and the Puerperium (MDC14) had the highest risk of readmission within 30 days (OR = 20.43, 95% CI: 13.32-31.34). Among the inpatients readmitted within 30 days, 75.05% of them were readmitted within 14 days. Only 0.16% of the inpatients were transferred to other hospitals. The study shows a significant correlation between Major Diagnostic Categories in surgery and ED visits, readmission, and hospital transfers. The results suggested that the main reasons for the high risk may need further investigation for MDCs in ED visits, readmissions, and hospital transfers.
Editor: United States: Public Library of Science
Idioma: Inglês

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Characteristics and related factors of emergency department visits, readmission, and hospital transfers of inpatients under a DRG-based payment system: A nationwide cohort study

Huang, Pei-Fang ; Kung, Pei-Tseng ; Chou, Wen-Yu ; Tsai, Wen-Chen Remuzzi, Giuseppe

United States: Public Library of Science

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