運用仿BCG矩陣模式提升TW-DRGs管理成效

The Application of Boston Consulting Group (BCG)-like Matrix Model to Improve the Efficiency of TW-DRGs Management

本研究主要目的是運用仿BCG矩陣模式及KPI方法，瞭解適當的醫院內部團隊管理介入機制對提升個案醫院在155項初步實施的TW-DRGs項目之績效。主要以某醫學中心2011年第一至四季Tw-DRGs實施案件為研究對象。運用KPI（損益率和個案占率）及仿BCG矩陣模式（明星Stars、金牛Cash Cows、問題QuestionMark及愛心狗Dogs群組）監測Tw-DRGs案件並持續追蹤管理介入後的表現。研究期間Tw-DRGs實施個案共4,595人次。研究結果發現相較於2011 Q1（基期），醫院整體損益率從19.63%成長至22.75%，整體損益率變化增加3.11%（△Q4-Q1=3.11%±1.04%；P≤0.05）、季CMI值（△Q4-Q1=0.077±0.035）及平均住院日（△Q4-Q1=0.01±0.09）沒有統計上差異。仿BCG矩陣模式可以協助醫院管理者將資源投注的焦點主要放在「明星」、「問題」群組案件，至於「金牛」「愛心狗」群組案件，則應以成本費用分析機制來嚴格控管成本，並適度進行流程再造，降低非必要的醫療成本，以增加醫院的整體獲利能力。

Objective: The purpose of this study is to assess BCG-like model and KPI management to improve hospital performance for 155 Tw-DRGs items through an internal team management intervention.Method: Data were derived from a medical center in southern Taiwan for study hospital's Tw-DRGs cases during 2011 from season 1 (Q1) to season 4 (Q4). Following BCG-like matrix, the profit margin and number of patients (two KPIs) for particular DRGs in 2011 Q1 data were calculated. This study further classified those Tw-DRGs and their associated MDC into 4 categories and named as stars, cash cows, question marks, and dogs; and then continuously monitor the efficiency for each category.Results: Total Tw-DRGs cases 4,595. The results indicated that after management intervention, overall hospital profit margin in Tw-DRGs increased about 3.11% from 19.63% to 22.75% (△Q4-Q1=3.11%±1.04%; P≤0.05). However, the findings showed significant in CMI value (△Q4-Q1=0.077±0.035) and average length of stay (△Q4-Q1=0.01±0.09).Conclusions: BCG-like model is an important management tool for hospitals to decide arranging health care resources on Tw-DRGs cases in categories like stars or cash cows and to control cost appropriately on categories like question mark, or dogs. Through using proper management (like BCG-like tool) and also controlling unnecessary health costs, hospitals may improve their efficiency and profit margin.