因應實施Tw-DRG,台灣醫療院所導入住院中ICD-10-CM／PCS編碼現況分析

Analysis of the Status of ICD-10-CM/PCS Coding in Taiwan-ese Inpatient Hospital Settings in Response to the Implementation of Tw-DRG

中央健保署為控制龐大的醫療費用支出，2010年實施醫院住院支付制度-台灣住院診斷關聯群Tw-DRG制度，並預計未來將DRG第3-5階段全面上線，部份醫院已導入住院中ICD-10-CM／PCS編碼因應，故本研究進行因應實施Tw-DRG，台灣醫療院所導入住院中ICD10-CM／PCS編碼現況分析。針對目前已實施或曾實施住院中ICD-10-CM／PCS編碼的醫療院所發放問卷，問卷收集彙整後，以SPSS for windows軟體24.0版進行統計分析；將問項分為政策、人力、資訊、效益四大構面，提出假設政策、人力、資訊構面會影響效益構面，利用皮爾森（Pearson）相關係數、IPA、複回歸分析結果，發現四大構面組內相關性高、IPA二維矩陣圖顯示「推動住院中編碼，需要政府機關提供疾病分類諮詢管道以協助釐清編碼問題」此項需要優先改善、複回歸在重要性題項分析得到政策、人力、資訊構面會影響效益構面和在滿意度題項分析得到政策、人力構面影響效益構面較大，特別是在政策構面的影響最大。建議政府及相關學術醫療單位能在醫療院所實施住院中ICD-10-CM／PCS時，提供援手，能無縫接軌未來Tw-DRG第3-5階段全面上線。

In order to control the extensive medical expenses, in 2010 the National Health Insur-ance Administration (NHIA) implemented the Taiwan version of Diagnosis Related Groups (Tw-DRG) system for western medicine in the circle of primary health care institutions, and started plans to launch the phases 3-5 of the DRG in all health care institutions in the years to come. As a result, some hospitals have introduced the ICD-10 code system for their inpatient services. This study is to investigate the current status of introducing ICD-10-CM/PCS for use in Taiwan inpatient hospital settings. Questionnaires were distributed to health care institutions that are currently using or having implemented the ICD-10-CM/PCS code set and the collected questionnaire responses were analyzed by using the SPSS Statis-tics 24.0 for Windows. The questions asked were divided into four major facets: policy scenario, manpower, information and benefits, and the hypothesis that the policy, manpower and information facets would affect the benefit facet were proposed. The Pearson correlation coefficient, IPA and multiple regression analysis were selected for analysis and the results showed a high intraclass correlation in the four major facets and the two-dimensional IPA matrix di-agram demonstrated the issue of “promoting inpatient coding requires government agencies to provide counseling channels for disease classification to help clarify problems in coding” needs to be resolved promptly. In multiple regression analysis, the item analysis of im-portance suggested the policy, manpower and information facets would affect the benefit facet, and the item analysis of satisfaction indicates the policy and manpower facets had a greater effect on the benefit facet, among which the policy facet had the greatest impact. Hence, we recommend that the government and relevant academic medical institutions to provide help in the implementation of ICD-10-CM/PCS in health care institutions for reporting of inpatient services for a seamless integration of the phases 3-5 of the Tw-DRG in the future.