下肢骨性膝關節炎住院病人的左右側性編碼狀態在各層級醫院的分佈探討

A Study on the Laterality Distribution of Inpatients with Osteoarthritis of the Lower Extremity at Hospitals of Various Levels in Taiwan

骨性關節炎（OA）是住院病人中常見高經濟負擔的特徵。ICD-10-CM／PCS雖開啟更細緻的編碼，但全國性分佈樣貌卻罕有呈現。本文以2018年住院健保資料進行回朔性分析。OA共42,370人次，其中M17膝關節OA佔84.0％。主診斷為雙側OA（M17.0）病人其主手術由「0SRC0J9及0SRD0J9」2個手術碼佔58.6％。此類主處置以申報右膝與左膝比為2.1：1。M17.0的病人相對在地區醫院較少。區域醫院與地區醫院在0SRC0J9的申報件數相近，但在0SRD0J9則差異達2.5倍。主手術0SBC4ZZ在區域醫院層級申報最多佔64.4％。主診斷為右側OA（M17.11）主手術最多為0SRC0J9佔73.6％。三項主手術「0SRC0J9+0SBC4ZZ+0SRT0J9」佔主診斷的88.8％。主診斷為M17.12病人主手術最多為0SRD0J9佔73.4％。三項主手術「0SRD0J9+0SBD4ZZ+0SRU0J9」亦佔主診斷的88.8％。變異數分析中醫學中心與區域醫院所收治的骨性關節炎病人嚴重於地區醫院。手術碼數量以區域醫院，高於醫學中心及地區醫院。急性住院天數區域醫院高於地區醫院，醫學中心最低。某些ICD-10-CM／PCS分類碼在各醫院層級間存在不同樣貌，透過這些分類碼所產生出的母群體特徵，可做為未來疾病分類編碼品質或病歷統計年報編列的比較參考。

Osteoarthritis (OA) is a common disease with high economic burden among hospital inpatients. Although ICD-10-CM/PCS has enabled more detailed classification in its coding, the national distribution has rarely been presented. With IRB approval, an analysis has been conducted through the 2018 inpatient health insurance database from NHIA. There were 42,370 hospitalization cases for OA, of which M17 OA over knee(s) accounted for 84.0%. The main operation for patients with bilateral OA of the knee (M17.0) consists of 2 operation codes ''0SRC0J9 and 0SRD0J9'' accounting for 58.6% of the operation distribution. This principle procedure is to declare the ratio of 2.1:1 for the right knee to the left. There are relatively fewer patients with M17.0 in district hospitals. The number of declarations in 0SRC0J9 between regional hospitals and district hospitals was similar, but the difference was 2.5 times in 0SRD0J9. The principle procedure 0SBC4ZZ is up to 64.4% in the district hospital level. The principle diagnosis of right knee OA (M17.11) in the principle procedure was 0SRC0J9, accounting for 73.6%. The three principle procedures ''0SRC0J9 + 0SBC4ZZ + 0SRT0J9'' accounted for 88.8% of the principle diagnoses. The principle diagnosis of left knee OA (M17.12) in the principle procedure was 0SRD0J9, accounting for 73.4%. The three principle procedures''0SRD0J9 + 0SBC4ZZ + 0SRU0J9'' accounted for 88.8% as well. Through the one way analysis of variances, the OA patients admitted to the medical center and the regional hospitals are more severe than those to the district hospitals. The numbers of operation codes are higher in regional hospitals than in medical centers and district hospitals. The number of acute length of hospital stays in regional hospitals is higher than that in the district hospitals, and that of the medical centers is the lowest. Some ICD-10-CM/PCS codes have different appearances among medical centers, regional hospitals and district hospitals. The features generated by all of these codes can be used as a comparative reference for the coding quality in the future.