상급종합병원 지정평가를 위한 환자구성상태 개선 연구

Abstract

This has two purposes. Firstly, it explores how to apply treatment type scores for evaluating whether cases are appropriate for tertiary level of care. Secondly, it proposes improvement of a system of case-mix assessment by developing a method for severity assessment. For these purposes, we conducted literature reviews on designation standards of tertiary medical institutions in other countries. We convened an advisory council consisting of members of medical societies, healthcare service experts and policy makers, and developed a method for case-mix assessment for impatients of tertiary hospitals. The assessment method either adopted an average admission treatment type score or developed scores with scaling from 60 to 100 for each medical institution. KDRG(Korea Diagnosis Related Group) corresponding to mental health and rehabilitation cases were excluded from the analysis. A severity assessment score was given between 0.6 to 1 point based on the ratio of severe emergency cases and severe-ill cases. We found that in case of the improvement measures being in place, some of current tertiary hospitals are expected to lose the designation status as tertiary hospitals while three new applicants are likely to be granted tertiary hospital designation. In the future, Items on the severity assessment list are needed to be expanded. A follow-up research is required to develop a patient-based assessment model which integrates inpatients and outpatients, who received medical services from tertiary hospitals.