병원급 의료기관의 종별 역할 강화를 위한 의료전달체계 평가지표 개발

Abstract

Background: This study estimated a single index that evaluates the functional level of medical institutions in the medical delivery system by using both the functional classification result of the medical institutions and the classification result of the suitable disease group. Methods: Inpatient and outpatient data from the 2019 Health Insurance Review and Assessment Service claim data were used for analysis. Medical institutions above the hospital level were classified into tertiary medical institutions, secondary medical institutions, and regional hospitals (general secondary and limited secondary medical institutions). Using the appropriate disease group classification system of adjacent aged diagnosis-related group(AADRG), the number of AADRG patients suitable for their function was calculated as an index in each inpatient and outpatient area. In the inpatient area, the Charlson comorbidity index was reflected. Results: The mean of the raw scores for the hospitalization-appropriate disease group of all 525 institutions was 76.8. The raw score for the hospitalization-appropriate disease group showed the highest frequency in the range of 80–90 points (214, 40.8%). The mean of the raw scores for the outpatient-appropriate disease group was 73.9 points. A total of 198 medical institutions (37.6%) were distributed in the 70–80 point range. Regional hospitals were distributed in high scores for both inpatient and outpatient services, and tertiary and secondary medical institutions were distributed in relatively low scores. Conclusion: It was confirmed that the proportion of medical institutions providing treatment according to their functions was low overall. Based on the results of this attempt to calculate the medical delivery system score, it will be possible to include the medical delivery system evaluation indicator in the medical quality evaluation system and use it as a policy tool to improve the medical delivery system.