Abstract
[Introduction] The purpose of this study was to assess the implementation of new comprehensive medicalfee system which utilizes a Diagnosis Procedure Combination (DPC) and a critical pathway (CP) for pulmonary resection with conventional thoracotomy in patients with pulmonary malignancy. [Methods] Patients in a DPC category (Diagnosis: malignant pulmonary tumor, Procedure: pulmonary resection with conventional thoracotomy for malignant tumor, Other procedures: none, Concomitant diseases: none) were divided into 2 groups. A control group (n=30) was applied to fee-for-service system without CP and the DPC+CP group (n=19) was applied to the new system with DPC and CP. We compared rationality and safety of postoperative management and the economic effects of medical care. [Results] Total hospital stay (control/DPC+CP: 29.6/17.1 days), postoperative stay (19.7/10.6 days), Intravenous drip (5.0/2.8 days), perioperative antibiotic use (10.3/3.8 times), venous blood examination (5.8/3.1 times), chest drainage tube placement (4.2/3.4 days), postoperative chest X-ray (8.9/5.1 times), postoperative oxygen therapy (80.4/74.9 hours). All parameters except oxygen therapy in DPC+CP group decreased significantly than those in control group (p<0.01). Postoperative morbidity rate was 0.33/0.44 and readmission rate was 0/0.083. There was no case of postoperative death. Although there was no significant difference between control and DPC+CP group in total medical-fee (174, 121/170, 832 points), daily medical-fee in DPC+CP group of 4, 876 points increased significantly than that in control group of 5, 318 points (p<0.001). [Conclusions] The simultaneous implementation of comprehensive medical-fee system with DPC and CP brought about improvement of postoperative management with improved quality of outcome and shortened length of hospital stay. Total medical fees with DPC were maintained at the level of fee-for-service medical care.
