醫師年資、醫療服務量與消化性潰瘍治療效果之相關研究

The Association between Physicians' Volume, Medical Care Institutions' Volume, or Physicians' Seniority and Healthcare Outcome for Patients with Peptic Ulcer

10.6288/TJPH2008-27-01-06

王庭荃(Ting-Chung Wang)；楊長興(Chiang-Hsing Yang)

醫事機構服務量 ； 醫師服務量 ； 醫師年資 ； 消化性潰瘍 ； 治療成效 ； hospital volume ； physician volume ； physician's seniority ； peptic ulcer ； healthcare outcome

台灣公共衛生雜誌

27卷1期（2008 / 02 / 01）

57 - 66

繁體中文

目標：探討醫事機構／醫師服務量與醫師年資對消化性潰瘍病患治療成效之關係。方法：研究資料為國衛院2000年至2002年健保資料庫中的醫事機構基本資料檔(HOSB)、專科醫師證書主檔(DOC)、門診處方及治療明細檔(CD)、門診處方醫令明細檔(OO)、住院醫療費用清單明細檔(DD)、以及住院醫療費用醫令清單明細檔(DO)等。樣本選取條件是：2001年間潰瘍門診患者、使用內視鏡檢與治療潰瘍相關藥物；排除的凖則是羅患胃癌、療程中死亡患者與資料錯誤樣本。採用邏輯斯迴歸模式檢視醫事機構/醫師服務量與醫師年資好消化性潰瘍病患治療成效之關係。結果：經風險校正後，機構服務量與住院率呈正相關；醫師年資與復發率。腸胃出血呈正相關；與潰瘍穿孔呈負相關。結論：消化性潰瘍至今已有發展健全的治療方式，比起這類議題在外科手術的研究，服務量與年資對於潰瘍的治療成效較無明顯的影響，應是受到這個疾病的特性影響所致：治療此疾病的技能學習難易度較低、醫師所能掌握影響治療成效的部份較外科手術少等，但服務年資較長者對於減少嚴重的併發症（潰瘍穿孔）有顯著的效果。

Objectives: To examine the association between hospital, physician volume, or physician seniority and healthcare outcome for patients with peptic ulcer. Methods: Data used in this study are HOSB file, DOC file, CD file. OO file, DD file, and DO file obtained from the National Health Insurance Research Database (National Health Research Institutes, Taiwan) between January 1, 2000, and December 31, 2002. Inclusion criteria for sample selection were peptic ulcer outpatients in 2001 and patients treated using upper G-I panendoscopy and drugs for peptic ulcer. Exclusion criteria were patients have gastric cancer and data error. Data was analyzed using logistic regression. Results: After risk adjustment, hospital volume was negatively related to hospitalization rate. Physician's seniority was positively related to recurrence rate and hemorrhage rate, and negatively related to pyloric stenosis rate. Conclusions: Compared with other surgical studies in this issue, patient volume and physician seniority do not obviously affect peptic ulcer treatment outcome, possibly because the skills for treating peptic ulcer are easier to learn than surgery and factors affecting internal medicine healthcare outcome controlled by physician are less than surgical healthcare. Even so, physician seniority can significantly aid serious complication prevention.

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