| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === Motivation and Purposes："Practice makes perfect" is our ancient proverb, is mainly intended when we do anything, to uphold a conviction spare normal practice, a naturally skilled clever of them to comprehend the truth of the trick, as long as cooked, cooked it fine, fine will be clever, clever will pass, a long learning can be successful. Learning curve used in the process of surgery also had the effect, Yasuda et al (2001) that the patient mortality rate will be lower than the amount of surgical services, surgical services, less the amount of physician is more surgeons play a learning curve - the effect of practice makes perfect , which is accumulated to a certain degree of quality of surgical volume, will improve the efficacy of surgery.
Medical treatment is to reduce health care costs, reduce medical resource utilization, maintain the quality of care, patient safety and satisfaction, and increase the hospital's reputation; The purpose of our research: to explore other things being equal The efficacy of gastric surgery patient care and resource consumption will provide surgical services as physician volume and improved.
Research Design and Methods：This study used secondary data analysis, using 2003-2006 National Health Insurance research database (National Health Insurance Research Database, NHIRD) of outpatient prescriptions and treatment of detail file (CD), the list of hospital medical expenses detail file (DD), medical institutions, the basic data files (HOSB) and coverage data files (ID), etc., is a retrospective study; and further excluded those who died within two years after surgery or gender unknown, 2,383 people were included.
Department of entire study sample of gastric surgery and a year before
admission, patient information two years after discharge, and further study sample import ACG software made the year before and after surgery the first two years of the ACG Weight. Surgical services to physicians in our group for the independent variable amount to ACG Weight and outpatient, emergency and hospital volume was changed by Zhe dependent variable and patient characteristics of gender, age, residence urbanization, and hospitals characteristics of the hospital level, hospital ownership as control variables, to analyze (1) the amount of physician services in surgery for 64 years of age group and for over 65 years of stomach surgery patients ACG weight and outpatient, emergency and hospital Zhe-year change in volume with no effect. (2) the patient characteristics of gender, age, degree of urbanization of residence under the age of 64 and 65 years old Gastrectomy Patients ACG weight and outpatient, emergency and hospital volume was changed by Zhe no effect. (3)
the hospital level and hospital characteristics of hospital ownership under the age of 64 and 65 years old Gastrectomy Patients ACG weight and outpatient, emergency and hospital volume was changed by Zhe no effect. The ACG software (version 9) of the 64 years of age over the age of 65 two calculations with the benchmark to calculate the individual patients after discharge from hospital the previous year and the first two years of the ACG Weight. Using SAS version 9.2 statistical software for data processing and statistical analysis, under the control of interfering variables, different amount of physician services, surgery and medical treatment and the relationship between the consumption of medical resources.
Results：Studies have shown that patients will choose to non-public hospitals,medical centers for treatment, and will choose to high-volume surgical services, physician an operation.
High-volume surgical services, physicians, surgery results in order to correct the patient characteristics of gender, age, residence urbanization, and hospital characteristics, hospital level, hospital ownership and other interfering factors, physician groups in the amount of impact on surgical services under the age of 64 patients with gastric surgery after the first year of hospital costs and hospital days and years after the first year ACG weight change in the amount of influence. Over the age of 65 gastrectomy patients affected after the addition of the first year ACG weight and outpatient visits, outpatient costs, emergency room costs every year after the first change in volume.
Conclusion：Practice makes perfect is the relationship between volume and outcome, the high volume of surgical services will reduce the consumption of medical resources, physician services, surgery and medical treatment is the amount of positive correlation.
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