政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/38365
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    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/38365


    Title: 看診時間長短與門診品質相關性研究
    The Effects of Physicians’ Visiting Time Length
    Authors: 林錦鴻
    Lin,Chin-Hung
    Contributors: 黄思明
    Hwang,Syming
    林錦鴻
    Lin,Chin-Hung
    Keywords: 正確診斷
    門診品質
    看診時間長短
    diagnostic accuracy
    quality of outpatient care
    physician time per patient
    Date: 2006
    Issue Date: 2010-04-08 15:38:02 (UTC+8)
    Abstract: 適度的壓縮醫療資源，可以讓醫療資源使用得更有效率，進而產生更好的醫療品質；然而過度的壓縮醫療資源，卻會造成醫療品質的惡化。
    因為醫療資源和醫療品質有高度的正相關，充足資源的投入，能提昇醫療品質，但在現行保險計量支付(Fee for Service)的制度下，醫療院所常藉由每節門診病人看診人次的增加，來得到較高的獲利和報酬，這種對醫療資源的壓縮經營方式，會對醫療品質產生某些負面的影響。本研究利用簡單的醫師看診時間控制方式，可以清楚的看到在不同的時間壓縮之下，醫師的醫療行為對於醫療品質所產生的直接影響。
    醫師對每個病人投入的時間，是無法由其它資源的投入所取代的，換句話說，醫師時間的投入是決定醫療品質的一個重要因素，可以做為醫療院所對門診投入的資源指標。疾病的正確診斷率相對於病人問卷和回診率高低應該是個比較有信度和效度之門診品質評量標準，所以在衡量醫療資源的投入如何影響醫療品質的評估上，本研究把醫師時間的投入做為醫療院所對門診投入的資源指標，而正確的診斷率（確診率）則作為衡量門診品質的標準。透過醫師看診時間控制的方式，分析ICD-9（The International Classification of disease, Ninth Revisione:國際疾病分類第九版）代碼的比對結果，可以正確反應醫師疾病認定和醫師診斷的差異程度，進而探討醫師時間投入和門診品質的關係。
    Objective: The quality of health care is directly proportional to physicians’ time input. The reduction of physician time per patient will affect outpatient diagnostic accuracy.
    Materials & Methods: This study was designed to detect the difference of group A (Control) & group B (Experiment) diagnostic accuracy in 4 specific time lengths by analyzing the difference in ICD-9 (The International Classification of Disease, Ninth Revision) codes assigned by the physicians to each patient. A method was developed to control average physician time per patient using 8, 4, 2 and 1 minute average visit time intervals. This process was repeated in non-informed physicians (group C & group D) to access the difference between informed and non-informed physicians.
    Results: There are significant differences in diagnostic accuracies between the control and experimental groups with the variation of time length by Chi-Square (X=20.16, 23.89, p< 0.05). There are no significant differences in diagnostic accuracies between the four different times when informed and non-informed physicians are compared (Fishers Z = 0.467, 1.001, 1.072 and 1.054, p> 0.05)
    Conclusion: The length of physician time per patient interaction plays an important factor for determining the quality of outpatient care.
    Reference: 1. Stafford, R., J. Ma, A.L. Stewart, National Trends in Outpatient Quality Indicators. 2006: Harvard Business School Press.
    2. Hansson, L., The quality of outpatient psychiatric care. A survey of patient satisfaction in a sectorised care organisation. Scand J Caring Sci, 1989. 3(2): p. 71-82.
    3. Laine, C., et al., Important Elements of Outpatient Care: A Comparison of Patients` and Physicians` Opinions. Ann Intern Med, 1996. 125(8): p. 640-645.
    4. Meyer, T.A., Improving the quality of the order-writing process for inpatient orders and outpatient prescriptions. American Journal of Health-System Pharmacy, 2000. 57(suppl_ 4): p. 18-22.
    5. Alfredo, S.J., et al., Risk-adjusted mortality rates as a potential outcome indicator for outpatient quality assessments. Medical care 2002. 40(3): p. 237-245.
    6. Krumholz, H.M., et al., Evaluating Quality of Care for Patients With Heart Failure. Circulation, 2000. 101(12): p. e122-140.
    7. Ma, J. and R.S. Stafford, Quality of US Outpatient Care: Temporal Changes and Racial/Ethnic Disparities. Arch Intern Med, 2005. 165(12): p. 1354-1361.
    8. Maio, V., et al., Outpatient Quality Improvement in Academic Faculty Practice Plans: Does it Exist? American Journal of Medical Quality, 2004. 19(6): p. 235-241.
    9. Starfield, B., et al., Costs vs quality in different types of primary care settings. JAMA, 1994. 272(24): p. 1903-1908.
    10. Jensen, G.A. and M.A. Morrisey, The Role of Physicians in Hospital Production. The Review of Economics and Statistics, 1986. 68(3): p. 432-442.
    11. Mathiowetz, N.A., Respondent Expressions of Uncertainty: Data Source for Imputation. The Public Opinion Quarterly, 1998. 62(1): p. 47-56.
    12. Young, A.S., et al., Measuring the Quality of Outpatient Treatment for Schizophrenia. Arch Gen Psychiatry, 1998. 55(7): p. 611-617.
    13. Davis, K. and L.B. Russell, The Substitution of Hospital Outpatient Care for Inpatient Care. The Review of Economics and Statistics, 1972. 54(2): p. 109-120.
    14. Thomas, J.W. and T.P. Hofer, Accuracy of risk-adjusted mortality rate as a measure of hospital quality of care. Med Care, 1999. 37(1): p. 83-92.
    15. Ross, C.E. and R.S. Duff, Quality of Outpatient Pediatric Care: The Influence of Physicians` Background, Socialization, and Work/Information Environment on Performance. Journal of Health and Social Behavior, 1978. 19(4): p. 348-360.
    16. Caplan, E.K. and M.B. Sussman, Rank Order of Important Variables for Patient and Staff Satisfaction with Outpatient Service. Journal of Health and Human Behavior, 1966. 7(2): p. 133-137.
    17. Jiang, H.J., et al., Multiple hospitalizations for patients with diabetes. Diabetes Care, 2003. 26(5): p. 1421.
    18. Solon, J.A., et al., Patterns of Medical Care: Validity of Interview Information on Use of Hospital Clinics. Journal of Health and Human Behavior, 1962. 3(1): p. 21-29.
    Description: 博士
    國立政治大學
    企業管理研究所
    91355502
    95
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0913555023
    Data Type: thesis
    Appears in Collections:[Department of Business Administation] Theses

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