政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/38365
English  |  正體中文  |  简体中文  |  Post-Print筆數 : 27 |  全文笔数/总笔数 : 113392/144379 (79%)
造访人次 : 51231685      在线人数 : 903
RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
搜寻范围 查询小技巧：
  • 您可在西文检索词汇前后加上"双引号"，以获取较精准的检索结果
  • 若欲以作者姓名搜寻，建议至进阶搜寻限定作者字段，可获得较完整数据
    •  进阶搜寻
    政大機構典藏 > 商學院 > 企業管理學系 > 學位論文 >  Item 140.119/38365


    请使用永久网址来引用或连结此文件: https://nccur.lib.nccu.edu.tw/handle/140.119/38365


    题名: 看診時間長短與門診品質相關性研究
    The Effects of Physicians’ Visiting Time Length
    作者: 林錦鴻
    Lin,Chin-Hung
    贡献者: 黄思明
    Hwang,Syming
    林錦鴻
    Lin,Chin-Hung
    关键词: 正確診斷
    門診品質
    看診時間長短
    diagnostic accuracy
    quality of outpatient care
    physician time per patient
    日期: 2006
    上传时间: 2010-04-08 15:38:02 (UTC+8)
    摘要: 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.
    參考文獻: 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.
    描述: 博士
    國立政治大學
    企業管理研究所
    91355502
    95
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0913555023
    数据类型: thesis
    显示于类别:[企業管理學系] 學位論文

    文件中的档案:

    档案 描述 大小格式浏览次数
    55502301.pdf48KbAdobe PDF2632检视/开启
    55502302.pdf12KbAdobe PDF2663检视/开启
    55502303.pdf80KbAdobe PDF2680检视/开启
    55502304.pdf12KbAdobe PDF2608检视/开启
    55502305.pdf16KbAdobe PDF2734检视/开启
    55502306.pdf30KbAdobe PDF21094检视/开启
    55502307.pdf66KbAdobe PDF2712检视/开启
    55502308.pdf86KbAdobe PDF2754检视/开启
    55502309.pdf31KbAdobe PDF2724检视/开启
    55502310.pdf15KbAdobe PDF2585检视/开启
    55502311.pdf12KbAdobe PDF2731检视/开启
    55502312.pdf16KbAdobe PDF2847检视/开启
    55502313.pdf2431KbAdobe PDF2807检视/开启
    55502314.pdf36KbAdobe PDF2662检视/开启


    在政大典藏中所有的数据项都受到原著作权保护.


    社群 sharing

    著作權政策宣告 Copyright Announcement
    1.本網站之數位內容為國立政治大學所收錄之機構典藏，無償提供學術研究與公眾教育等公益性使用，惟仍請適度，合理使用本網站之內容，以尊重著作權人之權益。商業上之利用，則請先取得著作權人之授權。
    The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

    2.本網站之製作，已盡力防止侵害著作權人之權益，如仍發現本網站之數位內容有侵害著作權人權益情事者，請權利人通知本網站維護人員(nccur@nccu.edu.tw)，維護人員將立即採取移除該數位著作等補救措施。
    NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - 回馈