頁籤選單縮合
題 名 | Operating Room Costs of Laparoscopic Cholecystectomy: Does Surgeon Volume Matter?=醫師服務量對腹腔鏡膽囊切除術手術室成本之影響 |
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作 者 | 仲偉靜; 李金德; 范保羅; 曾冬勝; 邱亨嘉; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 22:3 民95.03 |
頁 次 | 頁126-134 |
分類號 | 419.45 |
關鍵詞 | 成本; 服務量; 腹腔鏡膽囊切除術; Cost; Volume; Laparoscopic cholecystectomy; |
語 文 | 英文(English) |
中文摘要 | 背景:在亞洲國家中,鮮少有探討醫師服務量對腹腔鏡膽囊切除術 (laparoscopic cholecystectomy,LC) 成本控制之相關研究,因此本研究之目的在於分析不同醫院間 LC 手術室成本並進一步探討醫師服務量對 LC 手術室成本之影響。方法:研究個案為兩家急性醫院於 2002 年 10 月至 12 月期間診斷為膽囊疾病且以腹腔鏡切除之患者,成本資料來自醫院財務相關部門,統計方法以三個複迴歸模式預測成本之影響因子。結果:兩家醫院在病患的人口學特質與疾病嚴重度無統計之顯著差異。甲醫院和乙醫院相較,耗費較少的資源 (NT$ 21,674 與 NT$ 26,417)。特殊衛材成本、直接專業人力成本與間接成本在個別醫院與不同醫師服務量間皆存有顯著差異。高服務量的醫師和低服務量的醫師相較,有較低的成本與較短的住院日數。病人疾病嚴重度較高者 (ASA PS3) 和嚴重度較低者 (ASA PS1) 相較,耗用較多成本及較長住院日。結論:本研究證實醫院管理與醫師臨床經驗對於醫院維持長期競爭力有相同的重要性。除醫師服務量與醫院管理外,醫院成本控制應將病人疾病嚴重度列為考慮因素。 |
英文摘要 | Very few studies have addressed the issue of surgeon volume on cost savings of laparoscopic cholecystectomy (LC) in Asian countries. The objectives of the study were to analyze LC operating-room (OR) costs between two study hospitals and to examine the effect of surgeon volume on OR costs. Patients diagnosed with gallbladder disease who underwent LC in October through December 2002 at two acute tertiary-care hospitals were included. Patient demographics and clinical information were derived from patient charts. Cost information was obtained from purchasing departments or specific cost centers. Three multivariate linear regression models were performed to examine the association between surgeon volume, cost, and utilization. There were no significant differences in patient demographics and disease severity between the two hospitals. Hospital A consumed fewer resources than did hospital B (NT$21,674 vs NT$26,417). Direct materials cost, direct professional costs, and indirect costs varied significantly by study hospital and by surgeon volume. High-volume surgeons incurred lower costs and shorter stay as compared with low-volume surgeons. Patients who scored in the American Society of Anesthesiologists physical status (ASA PS) 3 incurred significantly higher costs and longer hospital stays than did patients with ASA PS 1. The present study supports the proposal that hospital management and experience of surgeons are of equal importance in maintaining the standing of hospitals in competitive positions. In addition to the differences in hospital management and surgeon volume, the patient’s severity of illness also needs to be taken into consideration in cost containment. |
本系統中英文摘要資訊取自各篇刊載內容。