The Study of Medical Quality Outcome of Hysterectomy in Taiwan

• Main Authors: Hsien-Ping Sun, 孫憲萍
• Other Authors: Shiao-Chi Wu
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/12736473460135501571

碩士 === 國立陽明大學 === 衛生資訊與決策研究所 === 90 === Abstract Hysterectomy is a common surgery in Obstetrics and Gynecology. However, there is a few studies in the quality of medical care after hysterectomy in Taiwan. Therefore, we studied the indexes of quality of medical care and relative factors in 49477 patients with hysterectomy from January 1999 to December 2000 in the National Health Insurance Database. In the analysis of patients received hysterectomy without pregnancy and cancer related. The length of stay and hospital fee was positive related to higher age, co-morbidity, abdominal operation, public hospital, high-volume hospitals and physicians. The in-hospital complication after hysterectomy was about 3.03%. It was positive significantly associated with lower age, co-morbidity, operated by non-OBS/GYN doctors, private hospitals and high-volume hospitals. The death rate was about 0.01% within 30 days after discharge. Additionally, the 30 days readmission rate was about 2.14%. It was positive significant related to patients with lower age, co-morbidity, operated by laparoscope, longer length of stay, local medical teaching hospitals or local hospitals and operated by non-OBS/GYN doctors. Furthermore, the patients visit the same out patient clinic about twice after discharge. The number of out patient clinic visit was positive related to lower age, operated by laparoscope, longer length of stay, operated by OBS/GYN physicians and private hospitals, but negative related to medical centers and high-volume hospitals or physicians. In the analysis of hospitals provided hysterectomy for malignancy patients. The average length of stay was positive significant related to the patient’s average age, the rate of abdominal operation, district and unqualified hospitals. The complication rate was negative significant related to the rate of abdominal operation, district and unqualified hospitals. In the analysis of hospitals provided hysterectomy for benign patients. The readmission rate within 30 days was positive significant related to district hospitals and high-volume hospitals. The average number of out patient clinic visit within 30 days discharge was positive significant related to the hospital with co-morbidity rate, district and unqualified hospitals. In this study, we suggest Bureau of National Health Insurance (BNHI) and hospitals should monitor the indexes of medical quality such as length of stay, mortality rate, complication rate, and readmission rate especially in unqualified hospitals, low-volume hospitals and physicians in order to maintain and improve the quality of health care provider. Keyword: hysterectomy, medical quality, hospital profile analysis