| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 97 === The relationship between surgical volume, quality of care and utilization is well discussed in many documentations abroad. End stage renal disease is a major health problem in Taiwan because its incidence and prevalence are both highest around in the world according to the report of USRDS(United States Renal Data System) in 2008. Kidney transplantation is the best choice of renal replacement therapy for end stage renal , no mater in quality of life or utilization of medical resource. Our study is using data of kidney transplantation in Taiwan to evaluate the relationship between surgical volume, quality of care and medical resource utilization.
The study design is retrograde by analyzing secondary data from academic research data bank of national health insurance which is provided by National Health Research Institutes. We collect 1,060 patients who declare kidney transplantation to Bureau of National Health Insurance from 1996 to 2003, patients who received secondary transplantation and aged below 18 years old were excluded. Statistics is calculated by SPSS 15.0.
We divided these hospitals, according to their surgical volume of performing kidney transplantation, as high-volume hospitals (over 72 cases) and low-volume hospitals (less than 72 cases), all patients were fit into these two groups. After adjusted with demography, predisposing disease characters and severity of disease, we found that surgical volume of performing kidney transplantation is the most important factor associated with survival rate of patient and graft. Age and gender are also major factors associated with three years patients survival , but not graft survival. The characters of disease are not associated with future outcome. Those hospitals have higher surgical volume resulted in lower surgical mortality and both bacterial and viral infection rate. The three years patient and graft survival rate are also higher. Additionally, the length of hospital stay and expenditure are both lower in these hospitals with high surgical volume . Above results are all reach statistical significance.
So we suggest that firstly the health authority should put more attention counsel the set-up scale of each hospital for organ transplant and reinforce monitoring of the quality of medical care, because the surgical volume of kidney transplantation positively related with quality of care and utilization of medical resource. Secondly, a medical institutions should use evidence-based data to evaluate the feasibility of building protocol as kidney transplantation, not only improve self quality of patients care but also management. The third, we hope forecoming researchers can analyze the threshold volume of kidney transplantation in each hospital, providing reference to our health authority and other medical institutions to reach their best benefits.
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