醫院、醫師手術量與肝癌病人術後死亡率之關係

The relationship between hospital, physician volume and in-hospital mortality for patients with hepatocellular carcinoma

目標： 探討醫院、醫師手術量與肝癌病人術後死亡率之相關性。方法： 採橫斷性研究，以1999年至2001年健保住院資料中肝癌手術病人為研究對象，採用描述性分析及邏輯斯回歸，分析醫院、醫師手術量與病人術後死亡率之關係。結果： 控制病人及醫院特性後，醫院的手術量或是醫師的手術量越大，病人術後死亡的危險性越低(OR=0.68, P<0.001; OR=.63, P<0.001)，而同時考量醫院的手術量與醫師的手術量後，由手術量大的醫師治療的病人，術後死亡的危險性越低(OR=0.65, P<0.001)，但醫院手術量的大小與病人的死亡率無關(OR=0.93, P=0.53)。結論：醫師個人的手術量的多寡比醫院整體的手術量更能解釋肝癌病人術後死亡的危險性，建議主管機關公開醫院及醫師醫療照護品質之結果，以作為民眾選擇醫院之參考依據，此外，深入研究與好的照護結果相關的行為或指標，並推廣至其他的醫院或醫師，使病人能有更好的照護結果。

Objectives：To examine whether there is an association between hospital, physician volume and in-hospital mortality for patients with hepatocellular carcinoma(HCC). Methods：A cross-sectional research design was adopted. Data set was obtained from the National Health Research Institute, which is a three-year (1999-2001) claimed data on the National Health Insurance. Patients who underwent liver cancer resections were used for analysis. Logistic regression was employed for examining the relationship between hospital, physician volume and operative mortality for patients with HCC. Results：Physician volume was inversely related to in-hospital mortality for patients with HCC(OR=0.65, P<0.001). Conclusions：Physician volume is a more important factor for in-hospital mortality for patients with HCC than hospital volume. Health report card concerning the outcome of care for HCC patients may be necessary for guiding the search for more cost-effectiveness and safer care.