Department of Health Management and Policy, University of Iowa College of Public Health, 200 Hawkins Dr. E206, Iowa City, IA 52242, USA.
Health Serv Res. 2010 Oct;45(5 Pt 1):1168-87. doi: 10.1111/j.1475-6773.2010.01137.x.
To investigate whether provider volume has an impact on the hazard of mortality for coronary artery bypass grafting (CABG) patients in Taiwan.
DATA SOURCES/STUDY SETTING: Multiple sources of linked data from the National Health Insurance Program in Taiwan.
The linked data were used to identify 27,463 patients who underwent CABG without concomitant angioplasty or valve procedures and the surgeon and hospital volumes. Generalized estimating equations and hazard models were estimated to assess the impact of volume on mortality. The hazard modeling technique used accounts for bias stemming from unobserved heterogeneity.
Both surgeon and hospital volume quartiles are inversely related to the hazard of mortality after CABG. Patients whose surgeon is in the three higher volume quartiles have lower 1-, 3-, 6-, and 12-month mortality after CABG, while only those having their procedure performed at the highest quartile of volume hospitals have lower mortality outcomes.
Mortality outcomes are related to provider CABG volume in Taiwan. Unobserved heterogeneity is a concern in the volume-outcome relationship; after accounting for it, surgeon volume effects on short-term mortality are large. Using models controlling for unobserved heterogeneity and examining longer term mortality may still differentiate provider quality by volume.
探讨在台湾，医师手术量对冠状动脉旁路移植术（CABG）患者死亡风险的影响。
资料来源/研究场所：来自台湾全民健康保险计划的多个数据源的链接数据。
利用链接数据确定了 27463 例未同时行血管成形术或瓣膜手术的 CABG 患者以及外科医师和医院的手术量。采用广义估计方程和风险模型来评估容量对死亡率的影响。所使用的风险建模技术可以解决因未观察到的异质性而产生的偏差。
外科医师和医院的手术量四分位数与 CABG 后死亡率的风险呈反比。外科医师手术量处于较高四分位数的患者在 CABG 后 1、3、6 和 12 个月的死亡率较低，而只有在手术量最高四分位数的医院接受手术的患者死亡率才较低。
在台湾，死亡率与医师 CABG 手术量相关。在容量-结果关系中存在未观察到的异质性；在对其进行解释后，外科医师的短期死亡率与容量之间的关系影响较大。使用控制未观察到的异质性并检查更长期死亡率的模型可能仍然可以根据容量来区分提供者的质量。
