[[alternative]]The Association between physicians’ volume, medical care institutions’ volume, or physicians’ experience and healthcare outcome for patients with peptic ulcer.

[[abstract]]背景：消化性潰瘍是我國常見的腸胃道疾病，過去對於潰瘍的研究趨於比較不同藥物、不同療法、幽門螺旋桿菌根除與否對於消化性潰瘍的治療成效，而未從醫療提供者角度看待潰瘍治療成效。且在國內外對於醫院醫師服務量或經驗與治療成效的關係已經被許多相關的研究所支持，但是對於內科疾病的研究並不多，因此本研究將以消化性潰瘍此議題進一步探討。目的：探討醫事機構/醫師服務量或醫師經驗對消化性潰瘍病患治療成效之關係。材料與方法：國家衛生研究院2000年至2002年全民健康保險學術研究資料庫之中的醫事機構基本資料檔(HOSB)、專科醫師證書主檔(DOC)、門診處方及治療明細檔(CD)、門診處方醫令明細檔(OO)、住院醫療費用清單明細檔(DD)、以及住院醫療費用醫令清單明細檔(DO)等，採用邏輯斯迴歸模式検視之。結果：研究中検視的成效指標有復發率、三種併發症發生比率、急診率、住院率等四種，其中醫事機構服務量與住院率達統計上顯著意義；醫師經驗與復發率、腸胃出血、潰瘍穿孔等達統計上顯著意義，其餘均未達統計上顯著意義。結論：消化性潰瘍至今已有發展健全的治療方式，比起這類議題在外科手術的研究，服務量與年資對於潰瘍的治療成效較無顯著的影響，應是受到這個疾病的特性影響所致：治療此疾病的技能學習難易度較低、醫師所能掌握影響治療成效的部份較外科手術少等。但是發現不同服務量的醫療提供者間，根除療法的使用率差異很大，建議由專業團體作為媒介，分享專業人員彼此的心得，降低不同醫療提供者間的成效差異。[[abstract]]Background: Peptic ulcer is a common upper gastrointestinal disease in Taiwan. Studies on the peptic ulcer always compared healthcare outcome between different drugs or treatments in the past, and the association between healthcare provider characteristic and peptic ulcer healthcare outcome still have not been studied. On the other hand, the relationship between hospital, physician volume, or physician seniority has been proved. But there are still few studies about internal medicine.Objectives: To examine the association between hospital, physician volume, or physician’s seniority and healthcare outcome for patients with peptic ulcer.Material & Methods: Data used in this study are HOSB file, DOC file, CD file, OO files, DD file, and DO file in National Health Insurance Research Database form National Health Research Institutes in Taiwan between January 1, 2000, and December 31, 2002. Logistic Regression is adopted for this study.Results: There are four outcome indicator for the study, including recurrence, complications, emergency treatment, and hospitalization. In which, hospital volume was inversely related to hospitalization rate, and physician’s seniority was correlated to recurrence rate, hemorrhage rate, and pyloric stenosis rate.Conclusion: There are well developed therapy for peptic ulcer nowadays. Comparing with other surgical studies in this issue, volume and seniority do not obviously affect peptic ulcer’s healthcare outcome. Because skills for treating peptic ulcer are easier to learn than surgery. And factors which affect internal medicine healthcare outcome controlled by physician are less than surgical healthcare; even so, physician’s seniority can significantly aid serious complication prevention