Yu-Chi Tung

Associations of Physician Volume and Weekend Admissions With Ischemic Stroke Outcome in Taiwan: A Nationwide Population-Based Study

Background:Although volume-outcome and weekend-outcome relationships have been explored for various procedures and interventions, limited information is available concerning “physician volume” and the “weekend effect” on stroke mortality. Moreover, little is known about the relative and combined influence of physician and hospital volume on stroke mortality. Objectives:We used nationwide population-based data to explore the influences of physician volume and weekend admissions on stroke mortality. Methods:We analyzed all 34347 ischemic stroke patients admitted in 2005, treated by 2424 physicians practicing in 245 hospitals in Taiwan through Taiwan’s National Health Insurance Research Database. Multilevel logistic regression analysis was performed after adjustment for patient, physician, and hospital characteristics to explore the individual and combined impact of annual physician volume and annual hospital volume, as well as the impact of weekend admissions, on 30-day mortality. Results:Higher physician volume, simultaneous contribution of higher physician and higher hospital volume, and weekday admissions were associated with decreased 30-day mortality, after adjusting for patient gender and age, comorbidities, surgery, physician age and specialty, hospital ownership, accreditation level, teaching status, geographic location, regional resources, and competition. Conclusions:Higher physician volume, rather than higher hospital volume is associated with lower 30-day ischemic stroke mortality, but the relationship has become stronger in higher-volume hospitals. Stroke patients admitted on weekends also have a higher mortality than those admitted on weekdays.

Patient satisfaction with and recommendation of a primary care provider: associations of perceived quality and patient education

OBJECTIVE To identify whether attributes of perceived clinic quality and patient education are associated with patient satisfaction and recommendation of a primary care provider. DESIGN Data used in this study were obtained through a national telephone survey by random sampling. SETTING Clinics throughout Taiwan. PARTICIPANTS A total of 1910 patients. MAIN OUTCOME MEASURES Overall patient satisfaction and recommendation were measured by single item questions. Attributes of clinic quality were measured using 11 items: doctors technical skill (four items), doctors interpersonal skill (three items), staff care and access (four items). Patient education was measured on the basis of education provided on disease prevention and control during the visit. RESULTS With regard to clinic quality, doctors technical skill was most related to overall satisfaction and recommendation, followed by doctors interpersonal skill. Staff care and access were associated with overall satisfaction but were not associated with recommendation. Patient education was related to both overall satisfaction and recommendation. CONCLUSION Doctors technical skill is the most critical attribute of primary care quality for both overall satisfaction and recommendation, followed by doctors interpersonal skill. Staff care and access are associated with improved overall satisfaction but not related to increasing the likelihood of recommending a clinic to relatives and friends. Doctors technical and interpersonal skills rather than staff care and access can be the essence of quality competition in the primary care market. Providing patient education during the visit on how to prevent or control diseases may also relate to improved patient satisfaction and recommendation.

The Effect of Cuts in Reimbursement on Stroke Outcome A Nationwide Population-Based Study During the Period 1998 to 2007

Background and Purpose— As healthcare costs keep rising, cuts in reimbursement such as the Balanced Budget Act in the United States or global budgeting have become the key to healthcare reform efforts. Limited information is available, however, concerning whether reimbursement cuts are associated with changes in stroke outcomes. The objective of this study is to determine whether 30-day mortality rates for patients with ischemic stroke changed under increased financial strain from global budgeting in Taiwan. Methods— We analyzed all 258 167 patients with ischemic stroke admitted to general acute care hospitals in Taiwan over the period 1998 to 2007 through Taiwans National Health Insurance Research Database. Multilevel logistic regression analysis was used to examine whether 30-day stroke mortality rates varied after the implementation of hospital global budgeting since July 2002 adjusted for patient, physician, and hospital characteristics. Results— The magnitude of payment reduction on overall hospital net revenues was between 4.3% and 10.0%. The 30-day mortality rates for patients with ischemic stroke in Taiwan increased after the implementation of hospital global budgeting after adjustment for patient gender and age, comorbidities, surgery, physician age and volume, specialty, hospital volume, ownership, accreditation level, bed size, geographic location, competition, and trend. Conclusions— The mortality rate of patients with stroke rose under increased financial strain from cuts in reimbursement. Therefore, stroke outcomes are more likely to be affected by hospital financial pressures. It is imperative to monitor stroke outcomes and develop strategies to maintain levels of stroke care as cuts in reimbursement are adopted.

Performance improvement after implementing the Balanced Scorecard: A large hospital's experience in Taiwan

Mackay Memorial Hospital (MMH) is a medical centre with 2149 beds and more than 9000 outpatient visits per day. In order to enhance its competition, MMH is the first hospital in Taiwan to implement the Balanced Scorecard (BSC) fully for the entire organisation, not just for a specific department. This paper will assess both direct and indirect outcomes since its inception in 2001. From 2003 to 2005, the revenue from services not covered by the National Health Insurance (NHI) increased from NT

Using path analysis to examine causal relationships among balanced scorecard performance indicators for general hospitals: the case of a public hospital system in Taiwan.

1407 million (US

Impact of a cultural belief about ghost month on delivery mode in Taiwan

1 = NT

The relationships among physician and hospital volume, processes, and outcomes of care for acute myocardial infarction.

32.9; €1 = NT

Impact of cuts in reimbursement on outcome of acute myocardial infarction and use of percutaneous coronary intervention: a nationwide population-based study over the period 1997 to 2008.

39.0) to NT

Processes and outcomes of ischemic stroke care: the influence of hospital level of care

17,894 million. Inpatient satisfaction rose from 89.07% to 91.9%. The number of visits by disadvantaged patients (those with economic, social or physical disabilities) increased from 82,350 to 97,658 visits. The number of research projects also increased from 46 to 61 projects. The percentage of patients admitted to an intensive care unit in less than 3 hours from arrival in the emergency department increased from 47.8% in 2004 to 82.5% in 2005. BSC has thus been successfully developed and implemented at MMH, most likely for two main reasons. First, right from the beginning, the BSC executive team included the Board of Directors along with senior management personnel. Secondly, departmental BSCs were successfully launched and linked to budget planning after two years of full implementation. It is hoped that the experience of MMH in implementing BSC can be applicable to other healthcare organisations.

Factors Associated with Pneumonia Outcomes: A Nationwide Population-Based Study over the 1997–2008 Period

Abstract: Examining whether the causal relationships among the performance indicators of the balanced scorecard (BSC) framework exist in hospitals is the aim of this article. Data were collected from all twenty-one general hospitals in a public hospital system and their supervising agency for the 3-year period, 2000-2002. The results of the path analyses identified significant causal relationships among four perspectives in the BSC model. We also verified the relationships among indicators within each perspective, some of which varied as time changed. We conclude that hospital administrators can use path analysis to help them identify and manage leading indicators when adopting the BSC model. However, they should also validate causal relationships between leading and lagging indicators periodically because the management environment changes constantly.