The physician as a factor in outpatient medical care after laparoscopically assisted vaginal hysterectomy: a multivariate analysis.
OBJECTIVE
To evaluate whether physician experience affects outpatient medical care utilization after laparoscopically assisted vaginal hysterectomy (LAVH).


METHODS
A total of 120 patients who underwent LAVH were included in the study; 84 underwent LAVH by 2 senior physicians, who had performed an average of 3 LAVHs per month for >6 years; 36 patients underwent LAVH by 3 junior physicians, who had performed an average of 1 case per month for < 3 years. Data were analyzed by the multiple linear regression model. The dependent variable was the number of outpatient visits within 3 months after discharge. The independent variables were patient age, parity, pelvic adhesions, chronic disease and physicians performing LAVH > 6 years.


RESULTS
The patients in the 2 groups did not differ in age, parity, chronic disease or pelvic adhesions. The level of physician experience significantly influenced the mean number of outpatient visits after LAVH within 3 months. After controlling for patient characteristics, the mean number of outpatient visits after discharge within 3 months of LAVH performed by senior physicians with 6 years of experience was reduced (-1.98).


CONCLUSIONS
LAVH performed by experienced physicians reduces the need for patients to seek postoperative outpatient medical care, thereby controlling medical costs incurred under the hospital global budget payment system. However, adding more variables to the multiple regression model, such as the socioeconomic status of patients, habits of seeking medical help, distance between home and hospital and relationship between patient and physician, may further explain the factors affecting outpatient medical care utilization.
Chang
Wei-Chun
WC
Departments of Obstetrics and Gynecology, China Medical University Hospital.
Chen
Huey-Yi
HY
Chang
Cherry Yin-Yi
CY
Ming
Ho
H
Lin
Cheng-Chieh
CC
Li
Tsai-Chung
TC
D000328:Adult; D000553:Ambulatory Care / Q000191:economics / Q000592:standards*; D016022:Case-Control Studies; D002983:Clinical Competence; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods / Q000592:standards; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011787:Quality of Health Care; D012189:Retrospective Studies