The Impact of Physician's Clinical Experience to In-hospital Quality of Care
Date Issued
2015
Date
2015
Author(s)
Hsu, Hung-Pin
Abstract
Background: The relationship between clinical experience and quality of care was not very clear in the past. Several studies for years ago showed that young physician provided medical service more compatible with clinical evidence due to having update medical knowledge and technology, and therefore provided better quality of care. However, the continued medical education has been carried out in Taiwan for about 20 years, and the senior physicians also could get the update medical knowledge and technology. In addition, the senior physician have more clinical experience then young physician, so the quality of care provided by senior physician maybe different from that decades ago. Aim of study: This practicum program was carried out at one municipal, regional teaching hospital in Taipei City of Taiwan. The aim of this study is to find the difference between the quality of in-hospital care provided by physician with different clinical experience in this hospital. However, there are many kinds of indicators about quality of care. Our study is focus on outcome indicators, which are most often being used to evaluate the quality of care in recent years. Methods: In-hospital patient in specific duration (ex: discharged between January 1st, 2013 to June 30th, 2013) with specific disease (ex: pneumonia, urinary tract infection and acute respiratory failure) were selected in this study. These patients were divided into groups according to the clinical experience of their physicians, and then compare the in-hospital death, re-admission in 14 days, hospital days and cost between these groups. The characteristics of physicians were also taken into consideration, and the relationship between these characteristics and outcome indicators was also discussed. Because these characteristics may confound the result, we took in-hospital death as an example, and used binary Logistic regression method to clarify whether clinical experience is an independent factor of in-hospital death. Result: There were 937 cases included in the study, and the analysis result showed patients cared by senior physicians had lower in-hospital mortality (p value = 0.001), fewer costs (p value < 0.001), and patients cared by young physicians had longer hospital days than mid-aged and senior physicians (p value = 0.001). There was no obvious difference between outcome indicators of disease with mild and moderate severity. The patients with high-severity disease cared by young physicians had longer hospital days (p value = 0.035) and higher costs (p value = 0.022). The outcome indicators of internist, physicians with critical medicine, and non-director were more poor. However, physicians with different characteristics may care patient with different severity of disease. If the disease severity and patient''s age were all taken into consideration, these physician characteristics didn''t showed obvious impact on outcome indicators according multivariate analysis. But the patients cared by senior physicians still have lower in-hospital deaths. So clinical experience still have important impact on outcome indicators of quality of care. Conclusion: The quality of care provided by senior physicians improved during recent 20 years in Taiwan after continued medical education was carried out. Their quality of care in disease of higher severity was better than young physicians due to their good clinical experience and update knowledge. For public health issue, reform of medical education and execution of continued medical education will push every physician to get update knowledge and technology, and therefore the quality of care will improve gradually in the society.
Subjects
clinical experience
quality of care
indicator of quality
SDGs
Type
thesis
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