종합병원 진료과의 구조적 복잡성과 기술적 숙련도가 치료결과에 미치는 영향

Abstract

Objectives: The purpose of this study is to analyze the effects of structural complexity and technical proficiency on treatment outcome of the clinical departments in general hospitals and to verify the conceptual independency of the two variables. Methods: Discharge summary data of 4,528 cerebrovascular diseases patients who underwent surgery during a month period between 2008 and 2011 were analyzed. The analytic model included the independent variables such as surgery volume and number of disease diagnosis in a neurosurgery department. The dependent variables were length of stay and mortality rate. Hierarchical logistic regression and poisson regression model were applied to test the hypothesis. Results: Results showed a high level of complexity departments have a low length of stay and mortality. Also, a high level technical proficiency had a significant negative relationship with the length of stay and mortality rate. In addition, a conceptual independency between the two variables was verified. Conclusions: The studies that intend to analyze surgery volume and mortality rate relationship should consider structural complexity as well as technical proficiency for more rigorous study design.