地域医療と健康教育

抽象的な

Production Efficiency of Physicians in Outpatient Consultation of Cardiovascular Cases

Tomoyuki Takura and Haruki Itoh

Background: We evaluated the production efficiency of physicians in outpatient consultation using Data Envelopment Analysis (DEA) to verify the applicability of this method in health care field.
Methods: Clinical accomplishment by outpatient consultation (number of complex cases) and economic contribution to health service income (fee claims) were defined as the contributions of physicians in medical institutions. We investigated consultations and fee claims of 963 outpatients (all aged: 72.9 ± 11.8 years, males aged: 72.0 ± 11.7 years / females aged: 74.0 ± 12.0 years, hypertension: 17.5% / angina: 13.1%) consulted by 15 physicians in a week at a medical institution specialized in cardiovascular disease. The physician’s fee claim per practice time was used as an index in production efficiency of each cardiovascular case. We determined production efficiency of physicians using both of total fee claim and number of complex cases per consultation time using DEA.
Results: There was no statistically significant difference between main disease of outpatients in consultation time (p=0.28). We showed a significant increment of physicians fee claim (point per min) according to the patient condition aggravated from mild to moderate cases in severity (71.4 ± 2.4: p=0.004). The production efficiency also significantly increased from the first consultation to follow-up (71.6 ± 2.4: p=0.048). There was a large variation among the 15 physicians in the consultations, and 4 physicians (26% of all subjects) formed a group with the most favorable production efficiency according to DEA.
Conclusion: We demonstrated evaluation of production efficiency of physicians using clinical and economic accomplishments. The production efficiency is significantly influenced by disease severity and consultation step. Our finding suggests that DEA may be applicable for evaluation of health care services.