柏列特原理在門診醫療之解析與運用

柏列特原理指出「精寡粗多」的現象。本研究應用此原理來分析醫院門診產出，並建構一個衡量此精寡程度的指標：單位價值對比值(RUV, Relative Unit Value)，以做為管理決策之參考。研究材料為某中型醫院之「勞保門診醫療費用申報明細檔」，方法則以RUV值探討門診產出之診斷別和醫師別在「就醫人次」指標上之精寡粗多程度。由80/20原理之經驗，RUV值等於16；故本文取16做為「精寡粗多」與否的初步臨界值。結果發現，診斷別之RUV值皆大於16；也就是病人集中在少部份診斷的現象明顯；且分科的RUV值大於未分科，即科別是影響診斷別RUV值高低的重要因素。反之，醫師別分科與否的RUV值則無差異且皆小於16。換句話說，該樣本醫院，並沒有少部份醫師看大部份診次的現象，而分科與否並不影響結果。此RUV值理論模式尚可應用於其他層面，如醫院成本控制、醫院倉儲管理、醫療品質管制…等。至於是否決定以16作為RUV臨界值，可因事制宜。

關鍵字

柏列特原理；門診；單位價值對比值

並列摘要

Pareto principle (80/20 rule) points out the phenomenon of ”vital few and trivial many”. The study applies this principle to analyze the outputs of ambulatory care and tries to generate an indicator: Relative Unit Value (RUV) to measure the concentration of ”vital few”, that can help the decision making of hospital management. Data was from the profile of outpatient claims for the Labor Insurance Payment in one middle-sized hospital. We studied the RUV of the visits on different diagnoses and different physicians, which were viewed as the output of ambulatory care. Due to the rule of ”eighty-twenty”, we set RUV equal to 16 as a primary standard. Results show that RUV of the visits on the diagnoses which are stratified by department are larger than non-stratified, and their values are also larger than 16. It means that a few diagnoses will include most diseases, and the stratification of department also playes an important role on the concentration of a few vital diagnoses. But it makes no difference that RUV of the visits on the physician. It means that phenomenon of a few physicians includes most of visits is not significant. RUV can also applied to many aspects as well, such as cost control, inventory management, and quality assurance.. etc. However, the setting of RUV standard value will depend on the characteristics of the event.

並列關鍵字

pareto principle ； ambulatory care ； relative unit value

國際替代計量

柏列特原理在門診醫療之解析與運用

全文下載

主題瀏覽