基于相对价值的骨科医师工作量研究

Estimating Orthopedics Physicians’Workload Based on the Relative Value Unit

目的:以骨科为例探讨医师工作量的相对价值(RVU)。方法:采用现场观察、量值估计法、德尔菲法、问卷调研、定量分析和多重回归等方法进行研究。通过德尔菲法组织专家会遴选样本医院骨科医疗处置项目39项,并以问卷形式在我国三甲医院进行调研,结果回收后结合客观数据探讨相对价值表。结果:(1)以"人工股骨头假体置换术,骨病型"的工作量为100,其余38项医疗处置的工作量相对价值范围为60~149,变异系数变动范围为14.4%~41.3%,相对价值最高的处置为"胸腰椎融合术,后路法",最低为"腱鞘囊肿切除术";(2)验证了四个维度对医师总工作量的总体解释合理性(调整R~2为0.986),脑力消耗、技能与体力消耗、心理压力对总工作量解释性较高(P<0.05)。结论:运用量值估计法对骨科医师工作量进行评价具有可行性,时间、脑力消耗指数、技能与体力消耗指数、心理压力能够合理解释39项服务项目的医师工作量,可以考虑采用本方法进行院内激励。

Objective:To examine the value of intra-service workload by relative value unit(RVU),in using common orthopedic procedures.Methods:Field observation,magnitude estimation,Delphi method,questionnaire,quanlitative analysis and Multiple linear regression were applied.Delphi method was used to valid the questionnaire for the most common 39 procedures.On site observation was add to examine the time and manpower of the procedures.The validated questionnaires were mailed to orthopedic surgeons across several institutions.Multiple linear regressions were performed to explore the predictive power for all procedures.Results:(1)The workload of"femoral prosthesis replacement(orthopedic)"was 100.The relative value of orthopedic total workload ranged from60 to 149 in selected procedures,with coefficient variation from 14.4%to 41.3%;the highest relative value was"posterior lumbar interbody fusion with cage",while the lowest was"excision of tecal cyst".(2)The predictive power for total physician workload was adjusted(R2 was 0.986).Mental effort,technical skill,psychological stress showed statistically significant on total workload.Conclusion:The study concluded that the RVU could identify the workload among the selected 39 orthopedic procedures.Hospitals and insurance agencies might consider to apply the methods to incentive physician or hospital performance by adopting the methods.