Many countries with health insurance systems conduct periodic payment standards reform. How to reach consensus in setting payment standards among different specialties with different agendas has become a critical issu...Many countries with health insurance systems conduct periodic payment standards reform. How to reach consensus in setting payment standards among different specialties with different agendas has become a critical issue. The purpose of this study is to construct an analytic hierarchy process （AHP） model to obtain judgments from experts about the importance of ＂factors related to establishing payment standards in the national health insurance program＂. Under this goal, the first tier contains four evaluation aspects, and the second tier contains sixteen evaluation criteria divided into four groups The AHP model was then used to collect and combine the opinions of experts through an empirical study. The results can be directly used to formulate standard values as the basis for establishing payment standards. The results of our study strongly support that an AHP model is effective in forming a consensus among surgical specialists.展开更多
Objective:To compare the prognostic prediction between dichotomized and fractionated evaluations of hormone receptor expressions. Methods: Patients with stages I-III breast cancers, who received adjuvant tamoxifen, we...Objective:To compare the prognostic prediction between dichotomized and fractionated evaluations of hormone receptor expressions. Methods: Patients with stages I-III breast cancers, who received adjuvant tamoxifen, were enrolled. The expression of estrogen receptor (ER) and progesterone receptor (PR) was evaluated by immu-nohistochemistry (IHC). A fractionated score (F score), the percentage of positive-staining nuclei (0=none, 1=1%-10%, 2=11%-30%, 3=31%-50%, 4=51%-70%, and 5=71%-100%), was assigned to each case. The dichotomized scoring method defines an F score >1 as positive. The prognostic values of both scores were compared by multiple Cox's proportional hazard models of disease-free survival (DFS) and overall survival (OS). Results: Four hundred and sixteen patients with a median follow-up of 78.0 months were included. F scores for ER and PR correlated directly with DFS and OS. Although both the dichotomized and fractionated ER and PR scores were significantly associated with DFS and OS in univariate analyses, only fractionated ER and PR scores remained as independent prognostic factors of DFS and OS in the final multiple Cox's proportional hazard models. Conclusion: Fractionated IHC hormone receptor expression evaluation enhances the prognostic prediction compared with a dichotomized assessment.展开更多
基金This study is deeply indebted to the Taiwan’s Bureau of National Health Insurance, Department of Health, Executive Yuan for providing research funding (BNHI Year 2002 Research and Development Project, Doc. No.:DOH91–NH-1040)
文摘Many countries with health insurance systems conduct periodic payment standards reform. How to reach consensus in setting payment standards among different specialties with different agendas has become a critical issue. The purpose of this study is to construct an analytic hierarchy process （AHP） model to obtain judgments from experts about the importance of ＂factors related to establishing payment standards in the national health insurance program＂. Under this goal, the first tier contains four evaluation aspects, and the second tier contains sixteen evaluation criteria divided into four groups The AHP model was then used to collect and combine the opinions of experts through an empirical study. The results can be directly used to formulate standard values as the basis for establishing payment standards. The results of our study strongly support that an AHP model is effective in forming a consensus among surgical specialists.
基金supported by the National Center of Excellence for Clinical Trial and Research of National Taiwan University Hospital (No.DOH97-TD-B-111-001),Taiwan,Taipei
文摘Objective:To compare the prognostic prediction between dichotomized and fractionated evaluations of hormone receptor expressions. Methods: Patients with stages I-III breast cancers, who received adjuvant tamoxifen, were enrolled. The expression of estrogen receptor (ER) and progesterone receptor (PR) was evaluated by immu-nohistochemistry (IHC). A fractionated score (F score), the percentage of positive-staining nuclei (0=none, 1=1%-10%, 2=11%-30%, 3=31%-50%, 4=51%-70%, and 5=71%-100%), was assigned to each case. The dichotomized scoring method defines an F score >1 as positive. The prognostic values of both scores were compared by multiple Cox's proportional hazard models of disease-free survival (DFS) and overall survival (OS). Results: Four hundred and sixteen patients with a median follow-up of 78.0 months were included. F scores for ER and PR correlated directly with DFS and OS. Although both the dichotomized and fractionated ER and PR scores were significantly associated with DFS and OS in univariate analyses, only fractionated ER and PR scores remained as independent prognostic factors of DFS and OS in the final multiple Cox's proportional hazard models. Conclusion: Fractionated IHC hormone receptor expression evaluation enhances the prognostic prediction compared with a dichotomized assessment.
