¡eAbstract¡f
The difference of medical diagnosis and its related effect is important to medical quality consistency and medical care cost-effectiveness. At present, the specialists including radiologists, chest medicine doctors & family medicine doctors able to perform X-ray diagnosis of foreigners¡¦ physical examination would cause the difference of flow fluency & consistency of medical quality in foreigners¡¦ physical examination. Due to the shortage of studies in discussing the difference among doctors¡¦ diagnosis in our country, the study is an experimental cross-section design that focuses on the diagnosis difference of 3595 foreigners¡¦ chest X-ray among 3 different specialists. The result of research may be useful for making policy of public health and be referent to the quality control and management in the hospital.
According to the result, the X-ray diagnosis of lung TB showed no difference between specialists & hospital levels in Chi-square analysis, but the diagnosis consistency of kappa between every 2 doctors was so fluctuant among 10 doctors, the kappa value ranged from ¡V0.005 to 1.0. Besides, the consistency of kappa among either 10 doctors, 4 chest medicine doctors, 3 radiologists or 3 family medicine doctors were poor, and the kappa value ranged from 0.035 to 0.2. The highest kappa was 0.18629 among 3 family medicine doctors, while the lowest kappa was 0.038197 among 4 chest medicine doctors. The other studying result also showed low consistency of kappa among 10 doctors in X-ray diagnosis of lung abnormality, the kappa value ranged from ¡V0.009 to 0.375. Besides, the low consistency of ICC was also noted among 10 doctors in X-ray diagnosis scores of lung abnormality. ICC value ranged from ¡V0.0159 to 0.5540.
The exploration of doctors¡¦ difference in X-ray diagnosis of lung was under no interference of medical payment system. If the X-ray diagnosis followed the standard of CDC, only requiring the abnormal TB, 3 specialists would show no difference in X-ray TB diagnosis. Therefore, the first line family medicine doctors who see the foreigners directly would also fit to make the diagnosis of X-ray lung TB. Moreover, due to the family medicine doctors understand the foreigners¡¦ history than other specialists, if the family medicine doctors make the diagnosis of X-ray lung TB, the overall examination procedure would be fast and better.
From the article review, the consistency was low among doctors in many medical diagnoses, such as chest X-ray, cytology, CT scan, breast sono, emergent chest X-ray, KUB and skeletal X-ray. Due to the low consistency, there were researchers making effort and doing study to suggest that the doctors could elevate the consistency and reliability by continual discussion and learning. However, our country is short of study in discussing the difference among doctors. From the study result, the variation of consistency is huge. Whether it would affect the medical behavior of doctors, such as overusing the related tests or medicine having influence on patients¡¦ health and safety, further studies will be needed.
| Identifer | oai:union.ndltd.org:NSYSU/oai:NSYSU:etd-0613104-080550 |
| Date | 13 June 2004 |
| Creators | Yeh, Ching-hui |
| Contributors | Hsueh-Wen Chang, Jin-Yuan Chern, Shu-Chuan Yeh |
| Publisher | NSYSU |
| Source Sets | NSYSU Electronic Thesis and Dissertation Archive |
| Language | Cholon |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.lib.nsysu.edu.tw/ETD-db/ETD-search/view_etd?URN=etd-0613104-080550 |
| Rights | withheld, Copyright information available at source archive |
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