Empirical study on the influence of educational function to Length of Stay in teaching hospitals in Japan.

目前的日本研究生医学教育（PGME）制度是根据修订后的《医疗从业者法》于1968年建立的。目前的PGME系统存在几个问题。没有最低标准要求，也没有建立教学项目的评估体系。该项目通过提高居民个人的临床技能，对全国医疗服务的供应产生了巨大影响。我们调查了日本所有的教学医院，以评估与LOS和成本相关的因素。为了确定造成LOS较长的因素，进行了分析。在本研究中，我们重点研究了住院医师培训的条件以及日本教学医院的一般特征对LOS的影响。基于多变量分析，住院医师培训条件的最重要影响因素包括住院人数、每次住院手术率、每张病床解剖率，以及其他19个影响因素。同样，与教学医院的一般特征相关的因素包括住院医师是否负责后续计划、住院医师是否有门诊经验、住院医师津贴的大小等。数据的多变量分析结果表明，LOS与住院医师培训条件有关，独立于医院的一般特征。为评估高医疗费用，对住院医师就诊患者的调查结果进行分析。在本研究中，国家保险计划中价值超过1000分的程序被包括在内。以性别、年龄、诊断、保险费用占比、保险类型、医院类型、预后和总费用占高费用程序的比例作为自变量来分析每位患者的医疗费用。结果发现，x光、注射、物理治疗和实验室检查必须按照规定的顺序办理费用手续。少

The current Japanese postgraduate medical education(PGME)system was established in 1968 under the revised Medical practitioners Law. Several problems exist in the current PGME system. There are no mminimum standards required, and no system for evaluation of the teaching programs has been established yet. PGME has a tremendous influence on the national supply of medical care by improving the clinical skills of individual residents. We surveyed all the teaching hospitals in Japan to evaluate factors related to LOS and cost.In order to identify the factors responsible for the longer LOS, the analysis was carried out. In this study, we focused on conditions of residency training as well as general characteristics of teaching hospitals in Japan for their effect on LOS. Based on multivariate analysis the most important factors related to conditions of residency training included number of inpatients, operation rate per admission, autopsy rate per bed, and nineteen other factors of lessor imp … More ortance. Similarly, factors related to general characteristics of teaching hospitals, were whether or not the resident was responsible for the work-up plan, whether or not the resident had experienced in an outpatient clinic, and the size of the stipend for residents, etc. were used. The result of multivariate analysis of the data suggested that LOS was related to the conditions of residency training independently of general characteristics of the hospitals.To evaluate high-medical cost, the survey results for the patients attended by residents were analyzed. In this study, procedures worth more than 1000 points in the national insurance scheme were included. Medical costs per patient were analyzed by using gender, age, diagnosis, proportion of cost paid for insurance, type of insurance, type of hospital, prognosis, and the proportion of the total cost going to high cost procedures, as independent variables. As a result, x-rays, injections, physical therapy treatments, and laboratory examinations were found to have to have cost procedures in the order given. Less