醫療品質指標發展的挑戰與展望：我們還能做什麼？

Challenges and Perspectives of Development in Quality of Care Indicators: What Else Can We Do?

鍾國彪(Kuo-Piao Chung) ； 游宗憲(Tsung-Hsien Yu)

《台灣公共衛生雜誌》 28卷5期 (2009/10) Pp. 345-360

https://doi.org/10.6288/TJPH2009-28-05-01

摘要

醫療品質指標是最常應用的品質改善工具之一，除了用於醫院內部品質改善之外，近年來更做進一步的外部應用。過去學界對於指標有許多論述，但卻缺乏發展脈絡的回顧，因此本研究的目的為利用Web of Science文獻資料庫進行文獻回顧，以探究醫療品質指標的沿革與發展。本研究共回顧430相關文獻，發現醫療品質指標相關的文章，於1990年代開始蓬勃發展，相關內容可分為(1)指標與品質測量的關係、(2)發展指標的方法、(3)指標風險校正方法、(4)指標的應用及(5)指標的挑戰及影響等五個部份來呈現。結果可以發現當今醫療品質指標的發展，已有一致性的作法，在應用上也越來越多元化，但在品質指標後續的維護與評估，仍有極大的進步空間。本文並從指標發展、指標評估、指標應用及指標輪替／汰換等四個重點，提出對醫療品質指標現況的檢討與未來的建議。

關鍵字

醫療品質指標 ； 指標發展 ； 指標評估 ； Web of Science文獻資料庫

並列摘要

Quality indicators are one of the most widely used tools for evaluating care. They can be used to provide not only internal quality improvement, but also (in recent years) external quality assurance. There are many previous studies but few reviews on quality indicators. Therefore, the purpose of this study was to use the Web of Science database to examine the development and evolution of quality indicators. A total of 430 papers were reviewed. Most related papers were published after the 1990s. These papers can be divided into 5 content groups including the relationship between quality measures and quality indicators, the methods of quality indicator development, the methods of risk adjustment, application of quality indicators, and impact of quality indicators. This review revealed that the methodology of quality indicator development is consistent, and the applications of quality indicators are diverse. However, implementation and evaluation of quality indicators still have room to improve. We also provide comments on the development, evaluation, application, and selection of quality indicators, and make recommendations for the future.

並列關鍵字

Quality Indicators ； Indicators Development ； Indicators Evaluation ； Web of Science database

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