血液透析中心實施臨床關鍵績效指標(KPI)之成效評估

研究目的本研究主要目的在探討血液透析中心,導入臨床關鍵績效指標後，臨床品質變化的情形,不同的醫師執業型態(專任或兼任醫師)是否有差異。研究方法本研究採回溯性之研究設計,針對同一透析集團北高雄三家血液透析中心之洗腎病人155人為對象,研究導入臨床關鍵績效指標前後各6個月,5項臨床指標(血球比容,鐵飽和度,尿毒素清除率,血中白蛋白,血磷)的變化情形。並利用電腦系统建立與取得單位醫師執業型態、人口學與臨床特性。統計分析採用SPSS 18版進行描述性统計分析,比較平均數與一般線性模式(GLM))之重覆量數法。研究結果整體臨床品質指標改善的有鐵飽和度(30.90%-->32.50%)、血磷(5.16??4.96)、尿毒素清除率(1.60??1.66)，沒有改善的有血球比容(31.77??31.92)、血中白蛋白(4.03??4.02)。專任醫師組在尿毒素清除率有顯着性上升(1.58??1.65)，其餘指標無顯着差異，達成百分比都超過標準且兼任醫師組高。兼任醫師組在血中白蛋白(3.98??3.95)、血磷(5.19??4.85)有顯着性的下降，在尿毒素清除率(1.61??1.67)有顯着性上升，其餘無顯着差異。兼任醫師組在尿毒素清除率上升、血磷下降二項，較專任醫師組顯着，進步的程度較大。結論與建議導入臨床關鍵績效指標後,整體而言臨床品質指標確有改善，但改善的程度不一。不同的醫師執業型態(專任或兼任)，臨床品質的改善情形不同；專任醫師組全部指標達成百分比較高，兼任醫師組部份指標進步較顯着。本研究建議血液透析中心可採取臨床關鍵績效指標(KPI),做為持續性品質改善的重要工具。

關鍵字

品質指標；持續性品質改善；策略績效管理；關鍵績效指標；專任醫師；兼任醫師

並列摘要

Research Purpose The aim of this study is to investigate the changes of clinical quality in hemodialysis centers, after implementing clinical Key Performance Indicators(KPIs) program, and whether there are differences relating to physician practice patterns(full-time or part-time physician). Research Methods In this retrospective study, 155 dialysis patients from three hemodialysis centers of one same dialysis provider located at North Kaohsiung area were enrolled. Physician practice patterns, demographic and clinical characteristic data were collected. After implementing clinical Key Performance Indicators (KPIs) program for 6 months, 5 clinical quality indicators(hematocrit, transferrin saturation,dialysis clearance,serum albumin,serum phosphorus) were compared. Statistical analysis using SPSS 18 editions with descriptive statistics, comparison of mean, repeated measures of general linear model (GLM) were adopted. Results Three clinical quality indicators improved : transferrin saturation (30.90% --> 32.50%), serum phosphorus (5.16--> 4.96), dialysis clearance,Kt/V(1.60-->1.66),not improved in the hematocrit level (31.77--> 31.92) and serum albumin (4.03--> 4.02). In the full-time physician group, dialysis clearance(Kt/V) achieved significant rise(1.58 -->1.65), the rest of quality indicators were not significantly different. All clinical Key Performance Indicators were achieved above the performance goal and better than the part-time physician group. In the part-time physician group, serum albumin (3.98--> 3.95), serum phosphorus (5.19--> 4.85) significantly decreased, dialysis clearance(Kt/V) significantly rised(1.61-->1.67). Comparing the changing degrees of both groups, the part-time physician group has better improvement in the dialysis clearance, serum phosphate than the full-time physician group. Conclusion and Suggestion The clinical quality indicators did improved to varying degrees after implementing clinical Key Performance Indicators (KPIs) program. Different physician practice patterns(full-time or part-time) have different results; the full-time physician group has better performance while the part-time physician group has better improvement. This study suggests hemodialysis centers can implement the clinical Key Performance Indicators (KPIs) program as a persistent and effective tool for continuous quality improvement(CQI).