探討醫院病歷部門主管與疾病分類人員對人力需求之認知差異及其實際工作情形

目標：疾病分類人員在醫療研究、衛生統計、費用申報上扮演了相當重要的角色，從學者研究得知我國疾病分類編碼整體正確率只有46.6%，其重要原因之一在於疾病分類人員的素質和人力。本研究目的是探討病歷部門主管與疾病分類人員對人力需求的認知差異及其實際工作情形。方法：一般病床100床以上醫院的病歷部門主管和疾病分類人員為研究對象，採問卷調查法，回收率各為86.7%和75.7%，有效樣本各為157份、345份。結果：醫學中心疾病分類人員有61%認為人力太少，地區醫院有21.9%認為人力太多，這與兩者主管認知有差異。實際工作情形是：醫學中心每人每日平均花最多時間從事最多本病歷的編碼，但仍覺得人力不足，因有92.9%人員尚需協助病歷量的審查、癌症登記、疾病統計、保險申報等工作。而地區醫院疾病分類人員平均每本病歷編碼時間與其他層級醫院比較明顯偏高，且通過疾病分類甄審考試人數比率最低。其他影響編碼速度與完整性的因素是醫師病歷書寫品質、病理檢驗報告未出來、花時間與醫師討論等。結論：醫學中心與地區醫院的病歷部門主管與疾病分類人員對人力需求的認知不同，建議加強地區醫院疾病分類人員的編碼訓練，增加醫學中心人員數，加強醫師病歷書寫品質和檢驗報告的時效性。

關鍵字

疾病分類,編碼人員,人力需求

並列摘要

Objectives: Disease coders playa very important role in medical research, health statistics and insurance claims. Previous studies showed that the overall correct rate of disease coding was 46.6% in Taiwan, and it was influenced by quality and manpower of coding personnel. The purpose of this study was to explore the different perceptions on manpower between directors and disease coders of the Medical Record Department (MRD) and to examine the practical Working situation of coders. Methods: Samples were directors and disease coders of MRD in hospitals with over 100 beds. We received 157 and 345 valid questionnaires from directors and disease coders, respectively. The return rate of directors is 86.7% and that of coders is 75.7%. Results: We found that 61 % of the disease coders from medical centers consider manpower insufficient, while 21.9% of the disease coders from district hospitals find it excessive. But their perceptions are different from those of their directors. The coders from medical centers spent lots of work-time on disease coding, and they still had to assist other works such as review quantity of charts, cancer registration, statistics of disease and health insurance claims. The average coding time of each chart from district hospitals was higher than that from other hospitals ,but fewer coders have obtained professional qualifications. Other factors influencing speed and completeness of coding were quality of written medical records from doctors, and the efficiency of pathological or exam reports. Conclusion: More professional training courses are needed for coders from district hospitals, manpower for medical centers should be increased, and the efficiency on reports and written quality of charts should be improved.

並列關鍵字

classification of disease,disease coders,manpower.

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