七十九年度暨八十年度台灣地區醫院評鑑結果之分析

Comparison Studies of 1990 and 1991 Hospital Accreditation in Taiwan

蘇喜(Syi Su) ； 戴政(J. J. Tai)

《中華公共衛生雜誌》 13卷2期 (1994/04) Pp. 183-201

https://doi.org/10.6288/CJPH1994-13-02-08

摘要

我國醫院評鑑制度肇始於民國67年，當時教育部及衛生署為了有客觀標準選定教學醫院，以為醫學生實習之場所，辦理第一次的教學醫院評鑑。75年醫療法實施後，衛生署期藉擴大醫院評鑑的範圍，提昇整個醫療服務水準，以保障病患之權益。木研究旨在比較衛生署接辦醫院評鑑工作以來之民國79年及80年二次之評鑑結果。
分析結果顯示：
1．在總得分方面，醫學中心及區域醫院二個年度平均分數相近而地區教學及地區非教學醫院則達顯著差異。
2．二評鑑年度之床位配置水準。醫學中心、區域醫院、地區教學醫院均未達顯著差異，而80年地區非教學醫院之各類床數（洗腎及嬰兒床除外）數目大於79年。
3．二評鑑年度之人員配置上，80年醫學中心之病壓人員配置較79年多，80年區域醫院之核醫技術人員比79年多。80年地區教學醫院之藥劑、放射技術及病歷管理人員均較79年增加，而80年地區非教學醫院除住院醫師、復健及社服人員外，其餘之專業人員均較79年多。
4．業務量方面，醫學中心及區域醫院二評鑑年度之業務量大致相同，地區非教學醫院之急診人次顯著減少，其餘業務量均增加或顯著增加。
目前評鑑表之設計對於品質項目之量化及測定不易，故只能注重硬體設施及人力配置之結構面，導致醫院群往人員、設備方面下具體可見之投資。結構面的充裕，雖不能保證醫療服務之品質，但至少是優良品質的根本。向此研究中發現，政策對醫療營運方向可能是頗具影響的，故屬醫療過程及結果面的可量化指標應是努力發展及期待的目標。

關鍵字

評鑑 ； 醫院評鑑

並列摘要

The Hospital accreditation program in Taiwan was launched first time in 1978 for the purpose of assigning teaching hospitals as practice site for medical students.
The enactment of the Medical Law authorizes the Health Department to be responsible for supervising the hospital accreditation program in coorepration with the Ministry of Education. Since then the database are available.
This research aims at comparing the evaluation data of the two accreditation programs.
The findings are as follows:
1. The total scores of medical centers and regional hospitals between the two accreditation runs are not significantly different, while those of district teaching and district non-teaching hospitals differ significantly.
2. The facility installment levels of medical centers, regional hospitals and district teaching hospitals between the two accreditation runs are not different while that of district non-teaching hospital has significant progress in installment level (kidney dialysis and infant bed are exceptions).
3. The medical related personnel staffing level of district non-teaching hospital has significant increase between the two accreditation programs, except residents, physical therapists, and social workers. Medical Centers have significant increase in the medical record management personnel while regional hospitals recruit more nuclear technologists significantly.
4. The productivity of medical centers and regional hospitals do not differ significantly between two accreditation runs while district non-teaching hospital has significant lower productivity amount in emergency care services but has significant higher amount in other services.
Owing to the difficulty in quantifying services, the current accreditation program focus mainly on structural explarotory investigation. The facility installment level, personnel staffing level and productivity amount seem all have progressed as were expected by the Health Department. In terms of the findings, the district non-teaching hospitals seem to reflect the most satisfactory result toward what are expected. The guiding power of policy are shown meaningful. The development of objective process and outcome indicators are thus highly recommended.

並列關鍵字

Accreditation ； Hospital Accreditation