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  • 學位論文

醫療照護市場中醫療結構面品質與結果面品質的相關性之研究

The research of health care structure quality and outcome quality in health care markets

指導教授 : 鄭守夏

摘要


研究目的:瞭解醫院的結構面特性與病患感受品質和專業觀點品質的相關性。 研究方法:本研究為橫斷性研究,資料來源為2002和2004二個年度對出院病人的調查問卷和全民健保資料庫的「住院醫療費用清單明細檔」。問卷調查對象是選取全國地區教學醫院等級以上醫院糖尿病、肺炎、中風和氣喘四類住院病人為研究樣本。結構面指標包括醫師病床比、護理人員病床比、護理師佔護士比率、高科技儀器數、急性病床數、加護病床數等。品質指標的測量方面,病患感受品質分為人際面和技術面的感受品質;專業的品質指標分為病患出院後30天內的再住院情形和30天內同科再住院情形。以線性迴歸模型及邏輯斯迴歸模型,檢驗醫院結構面特性與病患感受品質和專業觀點品質的相關性。 本研究結果顯示:(1)對於人際面病患的感受品質而言,醫院護理師佔護士的比率愈高,以及擁有較多高科技儀器數的醫院,其得分普遍顯著愈高。(2)對於技術面病患的感受品質,結構面品質愈佳(醫師病床比愈高、護理人員病床比愈高、護理師佔護士比率愈高、高科技儀器數愈多、急性病床數愈多、加護病床數愈多者)的醫院,其得分普遍顯著愈高。(3)護理師佔護士比率愈高的醫院,其再住院情形普遍愈低。 結論:結構面品質較佳的醫院,讓病患有較佳的感受品質和較低的再住院率及同科再住院率。建議衛生主管機關將醫院人力素質納為評鑑標準。

關鍵字

結果面品質

並列摘要


Objective: The objective of this paper is to examine the relationship between the structural measures of quality and outcome measures of quality. Methods: This study was a cross-sectional design. The data used in this study came from two sources: the 2002 and 2004 Hospital Discharged Patient Surveys and the National Health Insurance Research Databases (NHIRD) in Taiwan. We included patient discharged from hospital accredited as district teaching hospital and above and included patients with a diagnosis of diabetes mellitus, stroke, asthma or pneumonia. The structural measures of quality included physician-to-bed ratio, nurse-to-bed ratio, the percentage of registered nurse, the number of high-tech equipments, the number of acute beds and the number of ICU beds. The outcome measure of quality was divided into two parts: subjective and traditional objective quality of care measures. Subjective patient-perceived quality of care was measured by ratings of interpersonal skill and clinical competence. The traditional objective quality of care was measured by the readmission within 30 days of index discharge. The linear regression and logistic regression were applied to examining the relationship between the structural measures of quality and outcome measures of quality. Results: Results indicated that (1) hospitals with high nurse-to-bed ratios and with high hi-tech equipments were associated with significantly better interpersonal skill scores than those with low nurse-to-bed ratios and with low hi-tech equipments. (2) In addition, we also found that hospitals with higher structural measures of quality (including physician-to-bed ratio, nurse-to-bed ratio, the percentage of registered nurse, the number of high-tech equipments, the number of acute beds and the number of ICU beds) were associated with significantly better clinical competence scores that those with low structural measures of quality. (3) We found that the negatively association between the percentage of registered nurses and readmission within 30 days of discharge. Conclusion: Hospital with higher structural measures of quality is associated with higher outcome measures of quality, in terms of either subjective quality or traditional objective quality. According to our findings, we suggested that the government should incorporate the quality of hospital staff in the hospital accreditation system.

並列關鍵字

outcome quality

參考文獻


高秀娥 (2007)。影響呼吸器依賴病患家屬選擇呼吸照護病房因素及滿意度調查。臺北醫學大學護理學院護理研究所碩士論文。
邱士峰 (2004)。醫院自填評鑑資料與病人報告醫療品質之相關性研究。國立臺灣大學公共衛生學院衛生政策與管理研究所碩士論文。
余秀芳 (2003)。台灣地區病人重複住院之分析。國立臺灣大學公共衛生學院衛生政策與管理研究所碩士論文。
江慧珍 (2006)。台灣民眾的就醫第二意見行為之探討。國立臺灣大學公共衛生學院衛生政策與管理研究所碩士論文。
張瑋玲 (2004)。醫療市場競爭程度對醫療品質的影響。國立臺灣大學公共衛生學院衛生政策與管理研究所碩士論文。

被引用紀錄


張靈(2012)。專業觀點與病人觀點健康照護品質之探索型研究〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2012.00482
黃培銘(2010)。中醫與西醫的就醫選擇及其醫療成本分析〔碩士論文,國立臺北大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0023-0809201014154800

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