- 學位論文
基層診所社群網站評比與醫療品質指標的相關性
Associations between online ratings and quality measures of local clinics in Taiwan.
摘要
研究背景：近年來，越來越多病患於社群媒體或是醫師及醫療機構的評價網站上分享自己的就醫經驗以及對於醫師、醫院的看法，隨著醫療界對於以病患為中心的醫療照護品質越趨重視，病患滿意度也被看作醫療品質指標之一，病患於網路上留下的回饋也成為了促進提升醫療品質的參考工具。然而，醫院的醫療品質有著評鑑把關，診所卻沒有一定的品質指標結果可供民眾參考，目前現有政府公開的診所品質參考來源只有全民健康保險醫療品質公開網上的西醫基層指標，以及民眾在網路上查找他人的經驗分享能夠作為消費者進行醫療決策時的輔助。 研究目的：本研究意在了解病患於網路上留下的評分與西醫基層診所醫療品質是否存在關聯性。 研究方法：研究對象為全民健康保險醫療品質資訊公開網上的西醫基層指標以及Google地圖平台上診所獲得的評分，使用斯皮爾曼等級相關係數作為分析網路評價和基層診所醫療品質指標相關性的工具，同時採用複線性迴歸模型探討變項之間的線性關係以及採用羅吉斯迴歸分析探討不同變項與診所表現優劣之關聯性。 研究結果：在21項醫療品質指標之中，有8項指標與網路評分呈統計顯著的低度相關(ρ=−0.1~0.1, p-value<.05)，7項指標說明當評分增加時，醫療品質指標的表現也會更好；此外，在複迴歸模型中發現，在各個指標內所有呈統計顯著的項目之中，不同專科別(參數估計值: -0.04~17.76, p-value<.05)整體來說對於醫療品質指標表現的影響力較評分(參數估計值:-0.06~-0.89, p-value<.05)來得更大；從羅吉斯模型之中也能看出，專科別(OR: 0.05~18.15, p-value<.05)對於診所表現差異的影響力較評分(OR: 0.77~1.23, p-value<.05)來得更有鑑別程度。 結論：當民眾在網路上搜尋資訊以做出醫療決策時，網路上的評分能夠作為診所品質表現好壞的輔助資料，而政府在醫療品質資訊公開網上提供的資訊也有相等重要的參考價值，且由於網路評分和西醫基層指標所代表的醫療品質構面不同，因此民眾可將兩者作為尋求醫療提供者時互補的工具使用。
並列摘要
Background: Social media and patient rating websites that post ratings and comments on patient experience are increasingly popular in recent years. Leading to a higher awareness of patient-centered care, patient satisfaction was seen as an indicator of the quality of care. Also, studies showed online ratings had become a popular tool to facilitate quality improvement. However, hospitals in Taiwan had implemented accreditation by an official organization, while local clinics don’t have a standard for assessing their quality performance to date. When it comes to choosing primary care providers, social media ratings may offer another opportunity for patients to identify clinic performance. Objective: Little is known about the usefulness of consumer ratings when searching for a local clinic in Taiwan. Therefore, this study attempts to fill the knowledge gap by assessing the association between Google Maps ratings and quality measures of clinics, to know whether online ratings could steer patients to better performing clinics. Methods: Data were obtained from the national health insurance healthcare quality public reporting website, National Health Insurance Administration under the Ministry of Health and Welfare in Taiwan. Ratings(1-5 stars) from Google Maps were collected in April 2020. The association between ratings and quality measures of clinics is evaluated through spearman rank correlation coefficient analysis. Multivariate linear regression model and multivariate logistic regression models were performed for elaborating the association between clinic covariates and quality measures of clinics. Results: Among clinics with >10 Google Maps ratings, 8/21 quality measures were significantly associated with online ratings (ρ=−0.1~0.1, p<.05 for all). Thereof, seven associations indicated better online ratings for better quality performance. When compared with online ratings, multivariate linear regression model and multivariate logistic regression models showed specialties have significant impact on quality measures’ performances. Conclusion: These data suggest that consumers posting ratings on Google Maps may relate to quality measures of local clinics in Taiwan. However, the relatively weak strength as well as the lack of associations with several other quality measures may not draw strong conclusions. Since online ratings and quality measures of local clinics may represent different domains of quality of care, patients should use both data sources for guiding their choices of searching clinics.