探討以死亡率作爲加護中心照護品質指標之合理性

Is It Reasonable to Use Mortality Rate as a Care Indicator of Quality in Intensive Care Units?

徐曉雲(Hsia-Yun Hsu) ； 陳雅玫(Ya-Mei Chen) ； 周學智(Hsueh-Chih Chou)

《榮總護理》 28卷1期 (2011/03) Pp. 47-54

https://doi.org/10.6142/VGHN.28.1.47

摘要

影響加護中心照護品質的因素，與加護中心、醫院特性及品質審查指標相關，其中死亡率為結果指標之一。本研究目的為了解樣本醫院94年1至9月六個成人加護中心病患住進至離開加護中心之死亡率及存活時間，比較各加護中心間存活時間差異情形。研究樣本數共2220人次，平均住院天數6.6天，平均年齡62.97歲，男性病患佔71.4%，女性佔28.6%。本研究採檔案分析，由資訊室協助，收集病患資料檔中性別、出生年月日、住入那個加護中心、入出該加護中心日期及死亡日期，採excel彙整資料，以SPSS 13.0統計軟體進行描述性統計、百分數、標準差及存活分析(Kaplan-meier)。研究結果：六個加護中心間平均存活時間未達顯著差異(p=.28)，但比較死亡率卻達顯著差異(p=.003)，死亡率以內科加護中心12.7%最高，較心臟外科(4.6%)高2.76倍。結論：因僅比較死亡率未考量六個加護中心間住院天數差異，導致某些加護中心死亡率偏高，可能造成該加護中心照護品質不良誤解，故建議在比較加護中心間照護品質時不宜僅採用死亡率，應將平均存活時間一併納入。

關鍵字

死亡率 ； 加護中心 ； 照護品質 ； 平均存活時間

並列摘要

Mortality rate is one of the outcome indicators associated with quality of care. The purpose of this study was to compare the mortality rate, the survival rate and the difference in survival time of patients in 6 intensive care units. The sample size was 2220 patients. The mean length of ICU stay was 6.6 days. The average age was 62.97 years old. There were 71.4% of male patients and 28.6% of female patients in this study. The patient database were classified and coded. SPSS 13.0 statistical software was used for descriptive statistics and Kaplan-meier analysis. The result showed that the mean survival time was not significantly different. But the mortality rate was the highest and lowest in MICU and VICU (RR 2.76, p=.003). Comparing the mortality rate without considering the length of ICU stay will result in a misunderstanding of quality of care. It is better to replace mortality rate with mean survival time as an indicator of quality of care among ICUs.

並列關鍵字

mortality ； intensive care unit ； quality of care indicators ； mean survival time