醫療品質導向模式之醫院復健部門評鑑－以北台灣教學醫院試評之報告

A Survey of Quality Oriented Model for Hospital Accreditation of Department of Rehabilitation in Northern Taiwan

高木榮(Mu-Jung Kao) ； 蔡美文(Mei-Wun Tasi) ； 王顏和(Yen-Ho Wang) ； 王亭貴(Ytng-Guey Wang) ； 連倚南(I-Nan Lien) ； 賴金鑫(Jin Shin Lai) ； 譚開元(Kai-Yuan Tang)

《中華民國復健醫學會雜誌》 25卷1期 (1997/06) Pp. 73-79

摘要

本研究的目的是以醫療結構、醫療過程、醫療結果三個層面品質評量的新評估模式﹐對醫院復健部門作醫療品質的評估。
以北台灣教學醫院有復健科專科醫師及治療人員之復健部門為樣本，立意取樣26所進行調查，樣本回收23所，回收率88.5％，包含七家醫學中心，十家區域醫院及六家地區教學醫院。樣本醫院依評鑑資料分為醫學中心、區域醫院及地區教學醫院三組或分復健專科訓練醫院及非復健專科訓練醫院二組，依評鑑指標分類，及大項的得分，以變異數分析ANOVA、Scheffe事後檢定及t-test等統計分法進行各組間比較。結果如下：
(一)醫療結構、過程及總分的得分發現醫學中心比地區教學醫院高，區域醫院也比地區教學醫院高，統計上有差異，而醫學中心及區域醫院之間無差異。
(二)人力配置與人員素質、團隊復健醫療能力、環境空間、綜合性醫療指標及教學訓練與發展，而醫學中心及區域醫院較完善，地區教學醫院則差很多。
(三)復健設備與業務內容發現醫學中心最好，區域醫院居次，地區教學醫院最差，三位統計上有差別。
(四)個醫療結果、等候時間及早期復健介入等三組統計上沒有差別。
(五)復健專科訓練醫院除了等候時間及滿意度調查外，其他指標統計均比非復健專科訓練醫院得分高，統計上有差別。
研究建議如下:
(一) 應另設計適合基層院所、復健診所的評鑑指標。
(二) 進一步作全國醫院復健部門的評估。
(三) 復健醫療及教學評鑑應獨立評鑑，除了結構性的規範外，應漸漸將過程及結果納入評鑑。依本研究之建議訂定各級醫院復健部門之最低標準。
(四)評鑑應同時重視醫療品質，依本研究之建議將專科評鑑給付分級，並配合健保給予不同給付，才能實質提昇復健醫療品質。

關鍵字

醫院評鑑,品質保証,復健

並列摘要

The purpose of this study was to compare medical quality of department of rehabilitation in Northern Taiwan area by using a new evaluation form designed by quality-oriented model for hospital accreditation. In this study, the questionnaire was mailed to twenty-six teaching hospitals in this area and was responsed from twenty-three hospitals including seven medical centers, eleven regional teaching hospitals and five district teaching hospitals (responsible rate 88.5%). Comparison was done among medical center, regional teaching hospitals and district teaching hospitals, and was also done between board-certified physiatrist training hospitals and non-training hospitals. The results showed that:(1) medical center and regional teaching hospital groups had higher score than district teaching hospital group in most of the items of hospital accreditation including medical structure and process except waiting time and early intervention of beside rehabilitation. (2) Board-certified physiatrist training hospitals had higher score than non-training hospitals. (3) There was no difference among different groups of hospitals in the items of medical outcome (satisfaction survey). The author suggested that hospital accreditation for Department of Rehabilitation should include process and outcome components in addition to structure, and a wide quality-oriented survey of hospital accreditation in Department of Rehabilitation should be done in order to promote health care.

並列關鍵字

hospital accreditation,quality assurance,rehabilitation