兼顧醫療品質與醫師專業能力之健康照護矩陣

健康照護矩陣(Healthcare Matrix)以醫療品質六項目標為經，稱職能力六項要件為緯，整合成6X6的方格矩陣，提供完整而有系統的思考模式與實際操作的工具，適用於病例討論會。本研究在獲得原著者同意後，將矩陣表單翻譯成中文，率先於病例討論會及合併症討論會中使用。討論會前先檢討照顧病人之過程，是否達成醫療品質的六項目標，並分別填於矩陳表單之第一行，若己達成品質目標則填「是」，其下各方格可留空白；若答案為「否」，則依其他稱職能力，個別分析檢討其原因，最後註記學習改進之心得。討論會時先依傳統方式做病情報告及文厭回顧，隨後提出已預填之矩陣表單做分析報告。實施結果顯示以「健康照護矩陣」為依據的討論，不僅涵括知識面及技術面，亦能兼顧安全性、時效性、平等性、以病人為中心的醫療品質，頗受與會者贊同。「健康照護矩陣」以稱職能力評估醫療品質，可同時達成精進醫療品質及臨床教學的雙重功能，適用於所有的學科，值得推廣為醫學教育的創新方法。

關鍵字

健康照護矩陣；醫療品質；稱職能力

並列摘要

The Healthcare Matrix uses the Six Aims for Quality Improvement (Institute of Medicine. TOM) as columns and the Six General Competencies for Physicians (Accreditation Council for Graduate Medical Education, ACGME) as rows to form a 6x6 grid. The Matrix offers a comprehensive and systematic protocol for patient care and is at the same time suitable for clinical education, especially case conferences. This research project involved the preliminary implementation of the Healthcare Matrix for mortality and morbidity conferences after it was translated into Chinese with consent from the original authors. The conference participants examined patient's disease course to identify whether each of the six quality aims had been reached. If the aim had been reached, the ”YES” answer was entered into the first row (patient care) of the Matrix form. If the answer was ”NO”, the other competencies in that row were used to assess the reasons for this failure. Finally, what had been learnt from the analysis that might improve patient treatment was noted. The conference begat, with a traditional case report and literature review. The Healthcare Matrix, which had been filled prior to the meeting, was then analyzed by all the participants. Our experience with this Matrix-based conference process showed that, in addition to assessing the knowledge and skill aspects of healthcare quality, the Matrix also allowed the evaluation of care safety, timeliness, effectiveness, efficiency and equitability together with an assessment of patient-centered quality of care. In addition, this type of Matrix-based conference was well received and favored by the majority of the participants. By the use of general competencies to assess quality of care, the Healthcare Matrix addresses both healthcare quality and also acts as a clinical teaching tool. We recommend that the Matrix should be implemented as an innovative method in clinical education, and that it is suitable for all disciplines.