澳洲臨床指標計畫及其對台灣醫療品質指標之啓示

目的：國內現有的兩大全國性醫療品質指標；台灣醫療品質指標計畫(TQIP)與台灣醫療照護品質指標系列(THIS)，至今推行已將近十年，對於醫療品質的改善也有顯著的貢獻，但是在分析模式、報告產出等指標應用上仍有不滿意之處。澳洲Australian Council on Healthcare Standard(ACHS)的臨床指標計畫，近年來不斷地在分析方法及報告內容與格式上修正與精進，大幅提升其醫療品質指標的實用效果。本文說明ACHS臨床指標計畫之指標分析方式與報告內容，引進國外成熟的技術與觀念，希望做爲國內醫療品質指標分析、報告、與運用的參考。方法：本文依據文獻探討與專家諮詢，完成ACHS臨床指標系統之資料釐清與發展過程的確認。結果：ACHS臨床指標計畫自1989年創始，其成長與發展的演化可分爲四個階段；指標開創期、指標成長期、分析方法精進期、輸入／出系統精進期，其中分析方法最重要的變革是採用二階層Gamma-Poisson混合模式與潛在獲益(gains)概念，並提供醫院一份綜合院內所有指標間比較的分析結果報告，主動提示醫院需要注意的指標，最有助於醫療品質的改善規劃與稽核。結論：依據THIS、TQIP與ACHS臨床指標計畫之比較差異，提出四點精進方式的具體改善建議，在指標分析與報告輸出內容上可以做爲台灣醫療品質指標系統發展的參考，進而能在下一個十年中，改善其分析、報告模式，充份運用國內長期通報的指標資料，提供給各個階層的使用者更有用、好用、有效的資訊，達到促成醫療品質持續改善的目的。

關鍵字

臨床指標；醫院評鑑；台灣醫療品質指標計畫；台灣醫療照護品質指標系列；伽瑪卜瓦松混合模式

並列摘要

Objectives: Two national-level healthcare quality indicator programs (QIP) in Taiwan, the Taiwan Quality Indicator Project (TQIP) and the Taiwan Healthcare Indicator Series (THIS), have been implemented by many healthcare institutes over the last ten years. Although their contributions to quality improvement have been proven, the methods of statistical analysis and reporting indicators have not been satisfactory. The Australian Council on Healthcare Standards (ACHS) was the first in the world to introduce clinical indicators as part of the healthcare accreditation process. The method of analysis and reporting format for the ACHS clinical indicators program (CIP) have been refined in recent years. Applications of the refined program in practices produced a positive impact. This paper introduces ACHS CIP as a source of stimulation to improve Taiwan's quality indicators program in healthcare. Method: A literature review and consultation with experts were utilized to clarify the data and the evolutionary process. Results: The evolution of ACHS CIP occurred in four distinct developmental phases: the establishment of clinical indicators, the diversification of clinical indicators, the refinement of the method of analysis, and the redesign of input/output, from the inception of the program in 1989 to the present time. The most important changes in the method of analysis were to use the Gamma- Poisson hierarchical model and the concept of potential gains, and to provide a trend report for the integrated quality assessment. It is beneficial for hospitals to achieve the goal of continuous quality improvement. Conclusions: Four suggestions are made to the THIS and TQIP based on the ACHS CIP experience. It is hoped that this paper will stimulate a wider discussion of the enhancement in analysis and reporting methods for the Taiwan quality indicators programs. Within the next few years, refinement of the Taiwan QIP could be expected to produce useful, effective and easy to use information for continuous quality improvement.

並列關鍵字

Clinical indicator ； Hospital Accreditation ； TQIP ； THIS ； Gamma-Poisson model

參考文獻

財團法人醫院評鑑暨醫療品質策進會(2003)。醫療品質指標與應用。台北:合記圖書出版社。

Google Scholar

Chiu, W. T.,Yang, C. M.,Lin, H. W.,Chu, T. B.(2007).Development and implementation on a nationwide health care quality indicator system in Taiwan.International Journal for Quality in Health Care.19(1),21-28.