- 期刊
病歷審查對病歷品質的影響－彰化基督教醫院一年的經驗
The Effect of Peer Review on the Quality of Medical Records-The One-year-experience in Changhua Christian Hospital, Taiwan
摘要
The quality of medical charts is often considered as an indicator of the quality of medical service. It has been agreed that medical record review can effectively improve the quality of health service. However, only few reports about medical chart review are available in literature. In order to enhance the quality of both medical records and health service, the Changhua Christian Hospital has implemented a peer review system since April 1999. The results of the monthly peer review starting from April 1999 through August 2000 (N=6,117) were summarized and analyzed. Mixed regression model was performed to take the autocorrelation among scores graded by the same reviewers into consideration to analyze the effects of department, complexity of the chart and time. No significant difference of the overall score was observed between the surgical- and internal- system departments, after controlling for the variation from various reviewers. The average score of complicated medical records was significantly lower than that of simple ones, P＜0.05. The performance of Order Sheet, Operation Record and total score from attending physicians increased significantly with time. Admission Note and Discharge Summary scores declined significantly for residents, while Operation Note, Off-service Note and total score of residents gradually increased, P＜0.05. Both internal- and surgical-system departments had lower rejection rates of reimbursement from Bureau of National Health Insurance in year 2000 comparing to year 1999. With adequate administration strategies and rewarding mechanism, the overall performance of chart writing was significantly improved for both attending physicians and residents. This result implies that regular peer review of medical charts with adequate feedback can promote the quality of medical records and reduce the rejection rate of reimbursement from Bureau of National Health Insurance effectively.
並列摘要
The quality of medical charts is often considered as an indicator of the quality of medical service. It has been agreed that medical record review can effectively improve the quality of health service. However, only few reports about medical chart review are available in literature. In order to enhance the quality of both medical records and health service, the Changhua Christian Hospital has implemented a peer review system since April 1999. The results of the monthly peer review starting from April 1999 through August 2000 (N=6,117) were summarized and analyzed. Mixed regression model was performed to take the autocorrelation among scores graded by the same reviewers into consideration to analyze the effects of department, complexity of the chart and time. No significant difference of the overall score was observed between the surgical- and internal- system departments, after controlling for the variation from various reviewers. The average score of complicated medical records was significantly lower than that of simple ones, P＜0.05. The performance of Order Sheet, Operation Record and total score from attending physicians increased significantly with time. Admission Note and Discharge Summary scores declined significantly for residents, while Operation Note, Off-service Note and total score of residents gradually increased, P＜0.05. Both internal- and surgical-system departments had lower rejection rates of reimbursement from Bureau of National Health Insurance in year 2000 comparing to year 1999. With adequate administration strategies and rewarding mechanism, the overall performance of chart writing was significantly improved for both attending physicians and residents. This result implies that regular peer review of medical charts with adequate feedback can promote the quality of medical records and reduce the rejection rate of reimbursement from Bureau of National Health Insurance effectively.