- 期刊
臺北市立聯合醫院出生通報資料分析：2002-2003
Analysis of Taipei City Hospital's Birth Registry in 2002-2003
摘要
目的：改制成聯合醫院前的臺北市市立醫院中有七家綜合醫院具孕產婦生產服務其生產數約佔臺北市各醫療院所總生產數的20%，藉由分析其人口特性和周產期照護成果有助於研擬醫療服務計畫及提昇照護品質。方法：本報告乃藉由「臺北市立醫院孕產婦追蹤管理實施計畫」自九十一年四月至九十二年十月共十八個月中懷孕二十週以上出生的10,665位通報資料中，分析七家市立醫院孕產婦的人口特性包括：年齡，社經狀況、健康行為，初次產前檢查時間等以及在照護品質指標上的表現，並與臺北市的出生通報資料相比較，找出具統計意義之差異。此通報系統乃透過制定標準作業流程而實施，並接受定期品管測試信度，資料包含在此七家醫院所有生產數的97%。結果：相較於臺北市所有醫療院所的出生通報資料，市立醫院中新移民產婦比率較高（14.6%比8.2%）；早產比率較低（6.0%比8.8%），剖腹產比率較低（29.2%比33.0%），均具統計上顯著性差異。先天缺陷兒發生率為千分之14.7，依序為先天性心臟病(5.1%)，骨骼肌肉系統缺陷(2.3%)，染色體異常(2.0%)及其它。低體重新生兒（小於2500公克）發生率為6.0%，其中出生體重介於1000-1499公克之間的非常低體重兒及出生體重小於1000公克的極低體重兒共佔總活產新生兒之0.5%，其住院期間存活率分別為92.6%與76.5%。結論：市立醫院有照護一般非高危險群孕婦的特性，因此照護品質指標優於臺北市的整體表現，雖然高危險群個案較少，但因服務面較廣，以及特殊族群如新移民孕婦、未成年孕婦等相對較多，對於臺北市的整體周產期醫療品質有相當大的影響力，如何因應不同特性的孕產婦族群，制定最佳的照護模式，提供給其它醫療院所參考，是市立醫院的特色功能之一。為達到此一目標，運用整合性及前瞻性的追蹤管理制度如「臺北市立醫院孕產婦追蹤管理實施計畫」以持續性的監測照護品質，是基礎的建設工作，未來更可擴充其內容和加強管理機制以發揮更大效益。
並列摘要
Background and Purpose: Before the Taipei City Hospital was founded in 2005, there were seven municipal hospitals providing perinatal care, and at where up to one fifth of total births in Taipei City were delivered. The aim of this report was to do customer analysis and performance evaluation for future quality improvement projects. Methods: From the data base of Pregnancy Risk Assessment Monitoring System (PRAMS) between Apr. 2002 and Oct. 2003, we exclusively included 10,665 births, comparing their demographic characteristics and outcomes with data of all neonates in Taipei from National Birth Registry System. Results: In Municipal Hospitals, higher percentage of immigrant women was evident (14.6% vs. 8.2%), prematurity rate was lower (6.0% vs. 8.8%) and so was Cesarean section rate (29.2% vs. 33.0%). The prevalence rate of congenital birth defects was 14.7 in a thousand with the order of heart disease (5.1), musculoskeletal disease (2.3) and chromosomal disease (2.0). The rate of neonates with birth weight less than 2500gm and 1500gm was 6.0% and 0.5% respectively. And the in-hospital survival rate was 92.6% for weight between 1000 and 1499gm but76.5%forthatoflessthan 1000gm. Conclusion: Most of the women who delivered babies in City Hospitals were among low risk population and therefore outcomes of medical performance were better than average. However, higher proportion of births by immigrant women and teenagers provoked the necessity of establishing diverse models of care among them. To meet this goal, prospectively implementing a comprehensive management/audit system such as PRAMS is indispensable and better efficacy could be expected through its persistent improvement.