住院病人主觀評價與客觀照護結果之關聯

The Association between Subjective Assessment of Inpatients and Objective Healthcare Outcome Measures

曾荃璞(Chuan-Pu Tseng)

指導教授 ： 鄭守夏

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2022年)

https://doi.org/10.6342/NTU202200467

摘要

背景：在國際間提倡「以病人為中心」的醫療照護氛圍下，病人觀點的醫療品質測量逐漸受到關注。近年來各國積極發展病人經驗調查，如美國的CAHPS(Consumer Assessment of Healthcare Providers and Systems)、英國的PPE(Picker survey of patient experiences questionnaire)等，臺灣雖有「病人報告之醫院品質調查」，但無大規模定期的執行調查，相關研究也尚有不足。
研究目的：本研究欲比較主觀評價與客觀的照護結果評估的關聯性，爰透過探討「病人住院經驗」與「照護結果指標」的相關性以獲得解釋。同時，藉由分析研究對象就醫醫院的特質、人口學特徵及疾病狀況等，瞭解影響病人經驗的因子。
研究方法：本研究為橫斷性調查研究。透過健保署於2018-2019年在全國進行的「住院病人就醫經驗調查」委託計畫，獲得研究對象在住院期間的病人經驗資料，包含對醫院的整體評分及推薦程度等。接著，與健保申報資料連結，瞭解研究對象出院後的醫療利用情形，包含3日內再急診及30日內再入院，做為照護結果的指標。透過檢定及迴歸分析，驗證病人經驗與照護結果的關聯性。
研究結果：最終納入研究N=3,244。羅吉斯迴歸的結果顯示，在控制醫院特質和病人特質等變項後，醫院整體評分給予高分者，30日內再入院的OR=0.728、中等組OR=0.804，顯示相較於低分組再入院的風險較低，但相關性未達統計上顯著。在推薦意願方面，願意推薦醫院者再入院OR=1.169 (95%CI=0.736-1.857)，兩者間無顯著的關聯性。此外，其他特質包含醫院層級、教育程度、調查方式、入院管道、就醫科別、是否接受手術及住院天數，經統計與整體評分和推薦意願顯著相關，為病人評價可能的影響因子。
結論：雖然本研究顯示病人住院經驗調查結果與專業面照護指標無顯著相關，卻也象徵病人觀點的醫療品質測量是重要且無可取代的。建議衛生主管機關應定期辦理病人經驗調查，並做為醫療院所費用給付的參考，以改善病人觀點的醫療品質，提升以病人為中心照護。

關鍵字

病人經驗調查 ； 30日內再入院 ； 病人滿意度

並列摘要

Objectives: Delivering patient-centered care is an important issue of health care system worldwide. Meanwhile, patient experience is thought to be a key quality metric that represents patients’ perception of healthcare quality. The purpose of this study is to determine whether patients’ perception of their care correlates with healthcare outcomes, and what are the key characteristics of hospitals and patients that associated with better experience.
Methods: A cross-sectional study was conducted using the Patient Experience of Hospital Care survey (PEHC) in 2018-2019. Among patients aged 20 or older, data of two overall ratings: global rating and recommendation of the hospital were collected. Then, 3-day emergency department visit and 30-day readmission were examined as the indicators of the quality of hospital care. A multivariable logistic regression analysis was performed to determine the association between patient-reported measures and short-term healthcare outcomes.
Results: The sample included 3,244 patients. In adjusted analyses, the odds of 30-day readmission were lower among patients in the highest global rating group relative to the least, although the association was not significance (Odds ratio [OR] for readmission, 0.728; 95% confidence interval [CI], 0.454-1.168). On the other hand, the odds of readmission were higher in patients who would recommend the hospital, but there’s no significant association (OR, 1.169; 95% CI, 0.736-1.857). In addition, the results revealed that patient-reported overall ratings were associated with hospital accreditation levels, education level, survey modes, admission route, medical department, surgery and length of stay.
Conclusions: Since there’s no significant association between patient experience and objective outcomes, this finding suggests that patients’ perception information can be a meaningful and unique healthcare quality indicator. We are hopeful that regular reporting of patient experience survey will improve patient-centered care.

並列關鍵字

patient experience ； 30-day readmission ； patient satisfaction

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