醫院評鑑層級與醫療品質相關性之探討－以醫療品質資訊公開指標為例

The Association between Hospital’s Level of Accreditation and Healthcare Quality- Taking Public Reporting as an Example

鄭仁翔(Jen-Hsiang Cheng)

指導教授 ： 郭年真

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2020年)

https://doi.org/10.6342/NTU202003767

摘要

研究背景：
為確保醫療院所之健康照護品質、促進醫療資源的有效利用，衛生福利部與醫院評鑑暨醫療品質策進會共同辦理了醫院評鑑及教學醫院評鑑，並依此評定各醫療院所之醫院評鑑層級。衛生福利部也於2008年陸續於醫療品質資訊公開網，公開各層級醫院之品質指標，以期使民眾有更公開透明的醫療院所品質資訊可以參考，進而增進民眾在選擇醫療院所時的選擇能力。過去文獻指出評鑑結果與未必能反映出較好的照護品質，以及品質公開系統之間的不一致會造成民眾就醫選擇的障礙。然而過去國內則較少有研究探討醫院評鑑與醫療品質資訊公開指標的關聯性。
研究目的：
探討醫院評鑑所反映的醫院層級，是否與醫療院所在醫療品質資訊公開指標上具有顯著的相關性。以及醫院層級的差異與醫院層級的變動是否也反映了各層級醫療院所在醫療品質上的差異與變動。
研究方法：
本研究採橫斷式研究法，以2008年到2018年間，醫療品質資訊公開網中所公布的三類疾病別與處置別：急性心肌梗塞、糖尿病、透析治療，以及醫院整體性指標共16項品質指標進行分析。資料分析分為兩個階段，第一階段透過多變項分析，在控制權屬別、分區別、年度別、教學等級等醫院特質後，探討醫院層級別在三類疾病別與處置別的品質指標中，是否有顯著差異。第二階段則是針對2008年到2018年間醫院層級有發生變動的醫院，並以13項指標，比較其與變動前後的醫院同儕間品質的差異，檢視其評鑑等級的變動是否也反映在其醫療品質的表現。
研究結果：
第一階段的研究結果顯示，在本研究挑選的16項疾病別品質指標中，共有10項指標於醫院層級別呈現顯著差異。其中共有7項急性心肌梗塞的指標在平均數的比較上，皆是醫學中心優於區域醫院，區域醫院又優於地區醫院，但在糖尿病與透析治療的相關指標中，則無顯著差異。第二階段的研究結果顯示，在醫院層級升格的11間醫院中，僅有3間醫院的品質表現是明顯優於原層級醫院群體，且與新層級醫院群體之品質表現相當。
結論與建議：
本研究結果顯示，醫院評鑑之結果，未必能反映不同層級醫院在部分常見疾病別與處置別照護品質之品質表現。針對醫院評鑑結果與醫療品質資訊公開指標的不一致性，建議未來應進一步探討品質資訊公開與醫院評鑑標準中對醫療品質的測量，是否能全面性反應個別醫院醫療品質之良窳。使得民眾在參考醫院評鑑結果或品質公開資訊進行就醫選擇時，能夠更清楚醫院的高照護品質，進而做出更合適的就醫選擇。

關鍵字

醫院評鑑 ； 醫院層級 ； 醫療品質 ； 醫療品質資訊公開 ； 過程面指標 ； 結果面指標

並列摘要

Background:
In order to ensure the quality of healthcare in hospitals and facilitate the effective utilization of hospital resources, the Taiwan Ministry of Health and Welfare (MOHW) and the Joint Commission of Taiwan (JCT) conduct accreditations of hospitals and teaching hospitals. Based on the results of these evaluations, hospitals are then divided into different levels. The MOHW also developed the Public Reporting of Hospital Quality website in 2008, with the aim of providing more complete and transparent quality information to help members of the public choose a hospital appropriate for their needs. However, previous research has indicated that accreditations may not be consistent nor reflect better quality of care. Furthermore, few studies have assessed the association between the levels of hospitals and indicators of public reporting of quality.
Objective:
To investigate the association between hospital levels and indicators of hospital quality public reporting and to analyze whether performance changed in hospitals whose level changed.
Methods:
Sixteen quality indicators were derived from three types of diseases and treatments. Data for acute myocardial infarction (AMI), diabetes mellitus (DM), dialysis treatment and hospital outcome indicators from 2008 to 2018 were obtained from the Hospital Public Quality Reporting website. In phase 1, we used multi-variable analysis and controlled for ownership, areas, years, teaching hospital, and wards to examine differences in these 16 indicators among different levels of hospitals. In phase 2, we selected hospitals whose level had changed between 2008 to 2018 and compared their quality with hospitals in their original as well as new level.
Results:
The results of phase 1 demonstrated that 10 of the 16 indicators were significantly different among different hospital levels, and 7 out of these 10 were related to AMI. In these 7 indicators, the performance of medical centers was better than regional hospitals and district hospitals. We also found no differences in the other 6 indicators for DM and dialysis treatment. The results of phase 2 revealed that the quality performance of only 3 out of the 11 hospitals whose level of accreditation was raised was better than hospitals in their original level and was also similar with hospitals in their new level.
Conclusions:
This study showed that the results of hospital accreditation cannot completely reflect quality of care among different levels of hospitals. In order to rectify the inconsistency between hospital accreditation and the public reporting of quality, we suggest investigating if public reporting of quality as well as quality measurements in accreditation can accurately reflect the healthcare quality of hospitals. This would ensure that the public can make informed decisions in their choices for health services when referring to the results of hospital accreditation and the public reporting of quality in order to identify a “high quality hospital”.

並列關鍵字

Hospital accreditation ； Hospital level ； Healthcare Quality ； Public reporting of quality ； Process indicators ； Outcome indicators

參考文獻

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