醫院品質報告卡指標之篩選及以結構方程模式分析住院病人對其創新特性之知覺、態度與使用意願

Selection of Indicators of Hospital Report Cards and using Structural Equation Modeling to Analyze Inpatient’s Perception toward the Innovation, Attitudes, and willingness to use Hospital Report Cards

陳楚杰(Chu-Chieh Chen)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/醫療機構管理研究所/博士(2005年)

https://doi.org/10.6342/NTU.2005.01242

摘要

由於醫療服務具高度專業性，故醫療照護市場長期存在資訊不對等的問題。隨著消費者利益保護及病人權利運動的興起、民眾被要求在自己的健康上承擔更多的責任，積極參與健康決策、新資訊科技的發明，使得醫院醫療與服務品質資訊的收集更容易且成本更低廉，因此，歐美各國近年來積極建立健康照護市場的品質資訊，發展醫院品質報告卡，提供民眾就醫選擇所需的資訊，期望能達成保障民眾的醫療權益，同時促使醫院提升醫療與服務品質，及增進醫療照護市場運作效率的目標。
台灣自1995年起實施全民健康保險制度，醫院與中央健康保險局的特約率達90%以上，民眾享有極大的自由選擇就醫地點及醫院，然而到目前為止，仍然欠缺足夠的醫院醫療與服務品質資訊提供給民眾做為選擇醫院的參考。其次，相關研究的結果顯示，台灣民眾對於就醫選擇資訊的提供有高度的興趣，且對民眾就醫選擇決策亦有重大的影響。
目標：本研究旨在由民眾觀點篩選醫院醫療與服務品質報告卡的指標項目，及採用創新擴散理論(innovation diffusion theory)，以結構方程模式(structural equation model)探討住院病人對醫院醫療與服務品質報告卡創新特性的知覺、態度及使用意願。
方法：本研究首先以推動社會福利、關心民眾健康權益及病人團體的30位專家為研究對象，進行二回合的德菲法(Delphi method )問卷調查篩選醫院醫療與服務品質報告卡的指標項目。其次以台北縣市不同層級及權屬別的八家醫院內、外科共500位住院病人為研究對象進行面訪問卷調查，探討住院病人創新接受度、對醫院醫療與服務品質報告卡創新特性的認知、態度及使用意願，並以結構方程模式進行研究假說與架構的驗證。
結果：1.由民眾觀點所選出屬於高適用性且高重視度的指標項目計有院內感染率、手術傷口感染率、住院病人對醫師病情解說內容的滿意度、門診病人對醫師服務態度的滿意度等九項；2.只有17.2%的住院病人在填問卷前有聽過醫院醫療與服務品質報告卡這個名詞；3.有80.2%的住院病人認為醫院醫療與服務品質報告卡對選擇醫院是非常有價值或有價值的；4.住院病人對服務品質指標的瞭解程度相對地高於對醫療品質指標的瞭解程度；5.對呈現方式的瞭解程度由高至而低排序，依序為星號、百分比、長條圖；6.影響「住院病人是否看懂醫院醫療與服務品質資訊」的因素，在控制其他變項的影響後發現，教育程度愈高者、年齡愈輕者、個人平均月收入較高者，較看懂醫院醫療與服務品質報告卡範例中指標資訊；7.創新特性中，「相容性」及「結果展示性」對「對醫院醫療與服務品質報告卡的態度」具有正向的顯著影響；8.「知覺有用性」、「對醫院醫療與服務品質報告卡的態度」及「創新接受度」對「使用醫院醫療與服務品質報告卡的意願」具有正向的顯著影響；9.影響住院病人「對醫院醫療與服務品質報告卡的態度」最主要因素為「相容性」，且達到統計上的顯著水準；10.影響住院病人「使用醫院醫療與服務品質報告卡的意願」的最主要因素為「對醫院醫療與服務品質報告卡的態度」，且達到統計上的顯著水準；11.最後要特別強調的是，本研究的新發現為「知覺有用性」、「知覺易用性」、「相容性」、「結果展示性」、「創新接受度」，兩兩之間具有統計上之顯著相關，這是本研究與以往相關研究結果的最大不同發現。
結論：住院病人認為醫院醫療與服務品質報告卡對選擇醫院是有價值的，因此，建議行政院衛生署可考慮主導，整合醫院評鑑、全民健康保險申報及病人滿意度調查的資料，分區分醫院等級，評比其在高適用性且高重視度的九項指標項目之表現，以星號及百分比的形式呈現，再以小手冊及網際網路查詢的方式對外公佈，並加強對民眾的宣導教育，讓民眾可以將品質資訊運用在就醫選擇決策上，使民眾成為明智的醫療服務消費者及醫療與服務品質的共同監督者，以提升醫療體系的運作效能。

關鍵字

品質指標 ； 德菲法 ； 結構方程模式 ； 創新擴散理論 ； 醫院品質報告卡

並列摘要

There exists information asymmetry between providers and consumers in healthcare market due to the highly specialized knowledge in this market. Consumers were asked to bear more responsibility on their own health and to participate in the formulation of healthcare strategies and the inventions of new technology as the uprising in the movement of consumer right protection. These would result in the reduction in costs related to the medical services and information collection. Therefore, western countries have aggressively established the medical information system and developed hospital report cards in order to protect consumers’ right, to improve quality of medical services, and to increase the efficiency of healthcare market by providing service information to consumers.
Taiwan initiated the National Health Insurance since 1995 with the facility contract rate reaching over 90%. This provides consumers great access to healthcare institutions. However, few service data have been provided to consumers as a reference for the choice of providers to date. In addition, previous studies showed that consumers were interested in obtaining available service information and these information have a great influence on consumers’ decision of providers.
Objectives:
The purposes of this study were to select indicators of hospital report cards from public’s perspective and to adopt the innovation diffusion theory and structural equation modeling to explore inpatients’ perception characteristics of innovation, attitudes toward, and willingness to use hospital report card.
Materials and Methods:
Firstly, we selected 30 subjects who were experts in social welfare or consumer right to participate in two rounds of Delphi investigation to select appropriate indicators of hospital report card. Secondly, we purposely ask for the permission from eight hospitals representing different accreditation levels and ownerships to allow us to select 500 medical and surgical inpatients to conduct a face-to-face interview regarding their innovativeness, perception characteristics of innovation, attitudes toward, and willingness to use hospital report cards. Finally, we used structural equation modeling (SEM) to test research hypotheses by way of.
Results:
We found that (1) from publics’ perspective the most applicable and important indicators include nosocomial infection rate, postoperative infection rate, inpatient’s satisfaction toward physician’s explanation, and outpatient’s satisfaction toward physician’s service attitudes; (2) only 17.2% of surveyed sample heard the term “hospital report card” before; (3) a total of 80.2% of inpatients considered hospital report cards to be very valuable or valuable for the selection of providers; (4) inpatients understood more in service indicators than clinic indicators; (5) the order of inpatients’ preference in presentation of hospital report cards was to use stars, percentages, and bar charts; (6) those who had higher education and higher monthly incomes, and were younger were more likely to understand the information provided by hospital report cards after adjusting for other factors; (7) among inpatients’ characteristics of innovation toward hospital report card, ”compatibility” and “result demonstrability” had significant positive influence on ”inpatients’ attitude toward hospital report card”; (8)”perceived usefulness”, “inpatients’ attitude toward hospital report card”, and “inpatients’ innovativeness” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(9)”compatibility” had significant positive influence on “inpatients’ attitude toward hospital report card”；(10)“inpatients’ attitude toward hospital report card” had significant positive influence on ”inpatients’ willingness to use hospital report card”；(11)finally it is worth emphasize that this study had a new finding that ”perceived usefulness”, “perceived ease to use ”, “compatibility”, “result demonstrability ”,and “inpatients’ innovativeness” had significant positive correlation between each other.
Conclusions:
We concluded that inpatients considered hospital report cards to be valuable for the selection of hospitals. Therefore, it is recommended that hospital report cards be initiated by the Department of Health by integrating the information from hospital accreditation, medical claims data from the National Health Insurance, and survey of patient satisfactions. The rankings of hospital shown on report cards can be presented in stars or percentages, and these pieces of information can be released through booklet or Internet. In addition, consumers should be educated to use hospital information in order to monitor hospital performance and improve the efficiency of healthcare delivery system.

並列關鍵字

Delphi method ； hospital report cards ； quality indicators ； diffusion of innovation theory ； structural equation modeling

參考文獻

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