精神職能治療品質指標之建立初探

The Pilot Study of Developing Quality Indicators of Psychiatric Occupational Therapy

謝青霏(Ching-Fei Hsieh)

指導教授 ： 黃國哲

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2010年)

https://doi.org/10.6831/TMU.2010.00027

摘要

計畫名稱：精神職能治療品質指標之建立初探
研究所名稱：臺北醫學大學醫務管理學系碩士在職專班
研究生姓名：謝青霏
畢業時間：九十八學年第二學期
指導教授：黃國哲博士

前言：精神職能治療隨著醫療市場的需求增加及各界對精神醫療照護的重視，服務對象日益增多，服務內容及醫療品質亦逐漸受到關注。然而，目前國內臨床工作者多以財團法人醫院評鑑暨醫療品質策進會制定之評鑑標準作為衡量品質的依據，但其內容多與結構面及過程面品質相關，在職能治療結果面尚屬缺乏。在醫療品質評估日益受到重視的大環境下，臨床職能治療師需要一套整體性的品質指標，作為檢討與改善臨床醫療的依據。
研究目的：本研究依據Donabedian（1966）所提出的醫療品質測量架構及相關文獻探討結合專家意見方式，建立精神職能治療品質指標，以提供臨床工作人員作為監測職能治療醫療品質的工具。
研究方法：本研究參考國內外職能治療的醫療品質之相關研究，以及醫策會公佈之醫院評鑑標準後，先擬定精神職能治療品質的候選指標，接著藉由兩回合的德菲法彙整專家意見，篩選專家所建議之品質指標，以建立精神職能治療的醫療品質指標。
研究結果：德菲法問卷調查結果顯示，共有7個候選指標被評定為精神職能治療品質指標，結構面指標有兩個，分別為「貴單位有幾種職能評工具」及「職能治療人員病床比」；過程面指標有三個，分別為「個案接受職能治療的時數」、「職能治療人員平均服務個案數」及「職能治療評估報告內容的完備度」；而結果面指標則有兩個，分別為「個案接受職能治療後在職能參與方面的表現」及「個案接受職能治療後在自我照顧方面的表現」。
討論：結構面指標中的「貴單位有幾種職能治療評估工具」及「職能治療人員病床比」與過程面指標中的「個案接受職能治療的時數」、「職能治療人員服務的個案人數」、及「職能治療評估報告內容的完備度」與醫策會制定的醫院評鑑標準及美國職能治療學會所制定的治療準則相似。結果面指標中的「個案接受職能治療後在職能參與方面的表現」、「個案接受職能治療後在自我照顧方面的表現」則與美國職能治療學會所制定的治療準則，以及澳洲治療成效評量機構用以測量職能治療成效指標的結果相似。本研究的研究發現應可作為臨床工作人員監測與檢討臨床醫療的工具。

關鍵字

精神職能治療 ； 品質指標 ； 德菲法

並列摘要

Title of thesis: The Pilot Study of Developing Quality Indicators of Psychiatric
Occupational Therapy
Author: Ching-Fei Hsieh
Thesis advised by: Kuo-Cherh Huang, Dr.PH

Background: The issue of quality of health care has been discussed widely and is a topic of current concern. However, the topic of indicators of occupational therapy services has been rarely touched on. Quality assessment in health care is a growing need and interest among health professionals, and occupational therapy staffers need a set of comprehensive quality indicators as to review and improve clinical services.
Objective: The aim of the study was to develop quality indicators of psychiatric occupational therapy.
Methods: Potential quality indicators of psychiatric occupational therapy had been obtained from literature review and the evaluation criteria of the Taiwan Joint Commission on Hospital Accreditation. A multidisciplinary expert panel then was asked to rate the potential indicators by two rounds of Delphi technique.
Results: In the end, seven indicators were identified as quality indicators of psychiatric occupational therapy, including number of types of occupational therapy assessment tools, number of occupational therapy staffers per patient, hours of occupational therapy received per patient, number of patients served per occupational therapy staffer, the content of occupational assessment report, occupational participation of the patient, and functional activities of daily living of the patient.
Discussion: Among the seven identified quality indicators of the study, number of types of occupational therapy assessment tools, number of occupational therapy staffers per patient, hours of occupational therapy received per patient, number of patients served per occupational therapy staffer, and the content of occupational assessment report were mentioned in the evaluation criteria of the Taiwan Joint Commission on Hospital Accreditation. On the other hand, the content of occupational assessment report, and occupational participation of the patient were mentioned in the guideline for occupational therapy of the American Occupational Therapy Association. Finally functional activities of daily living of the patient was among the categories of the Australian Therapy Outcome Measures. The findings of the study should provide some suggestions to occupational therapy staffers as to review and improve clinical services.

並列關鍵字

Psychiatric occupational therapy ； Quality indicator ； Delphi technique

參考文獻

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