探討適合台灣醫院醫療品質審查組織模式

Exploring the Model of Quality Review Organization for Hospital in Taiwan

張文麗(Wenli-Li Chang)

指導教授 ： 林恆慶

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(2002年)

摘要

健保局論病例計酬案件相繼推出之後，醫療機構為控制成本，只好減少醫療服務，其品質堪慮。目前健保局並未對醫療照護的品質有任何的審查方法，也沒有建立公平、公正及公開的審查制度，以致常引起保險單位及特約醫療院所的爭議。許多研究報告中，提及建議推動同儕審查組織（peer review organization），或「成立第三者團體」發展類似美國同儕審查組織監測醫療品質，確保國人醫療品質適當。本研究即針對國內醫療機構做一調查，以了解醫療機構對成立專責醫療品質審查組織之看法，以及建立模式，做為衛生主管機關政策制定之參考。 本研究以全國507家地區級以上醫院進行調查。在問卷回收後另對國內五家醫院管理階層人員做專家訪談，以印證研究結果。調查期間為民國九十一年二月至五月，共計問卷回收174份，問卷回收率為34.3﹪。 研究結果發現：有86.3%的受訪者認為成立專責醫療品質審查組織是可行的，有94.1%的受訪者認為成立專責醫療品質審查組織對醫療品質有幫助；由醫策會或衛生署直接管理百分比較高；有效推行方式須與評鑑及給付結合；審查層級以二審制百分比較高；審查組織所涵蓋地區劃分方式，以台灣行政區域劃分為四個審查組織及以健保局所屬區域分為六個審查組織百分比最高；審查人員除醫師外，還應加入護理人員者佔93.5%；在審查類別方面，以「過程面」平均得分最高，「結構面」得分最低。以評鑑等級區分，「過程面」與「結果面」有顯著不同（p<0.05），經Scheffe’s事後檢定，醫學中心與地區醫院有統計上顯著差異。建議衛生主管儘速成立專責醫療品質審查組織，以有系統的、長期性的及客觀性的推動國內醫療品質相關活動，使醫院、病人及健保局成為三贏局面。

關鍵字

醫療品質 ； 同儕審查組織 ； 專責醫療品質審查組織

並列摘要

Since the Bureau of the National Health Insurance (BNHI) initiated the case payment system, the medical institutions have been cutting off the medical services in order to control the cost, which could resulted in downscales of the quality of medical care. To date, the BNHI has no means to monitor the quality of medical care. Neither has established any open, fair, and justice review systems. As a result, more and more disputes have occurred between the BNHI and hospitals. The need of establishing a organization similar to the peer review organization (PRO) in the United States to monitor and to ensure the quality of medical care provided to the public has been proposed in many studies conducted in the past. The purpose of this research is to explore hospitals’ opinions about the establishment of such review organization. The result will be useful to the Department of Health (DOH) in making policies. A self-administered, anonymous questionnaire was mailed to the 507 hospitals accredited by the DOH in 2001 as medical centers, regional hospitals, and district hospitals nationwide. In addition, five hospital administrators and managerial-level physicians were interviewed afterward to verify the results. The investigation period was between the February and May 2002. A total of 174 (34.3%) questionnaires were returned. The study revealed that 86.3% of hospitals considered the establishment of the quality review organization to be feasible and 94.1% suggested that such organization should be operated and managed by the Taiwan Joint Commission on Hospital Accreditation or the Department of Health. Additionally, more than 93.5% of respondents suggested that not only doctors, but also the nursing staff should be included in the review group. Among the review areas, the “Process Phase” got the highest score and the “Structural Phase” got the lowest. This showed that there was a significant difference in review areas between the “Process Phase” and the “Structural Phase” (p<0.05). Via the Scheffe’s post-history testing, a significant difference in review areas also exists between the medical centers and the regional hospitals. Finally, this research suggests that the DOH establish the review organization as soon as possible to assure the quality of medical care in hospitals in Taiwan.

並列關鍵字

quality of medical care ； peer review organization ； quality review organization

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