中醫門診病歷品質與診療適當性及其影響因素

A Study on the Quality of Medical Record ,Treatment Appropriateness Audit Related Factors for the Ambulatory Care of Chinese Medicine

李金秀(Jin-Shiow Li)

指導教授 ： 楊俊毓

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2003年)

摘要

本研究主要目的有：(1)瞭解高屏分局轄區內中醫門診腰痛疾患病歷品質現況。(2)瞭解高屏分局轄區內中醫門診腰痛疾患施以傷科、藥物及針灸診療適當性之現況。(3)探討影響中醫門診腰痛疾患病歷品質與診療適當性之差異情形。(4)對中醫門診病歷品質、腰痛診療品質及相關問題之改善提出具體建議。
研究工具係採用結構式「中醫門診病歷品質與診療適當性評量表」蒐集資料，以高屏分局91年1月至3月中醫院所申報疾病名稱為腰痛，ICD-9-CM碼7242之針傷科病患樣本病歷及其診療之中醫師為研究對象，採分層隨機抽樣方法，在91年7月22日至8月23日進行評量，共完成有效樣本1,080份，有效回收率88.2%，所蒐集資料以Excel 97/2000版與SPSS for window套裝軟體10.0版進行資料鍵檔與描述性統計、Pearson積差相關分析與One-way ANOVA等方法進行分析。
研究結果顯示：(1)高屏分局轄區內中醫門診腰痛疾患病歷品質屬中等程度。(2)高屏分局轄區內中醫門診腰痛疾患施以傷科、藥物及針灸治療診療適當性品質亦屬中等程度。(3)中醫門診病歷品質與中醫師執業年數、院所型態別及專任醫師數有關，執業年數6~30年、高雄市及專任醫師數愈少者，病歷品質較好；西醫附設中醫醫院之病歷品質較差。(4)中醫腰痛疾患診療適當性與執業資格及院所地區別有關，受過正規教育訓練並通過檢覆考者之傷科與藥物治療適當性品質較好；屏東縣之針灸與傷科治療適當性較其他縣市為佳。
本研究建議：(1)建請衛生主管機關加強輔導中醫門診病歷，尤其職業與性別欄之填寫完整。(2)建請中醫醫事團體規劃提昇中醫門診病歷品質之相關教育課程與訓練，並建立長期性整體的病歷品質與診療適當性評估制度。(3)建請中保會規劃應增加病歷記載完整性與正確性之品質審查機制。

關鍵字

中醫門診 ； 病歷品質 ； 診療適當性

並列摘要

The study on the ambulatory care of Chinese medicine provided by contracted hospitals and clinics of Bureau of National Health Insurance Kao-ping Branch divides into three parts. The first part is to realize how the completeness and exactness of medical record is. The second part focuses on the appropriateness of such treatments as medicine, acupuncture and massaging therapy which patients suffering from lumbago (ICD-9-CM code: 7242) are treated with. The third part is to explore whether both quality of medical record and appropriateness of treatments are related with the qualification of Chinese medicine practitioners, the time that doctors have been in practice, the location and types of Chinese medical hospitals and clinics, and the number of full-time doctors in the Chinese medical hospitals and clinics.
The research shows that it ranks medium either the appropriateness of treatments or the completeness and exactness of medical record. The quality of medical record for the ambulatory care of Chinese medicine is related with types of Chinese medical hospitals and clinics, the number of full-time doctors, and how long the doctor has been in practice. Among different types of Chinese medical hospitals and clinics, worse is the quality of medical record provided by hospitals where the department of Chinese medicine is appended. Besides, the longer the doctor has been in practiced and the less the full-time doctors are, the better the quality of medical record is. Upon evaluating the appropriateness of treatments which patients suffering from lumbago are treated with, the related factors are the qualification of Chinese medicine practitioners and the location of Chinese medical hospitals and clinics. The quality of appropriateness of medicine and massaging therapy is better while the doctors are those who were given formal education and orthodox training, and passed the examination of Chinese medical practitioner’s qualification. As for the quality of appropriateness of acupuncture and massaging therapy, the hospitals and clinics in Pingtung County are better than in the other counties (or city).

並列關鍵字

ambulatory care of Chinese medicine ； quality of medical record ； appropriateness of treatments

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