探討醫院評鑑放射組之品質指標及對醫療品質之影響－以某醫學中心放射組為例

研究目的本研究目的為瞭解醫院評鑑醫制度對放射科品質影響情形，及醫學中心放射組品質相關構面，及在保險總額預算的支付制度環境中，人員及設備在數量不變的條件下，如何由流程再造，縮短病人檢查排程等候時間，提供病人快速且及時性之診斷服務，達到可近性品質構面提昇病人照攝服務，提高整體醫療服務品質。研究方法採用回溯性研究設計比較南部某醫學中心前、後兩次醫院評鑑放射組品質，在人員素質、醫療品質、儀器設備、檢查流程改善下，取樣三項在放射科精密儀器檢查中提供臨床醫師作治療前正確之診斷，在92年與93年相同月份檢查人次中；92年血管攝影檢查225人次、電腦斷層檢查2375人次(門診1749人次、住院626人次)、與磁振造影1156人次(門診791人次、住院365人次)，93年血管攝影檢查263人次，電腦斷層檢查1989人次(門診1329人次、住院660人次)與磁振造影1044人次(門診583人次、住院461人次)排程等待時效差異性及相關性；並採用學者Donabidian提出之結構、過程、結果系統模式進行探討。研究結果發現某醫學中心放射組，93年度檢查項目中病人節省排程等待時間：CT.門診6047天(8.87天(92年排程平均等候天數)-4.32天(93年排程平均等候天數)＊1329人次（93年CT.門診檢查人次）)、住院1058天（2.23-0.54＊626人次），MRI.門診5871天（12.43-2.36＊583人次）、住院237天（1.32-0.67＊461人次），ANGIO.144天（1.90-1.35＊262人次），總共節省約13356天。 ANGIO流程、設備兩項均無改變，排程等待時間改善顯著性較小，CT流程有改變、設備無改變，排程等待時間改善顯著性稍大、MRI流程及設備兩項均有改變，排程等待時間改善顯著性差異最多，另外93年實施自主管理，致檢查件數減少及高科技HIS、RIS連結PACS啟用病人資料及影像快速傳輸，致病人排程等待時效改善皆有關連。三項在放射科精密儀器檢查中，門診與住院病人排程等待時效於統計學上均呈現顯著改善及X光檢查報告品質均符合醫療品質指標監控。討論與建議依據本研究結果可推論：醫院評鑑制度有關醫學中心放射組之指標，確實可達影響品質改善的目的，建議衛生主管機關，加強重視醫院評鑑放射組品質過程及結果指標之審查，並將評鑑資料依序整理，建構完整資料庫，以利後續相關議題之研究；另放射主管應加強重視以病人為中心之安全照護品質過程及結果指標之建立，持續管理監測改善，以提升醫學中心放射組之服務品質。

關鍵字

醫院評鑑；放射品質；結構；過程；結果

並列摘要

Abstract To evaluate the effects hospital accreditation system have on quality improvement of radiology department in medical center; how to operate the department efficiently under the global budgets to accomplish tasks such as shortening of scheduling time, prompt diagnostic services and at last escalating the quality of medical service without addition of equipments and personnel. Methods In the retrospective study, we compared the qualities of three high technology examinations provided by the radiology department in southern medial center before and after improvements of several measures including education levels of personnel, medical quality, imaging equipments and examination procedures suggested by hospital accreditation members. During the same month in 2003 and 2004, 225 patients had angiographic studies, 2375 patients had CT studies (1749 out-patients, 626 in-patients) and 1156 patients had MRI exams (791 out-patients, 365 in-patients); as for 2004, the number of patients underwent the respective studies was 263 for angiography, 1989 for CT (1329 out-patients, 660 in-patients) and 1044 for MRI (583 out-patients, 461 in-patients). The variance and correlation of the scheduling time is studied using structural, procedural and conclusive models proposed by Donabidian. Results We found that in this study group the waiting time is shortened by accumulative days for each examination as follows: (1) CT, out-patients:6047 days (8.87days(average waiting time in 2003)-4.32 days(average waiting time in 2004) * 1329(number of out-patient in 2004); in-patients:1058 days((2.23-0.54)* 626); (2) MRI, out-patient:5871 days((12.43-2.36)*583), in-patients:237days((1.32-0.67)*461); Angiography, 144 days((1.90-1.35)*262). The sum of the shortened waiting time is 13356 days. We found that the difference of waiting period improvement is least observable for angiography study since there was no change in procedure and equipments. Other the other hand, there was some improvements for CT study as there are changes in procedure and not in equipments. MRI study is where we see most improvement take place as there are both changes in procedures and equipments. Besides, the initiation of self executive management and implementation of HIS, RIS connections to PACS, also leads the shortening of schedule waiting periods. Discussions According to our study, we infer that the criterions imposed by the new hospital accreditation system will suffice the goals of quality improvement for the radiology department in medical center. We recommend health officials to reinforce the accreditation process, contemplate the outcome and establish a complete archived file for future studies of pertinent topics. The director of radiology department should emphasize the safety and care provided for the patients, maintenance of operation and surveillance for improvement in order to escalate the service quality of radiology department in a medical center.