X光巡迴車與在院X光攝影之影像品質、病人滿意度及成本效益之實證研究-以乳房攝影為例

Comparing X-rays Image Quality,Patient Satisfaction and Cost-Effectiveness between Fixed Unit and Mobile Car :An Empirical Study on Mammography

林宏翰(HONG-HAN LIN)

指導教授 ： 龔建吉

中臺科技大學/管理學院/醫療暨健康產業管理系碩士班/碩士(2019年)

摘要

目的：2010年起衛生署將婦女乳癌X光篩檢，下降至45歲。為增加婦女做乳癌X光篩檢比例，縣市衛生局提供數位乳房X光巡迴車服務，以深入社區方式推動乳癌篩檢。本研究想了解乳房X光巡迴車與在院乳房攝影之影像品質及乳篩過程指標，和兩者受檢者滿意度與成本分析之差異。方法：影像品質使用2014至2016年在院乳房攝影乳篩共做5080個案例，乳房X光巡迴車乳篩共做888個案例。針對兩者之影像分層抽樣，相互穿插後在雙盲狀態下，給予三位乳房影像專家評分，來探討影像品質。滿意度調查是調查2018年執行乳癌X光篩檢為對象。乳房X光巡迴車有167人受訪，在院攝影有342人受訪。成本分析，則以2014至2016年乳房X光巡迴車及在院乳房攝影作業流程，進行作業基礎成本制分析。結果：經三位乳房專家評分結果，乳房X光巡迴車與在院乳房攝影影像品質具顯著差異，在院乳篩過程監測指標優於乳房X光巡迴車；滿意度調查結果，總體滿意度兩者並無顯著性差異。但在有形性構面及確實性構面，具有顯著性差異。成本分析結果，在院乳房攝影比乳房X光巡迴車，每個乳篩成本少107.4元。結論：乳房X光巡迴車應效法外國做法，用於醫療服務不足的地方使用，鄰近醫院的社區，應將受檢者導向乳篩醫療機構做檢查，可提高影像品質、滿意度及降低成本，偏鄉使用乳房X光巡迴車建議給與較高給付。

關鍵字

乳房X光巡迴車 ； 在院乳房攝影 ； 影像品質 ； 乳篩過程監測指標 ； 滿意度 ； 成本分析

並列摘要

Aims: The purposes of this study are (1) understanding image quality; (2) using mammography screening benchmarks to recognize dissimilarities between mobile mammography units and fixed mammography units (3) analyzing the cost and the satisfaction in the two examine processes. Methods: Mammographic image data was used in 2014 to 2016, 5080 cases in fixed unit and 888 cases in mobile mammography unit. In order to review image quality, those sample image data were scored by three breast image experts with the double-blind. The satisfaction survey was conducted to investigate the implementation of mammography screening in 2018. There were 167 samples in the mobile mammography units, and 342 samples were in the fixed one. For the cost analysis, the activity-based costing analysis of the operation was carried out with the mobile mammography units in 2014 and 2016 and the mammography operation process in fixed mammography units. Result: After three breast expert scoring results, the mammogram quality was significantly different. Based on the result of the mammography screening benchmarks the fixed units much more better the mobile mammography units. Moreover, except tangible facets, both of the units without any significant difference on the result of the satisfaction survey. In the aspect of cost analysis results showed each mammographic examine in the fixed mammography units was NTD107.4 less than the mobile one. Conclusion: The running model of the mobile mammography units should be modifying in order to consist with the needs of people lived in Taiwan's remote areas. In the neighborhood hospital community, the examination should be directed to mammography medical institution for inspection, which can improve image quality, satisfaction and reduce costs. It is recommended to use a mobile mammography units’ vehicle to give a higher payment.

並列關鍵字

mobile mammography units ； fixed mammography units ； image quality ； mammography screening benchmarks ； satisfaction ； cost analysis

參考文獻

參考文獻

一、中文部分

王秀紅、黃志中（2010）。婦女的健康促進與疾病預防。醫療品質雜誌，4（3），28－30。

中華民國放射醫學會（2015）medical audit 自我評價指標統計表。取自https://www.rsroc.org.tw/news/news_detail.asp?news_id=279&NType=10

何子龍、劉時佐、詹慧倫、徐守民、潘師涵(2010)。國民健康局乳癌篩檢追蹤分析研究：台灣中部一所區域醫院的經驗（含數位乳房攝影巡迴車）。中華放射線醫學雜誌，35（2）， P89–95。