台灣地區醫療品質指標適用性之探討

A Study on the Applicability of Medical Quality Indicators in Taiwan

陳佩妮(Pey-Ni Chan) ； 鄭守夏(Shou-Hsia Cheng) ； 鍾國彪(Kuo-Piao Chung) ； 林王美園(Mei-Yuan Lin Wang)

《中華公共衛生雜誌》 16卷2期 (1997/04) Pp. 133-142

https://doi.org/10.6288/CJPH1997-16-02-03

摘要

本研究之目的為瞭解醫療品質指標在國內各級醫院的適用情形，以及目前醫院提報品質資料之可信程度，並利用實證資料探討各品質指標問之關係。經以結構式問卷對國內14位醫療品質專家學者，以德菲法(Delphi technique)進行兩回合的調查研究發現，大部份目前常用的醫療品質指標均被視為重要與適用的，其中以院內感染要生率被公認是「非常重要且適用」的品質指標。但在資料可靠性方面，只有結構面及少數結果面品質指標較為可靠。資料不可靠的理由可歸因於「環境」、「組織」及「資料本身」三大因素。以相關檢定分析實證資料要現，結構面的品質指標，除專科醫師比率外，隨醫院評鑑等級越高，各指標間呈一致而顯著的正相關。而絕大多數的過程與結果面品質指標之問，都沒有顯著相關專在。在醫療結構－過程－結果面品質指標問的相關性，只有各死亡率與結構面品質指標呈現較顯著的正向相關。實證分析的結果與專家們的意見是相符合的，唯目前似乎尚無可靠而適用的過程與結果面指標可茲應用。

關鍵字

醫療品質 ； 指標 ； 德菲法

並列摘要

The main purposes of this study are to understand the applicability and reliability of quality indicators in Taiwan's hospitals, and to explore the relationship among quality indicators. A structured questionnaire was designed and distributed to collect experts' opinions via Delphi technique. According to the response of 14 medical care quality experts, almost all currently used indicators are considered important and applicable, while hospital-acquired nosocomial infections is considered the most important quality indicator. However, only structural and a few outcome indicators are reliable. Factors affecting the reliability of quality measures can be classified into three categories-environmental, organizational and data problems. According to the empirical analyses, positive relationship are found among structural indicators except the rate of specialists. No consistent correlation can be found among the process-outcome indicators except several death rates. Empirical findings are consistent with those experts' opinions. However, under current situation, there is no reliable and applicable outcome indicator which can be employed for hospital accreditation.

並列關鍵字

Medical quality ； indicators ； Delphi technique