參與腦中風「疾病照護品質認證」對急性腦中風病人照護成效之探討

Exploration of Effect of Hospital Participation in Cerebrovascular Accident Disease Care Certification on Care of Patients with Acute Stroke

陳冠宇(Guan-Yu Chen) ； 黃柏豪(Pai-Hao Huang) ； 董鈺琪(Yu-Chi Tung) ； 陳哲維(Che-Wei Chen) ； 洪聖惠(Sheng-Hui Hung)

《醫療品質雜誌》 15卷5期 (2021/09) Pp. 52-59

https://doi.org/10.3966/199457952021091505009

摘要

目的：本研究探討醫院參與醫策會腦中風「疾病照護品質認證」，團隊藉由認證的過程強化作業流程及品質改善活動後，以急性腦中風醫院品質績效量測指標（P4P）監測病人整體照護之成效。材料與方法：本研究以台北市某醫學中心急性腦中風病人為研究對象，醫院提出參與認證時間為2019年5月。研究資料收集區間由2017年1月至2019年12月，分為認證前（566人次）、認證後（330人次）及效果維持組（216人次）。結果：藉由醫院品質績效量測指標（P4P）比較認證前後與效果維持，多項指標有顯著改善：如腦中風量表評估完成率、病人發生急性腦中風3小時內於急診施打靜脈血栓溶解劑比率、病人使用藥物比率及接受復健評估或治療比率等指標。此外，團隊在執行動脈取栓術的數量也有所成長。結論：本研究證實醫院參與疾病照護品質認證，進行團隊資源整合與流程改善後，可提升病人照護成效。

關鍵字

急性腦中風 ； 疾病照護品質認證 ； 醫院品質績效量測指標 ； 照護成效

並列摘要

Objective: This paper explores the participation of a hospital in cerebrovascular accident disease care certification and its effect on the care of patients with stroke. Throughout the certification process , in which the stroke team strengthened the operation process(standard operating procedure) and engaged in quality improvement activities, acute stroke hospital quality performance measurement index(P4P) were employed to monitor the effectiveness of care for patients with acute stroke. Materials and methods: This study was conducted on patients with acute stroke at a medical center in Taipei, Taiwan. The hospital applied for certification in May 2019. Data collection proceeded from January 2017 to December 2019. The control, intervention, and effect maintenance groups comprised 566, 330, and 216 individuals, respectively. Results: A comparison of the P4P before and after the certification and effect maintenance indicated that the following indicators have been significantly improved: stroke scale assessment completion rate, rate of intravenous tissue plasminogen activator being injected into acute stroke patients in emergency department within 3 hours, related drugs use rate, the rate of patients receiving rehabilitation assessment or treatment. In addition, the number of intra-arterial thrombectomy performed by the team has increased. Conclusion: The participation in the certification process, team resource integration, and process improvements increased the effectiveness of the care of patients with stroke.

並列關鍵字

acute stroke ； cerebrovascular accident care certification ； hospital quality performance measurement index ； care outcome