臺北市立醫院品質與績效指標關係之研究

A Study on the A Study on the Relationship of Indicators between Quality and Performancein Taipei Municipal Hospitals

黃鎮墻(Chen-Chiang Huang)

指導教授 ： 洪清霖 ； 王泰隆

臺北醫學大學/公共衛生暨營養學院/公共衛生學研究所/碩士(2000年)

摘要

台北市立醫院因為長期以來受到公立醫院人事僵化、會計欠缺彈性等諸多限制，加上受到公務預算將逐年減少之威脅，因此提昇醫療品質及改善營運績效將勢在必行。在未來可能走向自給自足之情形下，各市立醫院莫不為提高醫療品質而努力，但迄今尚無以台北市立醫院為對象，做品質與績效指標間關係之探討，有鑒於此，遂進行此項研究。 本研究的主要目的在於瞭解台北市立醫院之醫療品質與醫院績效指標並藉由選擇適當的評量指標以分析台北市立醫院醫療品質與績效之關係及影響程度。研究體裁取自七家台北市立醫院86年7月至87年6月之營運管理指標資料。研究之自變項為結構面以及過程與結果面的醫療品質指標，而應變項則包括醫院之服務量以及財務績效指標。基本資料以電腦鍵入Excel軟體做初步處理，再以SPSS軟體整合相關資料進行統計分析，使用之統計方法包括描述性統計以及Pearson積差相關分析、逐步複迴歸等推論性分析。 在結構面品質指標與醫院績效指標方面之關係，總病床數分別與住院人日、住院體檢人次及含政府補助之淨盈虧等呈顯著正相關；急性一般病床數則分別與健保核減率及住院手術人次呈正向相關。 至於過程與結果面品質指標和醫院績效指標之關係方面，剖腹產率分別與自然產數、剖腹產數、急性病床佔床率、總佔床率及急診人次呈正向相關；病人意外事件發生率分別與總佔床率、住院人日、住院手術人次亦呈正向相關；病人近期再入院率則分別與住院手術人次、累計總收入等呈顯著正相關。以上再經逐步複迴歸分析，醫療品質對醫院績效之影響中剖腹產率、病人近期再入院率、病人意外事件發生率等為較顯著之影響因子。 根據分析結果，各醫院如無公務預算補助則均有虧損現象，另由於社會及文化等因素與健保給付之方式，助長了台北市立醫院剖腹產率偏高之現象，是目前應重視之問題。另外亦建議衛生主管機構能逐步將本研究具影響性之醫療品質指標納入醫院評鑑標準，並列為保險給付申報之參考資料，以加強參與的醫院對醫療品質之重視。

關鍵字

醫療品質 ； 剖腹產率 ； 病人近期再入院率 ； 醫院績效 ； 總佔床率 ； 政府補助收入 ； 健保核減率

並列摘要

The main purpose of this study is to select proper indicators of medical quality, to screen the independent relationship among these indicators and to realize the impact between medical quality and hospital performance in Taipei municipal hospitals. This research started from July 1997 through June 1998. Based on the relativeness of research data, we collected the data of seven hospitals from all of Taipei municipal hospitals. The effective factors were set from medical quality indicators. The attributable outcomes were the levels of the service volume and financial performance of hospitals. Basic data were collected and processed by EXCEL at first,then SPSS statistic package to get the descriptive statistics, and to perform Pearson correlation analysis and the step-wise multiple regression. The effects of construction quality on hospital performance are as the followings. (1)The total bed number is positively related with in-patient days, the number of physical examination and net income of government supply. (2)the number of acute bed is positively related with OPD deducted rate of NHI and the number of IPD surgery patient. Analyzing the attribution of medical care process and result quality indicators to hospital performance, we found: (1)the Cesarean Section Rate is positively related with the number of vaginal delivery, acute bed stay rate, total bed stay rate and the number of ER patient. (2)The Accident Rate of patient is positively related with total bed stay rate, total number of in-patient stay and the number of surgery patient. (3)The Re-Entry Rate of patient is positively related with the number of surgery patient and total aggregated revenue. All of the above results were analyzed by aggregated regression. We found medical quality will influence hospital performance, and the most obvious factors are the Cesarean Section Rate, the Re-Entry Rate of patient and the Accident Rate of patient.

並列關鍵字

medical quality ； cesarean section rate ； the re-entry rate of patient ； hospital performance ； total bed stay rate ； income of government supply ； deducted rate of NHI

參考文獻

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