台灣療品質指標系統的建立與十家醫療機構可行性測試結果

Development of Taiwan Quality Indicators System (TQIS) and Results of Its Feasibility Study in 10 hospitals

林富滿(Lin Fu Man)

指導教授 ： 邱文達

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

醫療品質是目前各界關注的議題，要有效評估醫療品質並達到持續改善，須從建立評量指標與提供準確的測量開始，然台灣目前沒有一套完整客觀的監測工具，也未能完全掌握品質指標例行性的蒐集。有鑑於此，本研究主要目的，在於發展一套適用、客觀及可量化的指標系統，透過臨床測試進行該系統應用於國內醫療機構之可行性評估，試提出促進台灣醫療品質提昇之方案及政策施行的參考。 本研究分為三部份：第一部份以問卷調查，進行40位專家對目前品質指標適用性的調查；第二部份以十家測試醫院為對象，運用德菲法的精神，以一次專家座談會及一次問卷調查，進行指標定義共識之建立及問題探討；第三部份以問卷調查，針對十家測試醫院代表，進行「台灣醫療品質指標系統」可行性測試之意見調查。 研究結果發現：目前常用來評估醫療品質的154個指標中，有80%的指標被九成以上的專家認為是適用的指標。在指標定義及相關問題探討方面，經歸類後三個主要問題分別為：「指標定義不清楚明確」、「與目前的定義不同」、「定義不一致」；其建議方向為：「重新檢討指標定義」、「參考TQIP的定義」、「參考醫院評鑑指標定義」等。透過二回合的討論及修正，測試醫院代表認為TQIS對建立品管作業標準化、數據化的管理制度及本土品質文化的發展有正面的影響；但也認為可能造成增加人事費用及員工工作量的負面影響。整體而言，本系統之測試結果，100%的測試醫院認為該系統可行，對評估醫療品質有很大的幫助。

關鍵字

台灣醫療品質指標系統 ； 台灣醫療品質指標計劃 ； 德菲法

並列摘要

Medical quality has been a major subject of study in many social and economical fields. Yet, effective evaluation and improvement of medical quality must begin with establishment of legitimate indicators and practical evaluation process. Currently, Taiwan has not established an objective monitoring system with complete data result. This research intends to develop an objective system of medical indicators. A research of its feasibility is conducted through clinical applications in hospitals with goals to provide a model for policy making and to improve the medical quality in Taiwan. This study includes three phases. First of all, 40 experts are asked to fill out a questionnaire to express their opinions on the application and feasibility of the medical indicator systems they currently use. Second, Delphi Method is utilized to conduct a symposium participated by representatives from 10 hospitals. The purpose is to build consensus of the definition of medical quality indicators and to discuss issues concerning their applications. Third, a survey on the feasibility of the “Taiwan Quality Indicators System” is conducted and opinions from 10 hospitals are collected. Result findings show that 90% of the surveyed experts approved 80% of the 154 indicators currently used. After intensive discussions, it is concluded that there are three major problems about the definition of current medical quality indicators. Problems include that” the definition of an indicator can be unclear”, “what the definition was may vary from what it is now”, and “that the definition can be used inconsistently”. Possible solutions may gear toward “redefining indicators”, “referencing the definition of TQIP”, and “borrowing the definition used by the Hospital Accreditation here in Taiwan”. After two rounds of discussion, 10 tested hospitals have reached the agreement that TQIS has positive impacts on the establishment of a standardized system of quality control, a numeric evaluation system of quality control, and an indigenous culture of quality control. On the other hand, negative impacts may result in the increase of human resource expenses and workload. Over all, all the tested hospitals fully support the feasibility of the TQIS and believe that it will improve the reliability of future medical quality evaluation.

並列關鍵字

Taiwan Quality Indicators System(TQIS) ； Taiwan Quality Indicators Project (TQIP) ； Delphi Method

參考文獻

郭守仁:世界醫品質改善的新趨勢，醫療品質進階研討論資料，彰化基督教醫院切膚之愛七十週年系列活動，1998。 何宜真:住院病人對醫療品質之認知及其評估能力之初探，台大醫管所碩士論文，1998。 陳佩妮、鄭守夏、鐘國彪、林王美園:台灣地區醫療品質指標適用性之探討。中華衛誌1997；16(2):133-142。

蘇喜等:健保資料庫在醫資源耗用及醫療品質偵測上之功用。中華衛誌1997；16(1):527-535。

韓揆:醫院品質管理與門診服務定性指標，中華衛誌1994；13(1):35-52。

蔡素玲:醫策會與TQIP介紹，財團法人醫院評鑑暨醫療品質策進會-醫療品牌指標計劃簡介研討會手冊，1999；1-8。

邱淑芬、蔡欣玲:德爾菲預測術-一種專家預測的護理研究方法。護理研究1996；4(1):92-97。