中風照護品質指標的發展

Development of Stroke Performance Measures

中風是死亡和成人殘障的主因，醫療照護的重要課題，特別是在醫療資源有限的情況。公開醫療提供者的照護品質，以供比較，是評量醫療資源是否有效利用的重要方法。而照護品質的準確評量，有賴於建立適當的品質指標。美國在醫療團體積極參與下，已經發展出指標選擇的方法學，並建立了的一套中風照護品質指標，包含結構面、過程、以及預後，這些指標已經使用於聯合委員會（The Joint Commission）對醫療機構的認證中，也將成為醫療給付的標準。歐盟對歐洲中風照護的稽核展開清查，已整理出10 項多數稽核所使用的指標，並將建立一套歐洲共同的中風照護品質指標。台灣的中風照護品質指標，出現在醫院緊急醫療能力分級評鑑中，都與溶栓治療有關，對複雜的中風照護而言，顯然是不足的。藉由本文的回顧，可做為台灣建立更完整的中風照護品質指標的參考。

Stroke is a leading cause of death and disability in adults. Management of stroke is a major concern of healthcare, especially when resources are limited. Public reporting of performance is an important way to evaluate efficiency of using healthcare resources. Establishment of appropriate performance measures is an important step to evaluate healthcare performance. A methodology for the selection and creation of performance measures has been established by the American College of Cardiology/American Heart Association. A set of stroke performance measures is being used for clinical certification by the Joint Commission. Healthcare payment will be based on hospital performance. An inventory on European stroke audits by European Union generated 10 quality indicators that were used in most audits. An European quality indicator for acute stroke care will be developed for valid comparisons between European countries. In Taiwan, stroke performance measures are used for grading of hospital emergency medical capability. They are all limited to intravenous thrombolysis. It is obviously not comprehensive for a complicate condition such as stroke. A review of the development of stroke performance measures may provide a perspective for establishing more comprehensive performance measures for stroke care.