建構評估醫療糾紛之指標系統

Establishing a Medical-Dispute Estimate Indicator System

目的：根據美國Institute of Medicine（IOM）於1999 年的研究報告指出：在醫療過程當中，醫療錯誤在病房、手術室和急診發生的機率最高且最為嚴重。本研究透過Donabedian [1] 提出的「結構面、過程面、結果面」的三種切入面，建立評估醫療糾紛之指標系統。方法：本研究針對急診及住院兩大體系，依據醫療糾紛發生之原因，運用國內外常用之醫療指標系統，並以問卷調查及專家訪談方式進行研究。結果：本研究評估醫療糾紛之指標系統共計36 項指標，區分成急診和住院兩部分，其中急診共26 項，住院共27 項，二者共同指標17 個。結論：研究結果建議：（1） 對醫事人員進行醫療指標、醫療糾紛的教育訓練；（2）實證醫學的完整落實；（3） 並建立一套適當的醫療糾紛處理與預防機制，將有助於未來醫療相關機構在實務上的應用及研究的依據。

Objectives: According to research by the Institute of Medicine (IOM) issued in 1999, the highest number of serious medical mistakes occurs in the ward, operating room, and emergency room during medical procedures. This study established an estimate indicator system for medical disputes according to Donabedian’s [1] three perspectives,“the structural perspective, the process perspective, and the outcome perspective.”Methods: This study focused on the two major areas of concern: emergency rooms and hospitalization. Based on the factors causing medical disputes and the use of the medical indicator systems generally adopted both in Taiwan and internationally, this study conducted a questionnaire survey and interviewed experts. Results: This study evaluated a total of 36 estimate indicators for emergency rooms and hospitalization. Among these indicators, the indicators for emergency rooms included a total of 26 items, while the indicators for hospitalization included 27 items. Joint indicators amounted to 17 items Conclusions: The results suggest: (1) enhancement training for medical personnel in regard to medical indicators and medical-disputes; (2) implementation of Evidence-Based Medicine (EBM); (3) establishment of an indicator system to deal with medical disputes and medical-dispute estimates. These steps could assist health care institutions in improving the quality of their practice and research.