台灣區域級以上醫院之醫療品質績效分析

Performance Evaluation of Medical Quality of Regional and Higher Level's Hospitals in Taiwan

本文根據衛生署在醫院自主管理上所提供的「醫療品質報告卡」與「台灣醫療照護品質指標系列」(THIS)可取得的指標，建立衡量區域級以上醫院醫療品質績效的評估模式，並以2007年、2008年為例進行實證。結果發現：(1)醫學中心較區域醫院在「管理技術變動指數」與「生產力變動指數」上，具顯著的進步，可能是因醫學中心擁有較豐富的資源，可以顯著提升醫療品質的管理技術水準，因而也導致生產力水準的醫療品質績效顯著提升。(2)不論醫院等級別或權屬別，在各項醫療品質指標的改善上，2008年均較2007年為佳。(3)須持續改善的醫療品質指標，多屬於人力方面，主要是「醫師病床比」、「醫事人員病床比」，這可能要從評鑑與修改醫院設置標準人力規範等著手改善。(4)各種處方用藥重複率指標是少數醫院表現較差的項目，因此建議醫院應要有「多重專科醫療整合之程序」，或提供「整合性照護門診」，或將多重慢性病人之用藥存放於健保IC卡內，以避免醫療資源之浪費，及保障病患用藥之安全，進而提升醫療品質。

Based on the items of medical quality cards and some advisable items of Taiwan Healthcare Indicator Series (THIS), which are provided by the Department of Health, Executive Yuan via the self-management program of hospital, this study tried to establish a model referred to evaluate the performances of medical quality of regional and higher level’s hospitals and used the data of year 2007 and 2008 for example. The findings showed that：(1)The medical centers were significantly superior to the regional hospitals on “the management technique change index” and “the productivity change index”. It was possible that there were more resources for medical centers to improve the quality of management technique and thus increased the productivity change index of medical centers. (2)The improved effect of each medical quality term was better in year 2008 than in 2007, regardless of the hospital level terms or ownership terms. (3)The medical quality items mandatory to be improved in all hospitals mainly belong to the aspect of human items, especially the “ratio of doctor/ward bed” and the “ratio of medical staff/ward bed”. This phenomenon might be improved after the progress of medical assessment and revision of standard medical staff protocol. (4)The repetition of drug prescription was the demerit of a few hospitals. We suggested the establishment of the conformity of different medical departments, provision of an integrated out-patient department or record of drug prescription in IC card for patients with multiple chronic diseases. In this way, we could avoid the squander of medical resources, ensure the safety of patients and improve the medical quality.