台灣AMI品質報告卡住院過程指標的效度驗證

Validity of acute myocardial infarction inpatient process measures on the report card in Taiwan

Objectives: To investigate the validity of acute myocardial infarction (AMI) process measures on the public report card in Taiwan. If the quality measure of report card is highly valid, then it can enhance confidence over the use of report cards by citizens, and physicians would be more willing to make improvements based on the results of performance. Methods: The study analyzes the associations between the 5 process measures reported and the negative outcome measures from 2011 to 2012. Subjects were selected from the National Health Insurance Association (NHIA) admission files and had a principal diagnosis of acute AMI (ICD-9-CM 410) during the study period. The main outcome measures include return to the emergency department (ED) within 3 days, unscheduled readmission within 14 days, and 30-day mortality at the patient and hospital levels. Results: Four process measures are all negatively associated with the outcomes at hospital level, except for the LDL examination. Conclusions: Regarding the requirement for validity transparency of a report card, our research suggests that these process measures currently used on the AMI report card in Taiwan are valid based on their associations with negative outcomes. In other words, a hospital that achieves high scores on process measures probably also realizes better outcome quality. 目標：檢視台灣心肌梗塞品質報告卡過程指標的效度。若報告卡的品質指標具有高效度，則可以增加民眾使用品質報告卡的信心，醫師也較願意根據成效結果做出改善。方法：本研究主要分析2011到2012年，5個公開的過程指標與負向結果指標的關係，選取對象為前述期間健保資料庫住院資料有急性心肌梗塞主診斷（ICD-9-CM 410）的病人。主要的結果指標分別為病人和醫院層級的3天內重返急診、14天內非預期性再住院，以及出院30天死亡率。結果：除了低密度脂蛋白檢查指標外，4個過程指標皆與醫院層級的結果指標有顯著負相關。結論：因應報告卡效度透明化的要求，我們的研究指出，立基於報告卡使用的過程指標與負向結果有相關，現行台灣AMI品質報告卡上的過程指標具有效度。換句話說，在過程指標獲得高分的醫院，可能也具有較佳的結果品質。