醫院評鑑等級與醫療品質相關性之探討──以醫療品質資訊公開指標為例

Association between hospital accreditation level and publicly reported indicators of healthcare quality

目標：探討醫院評鑑的醫院分級結果，是否與醫療品質資訊公開指標有顯著的相關性，以及醫院層級的差異與異動是否也符合醫療品質指標的測量結果。方法：採橫斷式研究法，2008年到2018年間醫療品質資訊公開網中所公布的三類疾病別與處置別：急性心肌梗塞、糖尿病、透析治療、醫院整體性指標，共16項品質指標進行分析。在控制權屬別、健保分區別等醫院特質後，探討醫院層級別在三類疾病別與處置別的品質指標中，是否有顯著差異。另外，比較醫院層級有變動的醫院在13項指標品質的差異。結果：16項指標中有10項指標於醫院層級別呈現顯著差異；其中7項急性心肌梗塞的指標，皆是醫學中心的指標平均值優於區域醫院，區域醫院又優於地區醫院；但在糖尿病與透析治療的相關指標中，則無顯著差異。在研究觀察期間評鑑等級升格的11間醫院中，僅有3間醫院的品質表現是明顯優於原層級同儕醫院，且與新層級醫院群體之品質表現相當。結論：醫院評鑑之結果，未必能反映不同層級醫院在部分常見疾病別與處置別照護品質之品質表現。建議未來應進一步探討品質資訊公開與醫院評鑑標準中對醫療品質的測量，是否能全面性反應個別醫院醫療品質之良窳。使民眾在參考這些資訊時做出更合適的就醫選擇。

Objectives: This study investigated the association between hospital accreditation level and publicly reported indicators of healthcare quality. Methods: Sixteen quality indicators were derived from the treatment protocols for three conditions: acute myocardial infarction (AMI), diabetes mellitus (DM), and dialysis treatment. Data were obtained from the Hospital Public Quality Reporting website as well as hospital outcome indicators for the period between 2008 to 2018. The quality indicators were examined in the context of the accreditation level, ownership, and location of the hospitals. Further analysis was performed on facilities where the accreditation level has changed, including comparisons of quality before and after the change as well as comparisons with facilities that have not changed. Results: Among the 16 indicators, 10 differed significantly as a function of accreditation level. Note that 7 of the 10 indicators were related to AMI. Note also that in dealing with AMI, medical centers outperformed regional hospitals and district hospitals. We observed no differences in the indicators for DM or dialysis treatment. Among the 11 hospitals that raised their accreditation level, only 3 presented a corresponding improvement in care quality and none of them differed significantly from other hospitals of the same level. Conclusions: This study revealed that hospital accreditation level is not a reliable indicator of the quality of care. This inconsistency demonstrates the need to reassess publicly reported indices of care quality as well as the means by which hospital are assessed in the accreditation process. Only then public will be able to make informed decisions pertaining to their choice of health services.