門診排程檢查失約之相關因素探討──以中部某醫學中心為例

Preliminary Study of the Factors Related to Missing Appointments of Outpatient Examinations

目的：本研究利用檢查排程資料倉儲系統了解病人預約檢查排程失約的情況，並進一步分析失約相關因素，作為未來醫院管理之參考，提升病人優質的就醫服務。方法：回溯性研究，研究對象為2019 年9 月至2020 年8 月於中部某醫學中心開立檢查醫囑且預約排程之病人，利用獨立樣本T 檢定、單因子獨立變異數分析(ANOVA) 與卡方檢定進行分析排程檢查失約之相關因素。結果：預約排程之病人共計222,876 人次，失約率8.6%，比較完成檢查與失約兩族群之病人身分與就醫背景顯示，初診、未領有慢箋、計畫性檢查、看診醫師為女性之失約率顯著較高(p<0.05)，失約組之排程等候時間顯著高於完成檢查組(p<0.01)；比較兩族群之醫療資源耗用，除了檢查後門診費用外其餘皆具統計上顯著差異(p<0.01)，失約組之急、住診之費用顯著高於完成檢查組。結論：病人身分與檢查就醫背景與失約具有顯著相關，建議可作為排程設計之參考，並思考如何改善病人失約與醫療資源耗用。

Purpose：This study uses the data of appointment schedule system to investigate the status of patients' scheduled appointments and analyze the related factors of patients' presence or noshows in the appointments which could serve as a reference for future hospital management to improve the quality of medical services for patients. Methods：Data were collected retrospectively, the study subjects were outpatients who made appointments for examinations from September 2019 to August 2020 in the medical center. Independent sample T test、ANOVA and Chi-square test were used to analyze the related factors of no-shows. Results：222,876 patients were scheduled for appointments, the no-shows rates was 8.6%. A comparison between the patient status and medical background of the two groups who finished the examination and who did not show up shows that the rate of missed appointments is significantly higher for newly diagnosed patients, patients who had not received chronic disease prescriptions or planned examinations, and whose visiting doctor was female (p<0.05). The scheduled waiting time of missed appointments was significantly longer than that of those who completed the examination (p<0.01). The outpatient, inpatient and emergency medical fees 6 months of before examination for these two groups were all statistically significant (p<0.01). Only inpatient and emergency medical fees 3 months of after examination for these two groups were statistically significant. Conclusion：The patient's status and medical arrangement for the examination have a significant correlation with the no-shows rate of the appointments. The conclusion can be used as a reference for schedule design and improving no-shows rate for appointments and medical resource consumption.