| 摘要: | 目的: 驗證用於評估大規模燒傷事件的醫院韌性的初步概念框架，並量化醫院韌性，特別是大規模燒傷事故的醫院韌性。
參與者和設置：40家醫院的210名醫護人員，包括急診醫學科醫師，創傷外科醫師，急診護理師等醫療專業人員參加了本研究的調查。在台灣特有的全民健保制度下，參加醫院包括21家重度級創傷醫院，19家中度級別醫院和8家一般級醫院。
方法：根據以往的研究，我們設計了52項目針對大規模燒傷事件之燒傷特定醫院韌性（hospital burn-specific resilience, HBSR）問卷，我們假設這些項目具有六個潛在構面，包含四個一般性構面（即醫院的安全和基本結構，醫院位置和維護，突發能力和災害規劃以及指揮監控系統的控制）和兩個特定燒傷構面（即針對燒傷的處置和相互支持及預期性外援的策略）。本研究驗證HBSR構建效度、已知族群效度以及內部一致性。
結果：以主成分分析驗證HBSR構建效度，結果顯示：基於因子特徵值（> 1）和scree檢驗的兩個標準，有五個萃取後因子與41項目被提取，但項目與先前推定的六個HBSR提取因子的構面並不相符。以此五構面與41項目，針對五個醫院特徵：創傷照護水平、創傷小組啟動、醫院護病比、醫院佔床率及可用的燒傷特別床，測試已知群體的已知族群效度。且在台灣同類分級的醫院的醫院特徵同質性高。41項目的HBSR顯示出內部一致性為0.58-0.95，所有構面只有在大量燒傷病患湧入的控制及策略構面上存在地板值和天花板值。
結論：未來研究需進一步驗證修正HBSR針對大規模燒傷事故的醫療體系韌性的效度，同時也應在後續的研究對象加入更多其他相關專業人員參與。
Objective: To validate a preliminary conceptual framework for assessing hospital resilience for mass burn casualty incidents and to quantify hospital resilience specifically to a mass burn casualty incident in Taiwan.
Participants and Settings: Two hundred and ten healthcare workers in 40 hospitals, including emergency department (ED) physician, trauma surgeon, ED nurse, and other medical specialists, participated in our survey. In the unique national health insurance system in Taiwan, the participating hospitals consisted of 21 heavy-level trauma care hospitals, 19 moderate-level hospitals, and 8 ordinary level hospitals.
Measure: Based on previous studies, we designed a 52-item Hospital Burn-specific Resilience (HBSR), and these items were presumed to have six latent constructs or domains, consisting of four generic domains (i.e., safety and essential structure of hospital, hospital location and maintenance, surge capacity and disaster planning, and control of command and surveillance system) and two burn-specific domains (i.e., strategy specific for burn management and mutual support and expected outsourcing).
Results: To validate the construct validity of the HBSR, results of the principal component analysis shows that, based on the two criteria of factor eigenvalues (> 1) and scree test, only five extracted factors were selected, and they did not correspond with the presumed 6-domain structure for the HBSR. Forty-one items of the HBSR (factor loadings > 0.4) converged into the fiver factors. To test the known-groups validity, the 41-item revised HBSR statistically discriminated subgroups with regard to five hospital characteristics of trauma care level, trauma team activation, ratio of nurses to patients, ratio of bed occupancy, and available burn beds. And the hospital characteristics showed similar between the same levels of trauma care hospitals in Taiwan. The revised HBSR showed adequate internal consistency (0.58-0.95) and no floor and ceiling values for all domains but the Strategy and controlling of burn surge.
Conclusions: An assessment tool of measuring the resilience of hospitals or health care systems specifically responding to a mass burn casualty incident has been developing in Taiwan. Further research is warranted to validate the 41-item HBSR, as well as to add contributions from multiple professionals into the tool. |
