| 摘要: | 在現行的全民健保制度下，民眾擁有高度的就醫選擇自由。但是，民眾所得到就醫選擇資訊仍嫌不足。國內醫療市場需要客觀且具公信力的就醫選擇資訊。醫院品質報告卡(Hospital Report Cards)為醫院對民眾公佈其醫療品質資訊之工具。本研究之目的為研究影響國內醫院品質報告卡推行之因素，並且架構出可行的醫院品質報告卡。
本研究主要分為三個步驟，首先，對國外現有醫院品質報告卡與相關文獻進行探討。其次，訪談國內深具醫療品質實務經驗之專家，調查其對醫院品質報告卡的態度與建議。再運用前兩者之資料發展本研究之架構與問卷。最後，對國內醫學中心、區域醫院與地區醫院三層級之醫院進行問卷調查，共有504家樣本醫院。
問卷總共回收183份，總回收率為37%。研究結果發現醫院對醫院品質報告卡認為有意願推行者達52%。主要影響醫院整體意願之因素包括提升醫院形象( OR=4.695, p=0.003, 95% C.I.=1.711, 12.83)與可能增加醫療糾紛 ( OR=0.52, p=0.004, 95% C.I.=0.331, 0.861)。醫院對醫院品質報告卡認為有能力推行者達71.6%，高於有意願之比例。醫學中心、區域醫院與地區教學醫院認為有能力之比例高於地區非教學醫院。主要影響醫院推動能力的醫院特質為是否有專人負責醫療品質活動與教學醫院資格。
最適合主導推行之機構為財團法人醫院評鑑暨醫療品質策進會。依據調查醫院之意見，歸納出可行之醫院品質報告卡內容為醫院擁有專業醫師資格比率、主治醫師與病床比、醫師專長與資歷、貴重醫療儀器設備種類與數量、醫院評鑑等級、各類病床數、病患滿意度、平均住院日與佔床率等九項。
衛生主管機關應儘早統籌規劃醫院品質報告卡之推行，讓民眾能有充足且正確之就醫選擇資訊。此外，醫院總額預算制度即將實施，醫院品質報告卡不失為總額制度下監測與促進醫療品質之良策。
Under Taiwan National Health Insurance, the general public has high selectivity for medical service. But the general public doesn’t have enough informed information about health care. Health market has a need for reliable health care performance information of providers. Hospital report card is a tool for hospitals to release hospital performance to the public. The objectives of this study are to explore what factors influence hospitals in Taiwan to use hospital report card, and to compose feasible hospital report card.
The study consists of three steps: literature review, experts interview, and questionnaire development. A structured questionnaire is developed based on literature review and expert interview. The study subjects are general hospitals which are accredited as medical centers, regional hospitals, and district hospitals .
The response rate was 37%. In total 57% of hospitals that are willing to use hospital report card. The influence factors include promoting the image of hospital( OR=4.695, p=0.003, 95% C.I.=1.711, 12.83) and increasing the possibility of medical malpractice ( OR=0.52, p=0.004, 95% C.I.=0.331, 0.861). Among the sampled hospitals, 71.6% consider themselves to be capable of using hospital report card. The rate of considering themselves to be capable of using hospital report card is higher among the medical centers, the regional hospitals and district teaching hospitals than that among the district hospitals. The influence factors to the capability of executing hospital report card are whether there is a person who are in charge of medical quality activity and whether the hospital is qualified as a teaching hospital.
The Taiwan Joint Commission on Hospital Accreditation is the most suitable organization to initiate and to managed hospital report card. The feasible information of hospital report card should include (1) rate of physicians who have specialties, (2) rate of attending physicians to beds, (3) work experience, qualifications and specialty of physicians, (4) number and type of valuable equipment, (5) the accreditation status, (6) numbers and type of bed, (7) patient satisfaction, (8) length of stay, (9) occupancy rate.
To help the general public have sufficient and correct health care shopping information, health care authority should make an overall plan about hospital report card as early as possible. In addition, hospital global budget system has been implemented and hospital report card will be an excellent strategy to monitor and to advance hospital quality. |
