本研究結果顯示出醫院評鑑之結果，未必能完全反映出不同層級醫院在疾 病別過程面照護品質之品質表現。故應檢視當前醫療品質評估的制度，在評鑑 的制度與標準中，使評鑑制度與實際的照護過程、照護結果間加強連結，使之 能適度反映出醫療院所在結構面－過程面－結果面的綜合品質，使醫院層級的 變動可更確實的傳遞出其在醫療品質上的優劣，也可使醫院評鑑可以更確實的 協助醫院提升自身的醫療品質，以利提供病患更好的照護服務品質。
針對醫療品質資訊公開網，做為衛生主管機關將醫院品質資訊透明化之重 要管道之一。應可提高資料易讀性、資料可近性，並針對不同需求的民眾，提 供以民眾為中心之資訊。另外，為增加醫療院所與醫院層級別之間的可比較性，
建議衛生主管機關可針對醫療品質資訊公開網的結果面品質指標進行風險校正，
避免不同之醫院特質、病人特質，造成比較上的偏誤與民眾在解讀時的誤解。
而與國外相關文獻相比，所公開的疾病別與處置別之指標仍有落差，建議可參 考國外品質資訊公開系統、民眾實際需求公開更多疾病別與處置別指標。
提供民眾易讀、可近、可信賴且一致性的資訊，使之確實能幫助民眾作為 就醫選擇之參考資訊。
二、對醫療提供者的建議
以品質指標為基礎建立之現行醫院評鑑制度，是目前國內外針對醫院品質 評比之主流制度，各醫療院所也無不投入大量時間、人力、資金成本於醫院評 鑑。但國內外之各項研究也指出醫院評鑑結果並未能直接反映醫院之品質表現，
甚至部分品質指標也無法代表醫院之照護品質。故醫院除投入於國內醫院評鑑
或 JCI 等各項評鑑外，也應適當性投入資源於品質管理或品質提升之相關計畫。
以兼顧醫院在結構面－過程面－結果面之各項醫療品質發展。
三、對後續研究者的建議
(一) 建議未來研究者可同時評估醫院整體性與疾病別之品質指標，觀察醫 院評鑑與醫院層級對於整體性與疾病別指標，是否會產生有不同之影 響。
(二) 建議未來研究者可納入更多經風險校正之結果面之品質指標，以利對 於醫院之醫療品質有更全面之評估。
(三) 建議未來研究者可嘗試以人作為研究單位，可納入病人特質（如年齡、
疾病嚴重度）作為研究之控制變項。
(四) 建議未來研究者可導入其他國內現行之品質指標系統（如：TQIP, THIS）
進行醫院醫療品質之間的比較。可探討現行品質指標系統結果與醫院 評鑑結果間之關聯性。
第柒章 參考文獻
Alkhenizan, A., & Shaw, C. (2011). Impact of Accreditation on the Quality of Healthcare Services: a Systematic Review of the Literature. Annals of Saudi Medicine, 31(4), 407-416. doi:10.4103/0256-4947.83204
Austin, J. M., Jha, A. K., Romano, P. S., Singer, S. J., Vogus, T. J., Wachter, R. M., &
Pronovost, P. J. (2015). National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Aff (Millwood), 34(3), 423-430. doi:10.1377/hlthaff.2014.0201
Bilimoria, K. Y., & Barnard, C. (2016). The New CMS Hospital Quality Star Ratings:
The Stars Are Not Aligned. JAMA, 316(17), 1761-1762.
doi:10.1001/jama.2016.13679
Bogh, S. B., Falstie-Jensen, A. M., Bartels, P., Hollnagel, E., & Johnsen, S. P. (2015).
Accreditation and improvement in process quality of care: a nationwide study.
Int J Qual Health Care, 27(5), 336-343. doi:10.1093/intqhc/mzv053
Brubakk, K., Vist, G. E., Bukholm, G., Barach, P., & Tjomsland, O. (2015). A systematic review of hospital accreditation: the challenges of measuring complex intervention effects. Bmc Health Services Research, 15.
doi:10.1186/s12913-015-0933-x
Campbell, S. M., Braspenning, J., Hutchinson, A., & Marshall, M. N. (2003).
Research methods used in developing and applying quality indicators in primary care. BMJ, 326(7393), 816-819. doi:10.1136/bmj.326.7393.816 Casalino, L. P. (1999). The Unintended Consequences of Measuring Quality on the
Quality of Medical Care. New England Journal of Medicine, 341(15), 1147-1150. doi:10.1056/nejm199910073411511
Chen, J., Rathore, S. S., Radford, M. J., & Krumholz, H. M. (2003). JCAHO Accreditation And Quality Of Care For Acute Myocardial Infarction. Health Affairs, 22(2), 243-254. doi:10.1377/hlthaff.22.2.243
Cua, S., Moffatt-Bruce, S., & White, S. (2017). Reputation and the Best Hospital Rankings: What Does It Really Mean? Am J Med Qual, 32(6), 632-637.
doi:10.1177/1062860617691843
Donabedian, A. (1966). Evaluating the Quality of Medical Care. The Milbank Memorial Fund Quarterly, 83(4), 691-729.
doi:10.1111/j.1468-0009.2005.00397.x
Donabedian, A. (1988). The Quality of Care: How Can It Be Assessed? JAMA, 260(12), 1743-1748. doi:10.1001/jama.1988.03410120089033
Falstie-Jensen, A. M., Bogh, S. B., Hollnagel, E., & Johnsen, S. P. (2017).
Compliance with accreditation and recommended hospital care-a Danish nationwide population-based study. Int J Qual Health Care, 29(5), 625-633.
doi:10.1093/intqhc/mzx104
Feinstein, A. R. (2002). Is quality of care being mislabeled or mismeasured? The American Journal of Medicine, 112(6), 472-478.
doi:10.1016/S0002-9343(02)01043-4
Gagel, B. J. (1995). Health Care Quality Improvement Program: A New Approach.
Health Care Financ Rev, 16(4), 9.
Greenfield, D., & Braithwaite, J. (2008). Health sector accreditation research: a systematic review. International Journal for Quality in Health Care, 20(3), 172-183. doi:10.1093/intqhc/mzn005
measures in hospitals: a comparison of Joint Commission and Medicare outcomes scores in hospitals. Quality Management in Healthcare, 10(2), 29-38.
Kerr, E. A., Smith, D. M., Hogan, M. M., Hofer, T. P., Krein, S. L., Bermann, M., &
Hayward, R. A. (2003). Building a better quality measure: are some patients with 'poor quality' actually getting good care? Med Care, 41(10), 1173-1182.
doi:10.1097/01.mlr.0000088453.57269.29
Lam, M. B., Figueroa, J. F., Feyman, Y., Reimold, K. E., Orav, E. J., & Jha, A. K.
(2018). Association between patient outcomes and accreditation in US hospitals: observational study. BMJ, 363, k4011. doi:10.1136/bmj.k4011 Lee, R. I., & Jones, L. W. (1933). The Fundamentals of Good Medical Care. Chicago:
University of Chicago Press.
Manian, F. A., Gillman, M., & Spitznagel, E. L. (2012). A Comparison Between Rankings of Top Hospitals by the U.S. News & World Report and the Consumer Reports Patient Ratings: Clarity or Confusion for the Empowered Consumer? Journal of Consumer Health on the Internet, 16(2), 162-169.
doi:10.1080/15398285.2012.673462
Menachemi, N., Chukmaitov, A., Brown, L. S., Saunders, C., & Brooks, R. G. (2008).
Quality of care in accredited and nonaccredited ambulatory surgical centers. Jt Comm J Qual Patient Saf, 34(9), 546-551.
Miller, M. R., Pronovost, P., Donithan, M., Zeger, S., Zhan, C., Morlock, L., & Meyer, G. S. (2005). Relationship between performance measurement and accreditation: implications for quality of care and patient safety. American Journal of Medical Quality, 20(5), 239-252.
Moore, L., Lavoie, A., Bourgeois, G., & Lapointe, J. (2015). Donabedian’s structure-process-outcome quality of care model: Validation in an integrated trauma system. Journal of Trauma and Acute Care Surgery, 78(6), 1168-1175.
doi:10.1097/ta.0000000000000663
Rothberg, M. B., Morsi, E., Benjamin, E. M., Pekow, P. S., & Lindenauer, P. K.
(2008). Choosing the best hospital: the limitations of public quality reporting.
Health Aff (Millwood), 27(6), 1680-1687. doi:10.1377/hlthaff.27.6.1680 Schmaltz, S. P., Williams, S. C., Chassin, M. R., Loeb, J. M., & Wachter, R. M. (2011).
Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation. J Hosp Med, 6(8), 454-461.
doi:10.1002/jhm.905
Shahian, D., Friedberg, M., Hutter, M., & Pronovost, P. (2016). Rating the Raters: The Inconsistent Quality of Health Care Performance Measurement. Ann Surg, 264.
doi:10.1097/SLA.0000000000001631
Shahian, D. M., Normand, S. L., Friedberg, M. W., Hutter, M. M., & Pronovost, P. J.
(2016). Rating the Raters: The Inconsistent Quality of Health Care Performance Measurement. Ann Surg, 264(1), 36-38.
doi:10.1097/sla.0000000000001631
Shaw, C. D. (2004). Toolkit for Accreditation Programs. Retrieved from Australia:
Sinaiko, A. D., Eastman, D., & Rosenthal, a. M. B. (2012). How Report Cards On Physicians, Physician Groups, And Hospitals Can Have Greater Impact On Consumer Choices. Health Affairs, 31(3), 602-611.
doi:10.1377/hlthaff.2011.1197
Weled, B. J., Adzhigirey, L. A., Hodgman, T. M., Brilli, R. J., Spevetz, A., Kline, A.
M., . . . Wheeler, D. S. (2015). Critical Care Delivery: The Importance of Process of Care and ICU Structure to Improved Outcomes: An Update From
the American College of Critical Care Medicine Task Force on Models of Critical Care. Crit Care Med, 43(7), 1520-1525.
doi:10.1097/ccm.0000000000000978
World Health Organization, W. (2000). The World Health Report 2000: health systems: improving performance. Retrieved from Geneva:
中央健保署. (2020). 急性心肌梗塞－指標項目說明. 全民健康保險醫療品質資
訊 公 開 網 . Retrieved from
http://www.nhi.gov.tw/mqinfo/Content.aspx?List=3&Type=AMI#oTable114 王文芬, 吳世望, & 錢才瑋. (2015). 不同層級醫院三高處方用藥重複率改善結
果的比較. [Evaluation of Therapeutic Duplication of Medication in Patients with High Blood Pressure, High Blood Sugar, and High Blood Lipids between Local Hospitals, Regional Hospitals, and Medical Centers in Taiwan]. 醫務管 理期刊, 16(4), 279-293. doi:10.6174/jhm2015.16(4).279
王 俊 文 , 葉 德 豐 , & 曾 坤 儀 . (2003). 台 灣 醫 院 評 鑑 趨 勢 之 探 討 . [The Meta-Analysis for the Trend of Hospital Accreditation in Taiwan]. 中山醫學 雜誌, 14(4), 513-522. doi:10.30096/csmj.200312.0004
石曜堂. (1978). 醫療品質評估. 醫院, 11(2), 4. National Health Insurance: A Preliminary Study on Dental and Primary Care Facilities]. 台 灣 公 共 衛 生 雜 誌 , 25(2), 152-162.
doi:10.6288/tjph2006-25-02-08
張耀懋, & 白佳原. (2016). 民眾對健保醫療品質資訊公開內容觀感之評估.
[Public assessment toward the disclosure of medical quality information]. 醫 院雙月刊, 49(5), 10-21.
陳玉寧. (1996). 醫院評鑑對醫療品質之影響. 高雄醫學大學. Available from Airiti AiritiLibrary database. (1996 年)
陳政志. (2016). 醫院評鑑對醫院產生預期與非預期效果之初探. 臺灣大學.
Available from Airiti AiritiLibrary database. (2016 年)
陳淑如, 盧美秀, 陳靜敏, & 沈宗奇. (2003). 醫院評鑑制度的探討. 台灣醫界, 46(11), 3.
傅立葉. (2007). 全民健保醫療品質資訊公開之社會效益評估. Retrieved from 傅蘭英. (2014). 醫院建立內控機制之探討. [A Study on the Establishment of
Internal Control Mechanism in Hospitals]. 醫院雙月刊, 47(3), 61-71.
黃偉益. (2014). 子宮切除術與發生尿失禁相關因素之探討. (博士), 國立陽明大 學, 台北.
黃莉蓉. (2011). 2007-2010 年新制醫院評鑑結果初探. 醫療品質雜誌, 5(2).
黃 聖 堯. (2001). 醫院評鑑制度對外科系醫療品質之影響. 高雄醫學大學.
Available from Airiti AiritiLibrary database. (2001 年)
楊漢湶, & 王美芳. (1992). 我國醫院評鑑工作之回顧與展望. 醫院, 25(1), 25.
[Challenges and Perspectives of Development in Quality of Care Indicators:
What Else Can We Do?]. 台 灣 公 共 衛 生 雜 誌 , 28(5), 345-360.
doi:10.6288/tjph2009-28-05-01
韓揆. (1994). 醫療品質管理及門診服務品質定性指標. [A Review on Health Care Quality Management and a Proposal upon Indicators for Evaluating Hospital OPD Services]. 中 華 公 共 衛 生 雜 誌 , 13(1), 35-53. 系統. [The Evolution of Healthcare Quality Assessment: From Accreditation to Report Card System]. 台 灣 公 共 衛 生 雜 誌 , 24(4), 275-283.
doi:10.6288/tjph2005-24-04-01
蘇永裕. (2001). 醫院長期經營效率評估. (碩士), 高雄醫學大學, 高雄.