醫院推行實證醫學現況、醫師認知與推行態度及其影響因素探討

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醫院推行實證醫學現況、醫師認知與推行態度及其影響因素探討 - 以台北市區域級以上醫院為例

 本研究之主要目的在於瞭解台北市區域級以上醫院推行實證醫學的現況，醫師參與實證醫學之情形及應用上的障礙，並探討醫師對實證醫學的認知與推行態度，及其影響因素，期能作為醫院管理者推動實證醫學之參考。

本研究為橫斷性研究，以台北市區域級以上之醫院為研究對象，研究內容分為質性研究與量性研究兩部份，在質性研究方面，針對 5 位已推行實證醫學之醫院關鍵人進行深入訪談，以了解醫院推行實證醫學之實際情形。量性研究方面，以結構式問卷進行調查，以了解醫師對實證醫學之認知與推行態度，問卷共發出 3,776 份，回收之有效問卷為 757 份，回收率為 20.05% 。

本研究之主要結果如下：

一、醫院推行實證醫學現況：目前台北市區域級以上醫院中，有 5 家醫院已開始推動實證醫學，另有 3 家醫院表示正在規劃中。

二、醫師參與實證醫學相關活動情形：有 37.9% 醫師過去曾參與實證醫學相關課程，但有 91.3% 表示未來願意參與實證醫學相關活動。

三、醫師在應用實證醫學所遭遇到的障礙主要依序是缺乏實證醫學教育訓練（ 49.3% ）、沒有時間（ 48.1% ）。

四、醫師對實證醫學之認知與推行態度及其影響因素：

1 、醫師對實證醫學英文名詞的了解程度方面，醫師對各項實證醫學英文名詞的了解程度平均分數介於 2.56 至 3.51 分之間（以非常了解為 5 分，

完全不了解為 1 分）。而推行範圍、執業年資、過去是否曾參加實證醫學課程及過去參加實證醫學課程時數對醫師對實證醫學英文名詞的了解程度有顯著影響。

2 、受訪醫師對各項實證醫學敘述的贊同程度平均分數介於 3.04 至 4.12 分之間（以非常贊同為 5 分，完全不贊同為 1 分）。而是否擔任教職、未來參與實證醫學相關活動意願及身邊其他人的贊同程度對於醫師對實證醫學敘述的贊同程度有顯著影響。

3 、醫師自評診療中符合實證醫學的程度平均為 54.42% 。而醫院權屬別、

是否擔任教職與身邊其他人的贊同程度對於醫師自評診療中符合實證醫學的程度有顯著影響。

4 、醫師自評診療中符合實證醫學的合理程度平均為 72.63% ，而醫院權屬別與身邊其他人的贊同程度對於醫師自評診療中符合實證醫學的合理程度有顯著影響。

根據研究結果，本研究提出下述建議：一、建議衛生主管機關可成立全國性的實證醫學中心，積極鼓勵醫療院所推行實證醫學，也可考慮將實證醫學的相關教育訓練納入醫院評鑑。二、建議教育單位可將實證醫學相關的課程納入正規醫學教育，使醫師未來能更順利、迅速且正確的將實證醫學的方法應用在臨床的診療中。三、醫院若欲推行實證醫學，建議可設置專責單位或運用任務編組的方式成立推動小組或委員會，以整合相關資源及給予醫師適當的援助。四、後續研究者可在實證醫學的推行一段時間後，再調查醫師對其認知與推行態度及應用實證醫學的程度是否有不同，以了解實證醫學推行之成效。

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The Implementation EBM in Hospitals in Taipei City and Fa ctors Influencing Physicians''Attitude Toward

Applying EBM

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After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

　　 The study samples include about 128 regional (and above) teaching hospitals in Taiwan. A questionnaire will be sent to each hospital for collecting related information. An interviewer will be sent to those hospitals without providing sufficient inf ormation for collecting supplemental information. All the data collected was linked to the National Hospital Survey conducte d by the Department of Health, the Executive Yuan for analysis. Data collected from the questionnaire including quality mana gement programs promoted in hospitals, beginning time of each program, and some hospital performance indicators over the past decade (1993-2004). The response rate was 54.68%. GEE regression was then applied to analyze the longitudinal impact of quality management activities on hospital performance.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

In conclusion, the results proved that quality management activities have positive effects on hospital performance. In other wo rds, promoting health care quality will lead to better hospital performance. Therefore, we suggest hospital administrators to de sign a long term plan to promote quality management activities continuously.

醫院推行實證醫學現況、醫師認知與推行態度及其影響因素探討

The Implementation EBM in Hospitals in Taipei City and Fa ctors Influencing Physicians''Attitude Toward

Applying EBM

After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

Keywords: Quality management activities, Hospital performance,

Longitudinal study

醫院推行實證醫學現況、醫師認知與推行態度及其 影響因素探討

The Implementation EBM in Hospitals in Taipei City and Fa ctors Influencing Physicians&apos;&apos;Attitude Toward

Applying EBM

After the implementation of the National Health Insurance in Taiwan in 1995, the competition among hospitals in Taiwan incr eased dramatically. Therefore, for

attracting more patients, many hospitals invest a lot on many quality management activities, such as TQM, QCC, developmen t of clinical pathway, ISO standards, suggestion system, reengineering, 5S, EBM, learning organization, six sigma, QIP, etc.

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It&apos;s expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.

The results were as follows:

1. The Quality indicator project and clinical pathway are the most popular quality activities in Taiwan now.

2. EBM and six sigma have remarkable impacts on hospital overall performance.

3. TQM, reengineering, 5S, and EBM have significant and positive impacts on physician productivity.

4. TQM and EBM have significant positive influences on occupancy ratio.

5. The more the hospital management activities, the higher the physician productivity and hospital performance.

6.The increases of ”inpatient days”, ”outpatient visits”, ”staff satisfaction”, ”patient satisfaction”, ”quality of administration”,

”hospital overall reputation”, ”hospital operation”, and ”control of average length of stay” and reduction of” malpractice reduc tion” were attributed to quality management activities.

Keywords: Quality management activities, Hospital performance,

Longitudinal study

醫院推行實證醫學現況、醫師認知與推行態度及其影響因素探討

The Implementation EBM in Hospitals in Taipei City and Fa ctors Influencing Physicians''Attitude Toward

However, no empirical study has been conducted for examining the relationship between quality management activities and h ospital performance. It's expected to examine the relationship between quality management activities and hospital perfo rmance in this study longitudinally.