探討適合台灣醫院醫療品質審查組織模式

探討適合台灣醫院醫療品質審查組織模式

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本研究以全國 507 家地區級以上醫院進行調查。在問卷回收後另對國內五家醫院管理階 層人員做專家訪談，以印證研究結果。調查期間為民國九十一年二月至五月，共計問卷 回收 174 份，問卷回收率為 34.3﹪ 。

研究結果發現：有 86.3% 的受訪者認為成立專責醫療品質審查組織是可行的，有 94.1%

的受訪者認為成立專責醫療品質審查組織對醫療品質有幫助；由醫策會或衛生署直接管 理百分比較高；有效推行方式須與評鑑及給付結合；審查層級以二審制百分比較高；審 查組織所涵蓋地區劃分方式，以台灣行政區域劃分為四個審查組織及以健保局所屬區域 分為六個審查組織百分比最高；審查人員除醫師外，還應加入護理人員者佔 93.5% ； 在審查類別方面，以「過程面」平均得分最高，「結構面」得分最低。以評鑑等級區分

，「過程面」與「結果面」有顯著不同（ p<0.05 ），經 Scheffe’s 事後檢定，醫學中心 與地區醫院有統計上顯著差異。建議衛生主管儘速成立專責醫療品質審查組織，以有系 統的、長期性的及客觀性的推動國內醫療品質相關活動，使醫院、病人及健保局成為三 贏局面。

Exploring the Model of Quality Review Organizatio n for Hospital in Taiwan

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Since the Bureau of the National Health Insurance (BNHI) initiated the case payment system, the medical i nstitutions have been cutting off the medical services in order to control the cost, which could resulted in d ownscales of the quality of medical care. To date, the BNHI has no means to monitor the quality of medica l care. Neither has established any open, fair, and justice review systems. As a result, more and more disput es have occurred between the BNHI and hospitals. The need of establishing a organization similar to the pe er review organization (PRO) in the United States to monitor and to ensure the quality of medical care prov ided to the public has been proposed in many studies conducted in the past. The purpose of this research is to explore hospitals’ opinions about the establishment of such review organization. The result will be usefu l to the Department of Health (DOH) in making policies.

A self-administered, anonymous questionnaire was mailed to the 507 hospitals accredited by the DOH in 2 001 as medical centers, regional hospitals, and district hospitals nationwide. In addition, five hospital admi nistrators and managerial-level physicians were interviewed afterward to verify the results. The investigati on period was between the February and May 2002. A total of 174 (34.3%) questionnaires were returned.

The study revealed that 86.3% of hospitals considered the establishment of the quality review organization

to be feasible and 94.1% suggested that such organization should be operated and managed by the Taiwan

Joint Commission on Hospital Accreditation or the Department of Health. Additionally, more than 93.5% o

f respondents suggested that not only doctors, but also the nursing staff should be included in the review gr

oup. Among the review areas, the “Process Phase” got the highest score and the “Structural Phase” got the

lowest. This showed that there was a significant difference in review areas between the “Process Phase” an

d the “Structural Phase” (p<0.05). Via the Scheffe’s post-history testing, a significant difference in review

areas also exists between the medical centers and the regional hospitals. Finally, this research suggests that

the DOH establish the review organization as soon as possible to assure the quality of medical care in hosp

itals in Taiwan.