探討醫院品質策略、緊急醫療能力分級與腦中風照護品質及利用之關係

Abstract

背景與目的：中風所導致的長期失能與隨之而來的財務負擔是很沉重的。為提升照護品質，各國均發展出多元的策略與監測指標。從文獻回顧可以發現，策略對於照護品質的影響並不一致，再加上目前相關的研究較多是針對單一策略的介入，來探討其介入後的照護品質，較少針對醫院整體執行策略的情形與照護品質的相關性進行探討。因此，本研究希望以問卷的方式，了解台灣醫院品質策略執行的狀況，並結合目前醫療品質公開網上的中風照護指標，探討兩者的相關性。 方法：本研究以郵寄的問卷作為資料來源，研究對象為105年全民健康保險醫療品質資訊公開網中6項中風指標均有公布之154家醫療院所。將問卷結果與中風指標結合並進行複迴歸分析，探討醫院品質策略、緊急醫療能力分級與腦中風照護品質及利用之關係。 結果：收回的問卷共有94份，回覆率為61.04 %，並具有樣本代表性。有電腦化醫令系統之醫院，其住院日起180日內之平均住院日數較低（P＝0.042）；有提供中風出院病人書面文件/衛教資料之醫院，其住院日起180日內之平均住院醫療費用較低（P＝0.043）。中風緊急醫療能力為中度級或重度級的醫院有較低的平均住院日數（P＝0.001；P＝0.007），以及較低的平均住院醫療費用（P＝0.002；0.012）。 結論：醫院若有電腦化醫令系統、有提供中風出院病人書面文件/衛教資料，或是醫院擁有中度或重度之中風緊急醫療能力，即與較好的中風照護結果有關。但是，醫院品質策略與中風緊急醫療能力對於中風的照護過程品質（出院時、住院1日內、住院2日內有處方抗血栓藥物的比率）並沒有顯著的影響。

Background: Stroke can cause long-term disability and heavy financial burdens. To improve quality of stroke care, many countries develop various strategies and indicators to measure stroke care. Through a literature review, I found that the impact of improvement strategies on healthcare outcomes is inconsistent, and research studies focus more on a single strategy intervention, rather than the overall stroke improvement strategies in the hospital. Therefore, this research intends to understand current improvement strategies in hospitals by using a questionnaire and evaluating the associations among those strategies and indicators of stroke care. Methods: A structured questionnaire was mailed to 154 hospitals specifically selected for their complete online indicators. This research evaluated the associations of improvement strategies in the hospitals, emergent rescuer responsiveness levels and quality and utilization of stroke care by using multiple regression analysis. Results: The response rate was 61.04%, and the sample was representative. The hospitals that implemented computerized physician order entry were associated with lower length of stay (P=0.042). The hospitals that provided stroke education booklets during discharge were associated with lower medical expenses (P=0.043). The hospitals that had a moderate or severe emergent rescuer responsiveness level of stroke care were associated with lower length of stay (moderate: P=0.001; severe: P=0.007) and lower medical expenses (moderate: P=0.002; severe: P=0.012). Conclusions: Computerized physician order entry and providing stroke education booklets along with emergent rescuer responsiveness level of stroke care lead to better care outcomes. However, these strategies and levels show no significant impact on the process of stroke care, which includes physicians prescribing anticoagulant within 24 and 48 hours and when patients leave.