探討改善醫院品質策略與急性心肌梗塞照護過程及結果之關係

Abstract

背景：在台灣，心血管疾病位居前十大因死因，急性心肌梗塞的發生率與死亡率有下降的趨勢，然而在不同醫院照護結果存在差距，醫院執行醫院策略，提升照護結果，但是目前醫院策略與照護結果的相關性仍不明確。 目的：瞭解台灣醫院目前針對急性心肌梗塞的照護品質改善策略實施的狀況，並探討醫院策略與照護過程及結果的相關性。 方法：本研究使用郵寄問卷調查，研究對象為中央健康保險署醫療品質資訊公開網，所公開之急性心肌梗塞疾病照護醫院，共98家醫院。將問卷結果與醫療品質公開網過程及結果指標結合，控制醫院特性與病人特性，使用複迴歸分析，探討醫院策略與策略數量與照護過程及結果之相關性。 結果：本研究回覆問卷共71家醫院，回收率達72.45%，且具樣本代表性。執行醫院策略與照護過程及結果有關，且醫院策略執行數量與照護過程呈現正相關。 討論與結論：醫院策略與照護過程及結果有相關性，衛生主管機關可藉由政策引導，鼓勵醫院推行改善急性心肌梗塞照護過程及結果的策略；醫療服務提供者也可逐步提升醫院策略執行的數量，或可改善急性心肌梗塞病人的照護過程及結果。

Objective: The objective of this study was to understand the current situation of hospital quality improving strategies for acute myocardial infarction (AMI) in Taiwan. Furthermore, this study also explored the associations of hospital quality strategies with processes and outcomes of care for acute myocardial infarction. Method: A total of 98 hospitals were selected as study samples. A structured questionnaire was developed and mailed to executive officers of the hospitals to measure the implementation of hospital strategies. The study combined the public data of acute myocardial infarction report cardfrom the National Health Insurance Administration with the results of questionnaire. Multiple regression analysis was applied in this study in order to explore the associations of implementation of hospital strategies with processes and outcomes of care for acute myocardial infarction. Results: The response rate was 72.45%. The response sample was representative.The implementation of hospital strategies was associated with better processes and outcomes of care for acute myocardial infarction, and the number of hospital strategies was associated with better processes. Conclusion: The implementation of hospital strategies was associated with processes and outcomes of care. According to the result, health policy makers can encourage hospitals to implement strategies for improving AMI care. Moreover, health services providers can also focus on increasing the numbers of hospital strategies to improve processes and outcomes of care for AMI.