品質資訊公開對於急性心肌梗塞照護過程與結果之影響

Abstract

研究背景：品質報告卡已成為加速品質改善的最廣泛提倡的策略之一。為提升急性心肌梗塞照護品質，中央健康保險署自102年10月實施急性心肌梗塞品質報告卡。 研究目的：探討醫療品質資訊公開對急性心肌梗塞照護過程與結果之影響。 研究方法：本研究使用中央健康保險署急性心肌梗塞醫療品質資訊公開之2011年上半年至2014年上半年資料，總計115家醫院納入分析，利用廣義估計方程式(Generalized Estimating Equations, GEE)控制病人特性、醫院特性及時間趨勢，探討醫療品質資訊公開對急性心肌梗塞照護過程與結果之影響。為深入瞭解醫療提供者對於品質資訊公開之看法與因應，本研究也針對3位醫院管理階層與3位心臟內科醫師進行深度訪談。 研究結果：醫療品質資訊公開與血脂低密度脂蛋白檢測比率、阿斯匹靈給藥比率、乙型阻斷劑給藥比率及血管收縮素轉換酶抑制劑或血管張力素受體阻滯劑給藥比率、3日內急診返診比率及14天內再住院比率變化無關。資訊公開指標項目及醫師對此政策瞭解程度可能影響急性心肌梗塞資訊公開之成效。 結論：醫療品質資訊公開對急性心肌梗塞照護過程與結果之改善，初期未有影響，尚待評估長期影響。

Backgrounds: Report Cards have emerged as one of the most widely advocated strategies for accelerating quality improvement. In order to promote quality of care in acute myocardial infarction, the acute myocardial infarction report card has been implemented by the National Health Insurance Administration since October 2013. Objectives: The main purpose of this study was to evaluate the impact of a quality reporting program on processes and outcomes of care for acute myocardial infarction. Methods: This study used the public data of acute myocardial infarction report cards from the first half of 2011 to the first half of 2014 from the National Health Insurance Administration. A total of 115 hospitals were selected for analysis. Generalized Estimating Equations (GEE) models were used after adjustment for patients and hospitals characteristics, and time trend to examine the effect of a quality reporting program on processes and outcomes of care for acute myocardial infarction. We also conducted an in-depth interview with three hospital managers and three cardiologists to better understand their opinions and responses on acute myocardial infarction report cards. Results: The implementation of a quality reporting program was not associated with changes in the rates of low-density lipoprotein cholesterol (LDL-C) test, aspirin use, beta-blocker use, angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs) use, 3-day return to the emergency department, and 14-day readmission. The measured indicators of report cards and the level of cardiologists’ awareness about the program may affect the effectiveness of acute myocardial infarction report cards. Conclusions: The implementation of the quality reporting program does not initially affect improvements in processes and outcomes of care for acute myocardial infarction. The long-term effects of the program need to be evaluated.