專業觀點與病人觀點健康照護品質之探索型研究

Abstract

背景 在臺灣的全民健保制度下，病人選擇健康照護服務機構之自由度大，且隨著「以病人為中心」的照護模式於國際間盛行，病人觀點健康照護品質開始受到重視。在臺灣，傳統健康照護品質評估主要以專業意見為主，而醫院評鑑為完整且有系統的醫療品質審查機制，近年也將增加過程面的評量基準列為評鑑改革重點，希望藉由醫院評鑑督促醫院提升健康照護之品質。不論是病人報告的品質調查或是醫院評鑑等級的資料，皆是民眾就醫選擇資訊的重要來源。 目的 本研究旨在探討病人觀點與專業觀點健康照護品質間之相關性。 材料與方法 本研究資料來源有二，一為2011年全民健保病人住院服務調查，另一為2007-2010年新制醫院評鑑資料。兩者分別作為病人觀點品質及專業觀點品質之資料來源，將兩資料進行串檔分析，以探討兩者間之關係。病人觀點品質之測量是採用臺灣本土發展，具信效度之病人報告醫院品質問卷 (Patient Reported Hospital Quality)。而專業觀點品質測量則包括傳統專業指標 (主治醫師病床比、住院醫師病床比、護理人員病床比、護理師比例、佔床率及淨死亡率)，以及與人際面照護品質相關之過程面測量。 討論與結論 新制醫院評鑑資料中部分傳統專業品質指標 (住院醫師病床比、護理人員病床比、護理師比例、佔床率)、部分過程面評鑑基準 (對病人之解釋告知相關等)，以及醫院整體評鑑之表現，與病人觀點品質皆有顯著相關。然而，各專業品質變項與醫院規模大小呈相關，且其對病人觀點品質得分之解釋力皆偏低，僅介於4％-5％之間。此外，單就病人感受護理照護向度而言，護理素質相較於護理人員數量來得重要。因此，本研究認為病人觀點品質與專業觀點品質為兩獨立之健康照護品質面向，未來應建構臺灣本土化之病人調查資料蒐集與資訊公開，提供多元的健康照護資訊，以促進病人求醫選擇，並提高市場競爭而提升健康照護品質。

Background Under the national health insurance (NHI) system in Taiwan, patients are free to choose any healthcare providers they prefer for services. Along with the development of “patient-centered care”, quality of care from patient’s perspectives has received increasing attention. Traditionally, healthcare quality was mainly assessed from professional perspectives. Hospital accreditation is a comprehensive and systematic evaluation for hospital care quality in Taiwan. Since 2007, the accreditation system has incorporated “process measures” to better achieve the core value of patient-centered care. Both of the information from patient reported healthcare quality or hospital accreditation level are important sources for patients while choosing a preferred healthcare provider. Objectives

The objective of this study was to evaluate the association between healthcare quality from patient’s perspective and professional perspective. Materials and Methods Data for this study came from two data sources. First, a survey of discharged patient (reporting hospital quality) conducted on 2011 was used as the source of patient’s perception of healthcare quality. Second, an administrative data of hospital accreditation from 2007 to 2010 was used as the source of professional perspective. The two data files were combined and analyzed. The measurement of patient perceived quality of care in this study was the “patient reported hospital quality, PRHQ” which was a verified, structured questionnaire. Traditional quality indicators used in the study included “physician to bed ratio” “resident to bed ratio”, “nurse to bed ratio”, “RNs to nurse ratio”, “net mortality rate”, and “occupancy rate”. The process measures of quality included measurements about interpersonal quality of healthcare. Disscussion and Conclusion Major results of this study were as follows. First, several traditional quality indicators such as “resident to bed ratio”, “nurse to bed ratio” , “RNs to nurse ratio”, and “occupancy rate”, and several process measures were associated with the score of PRHQ. However, all of these professional measures were closely associated with the scale of the hospital and could account for only a minor portion of the variance in PRHQ scores. Moreover, we also found that quality of the nursing staff was more important to patient’s perception of nursing performance than quantity of nursing staff. These findings implied that the measures from patient perspectives and from professional perspectives might be two independent dimensions for measuring quality of hospital care. Providing quality information from various perspectives might facilitate patient’s selection of healthcare providers and improve quality of care via market competition.