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研究生:曾荃璞
研究生(外文):Chuan-Pu Tseng
論文名稱:住院病人主觀評價與客觀照護結果之關聯
論文名稱(外文):The Association between Subjective Assessment of Inpatients and Objective Healthcare Outcome Measures
指導教授:鄭守夏鄭守夏引用關係
指導教授(外文):Shou-Hsia Cheng
口試委員:董鈺琪邱尚志
口試委員(外文):Yu-Chi TungShang-Jyh Chiou
口試日期:2022-01-12
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:健康政策與管理研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:121
中文關鍵詞:病人經驗調查30日內再入院病人滿意度
外文關鍵詞:patient experience30-day readmissionpatient satisfaction
DOI:10.6342/NTU202200467
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背景:在國際間提倡「以病人為中心」的醫療照護氛圍下,病人觀點的醫療品質測量逐漸受到關注。近年來各國積極發展病人經驗調查,如美國的CAHPS(Consumer Assessment of Healthcare Providers and Systems)、英國的PPE(Picker survey of patient experiences questionnaire)等,臺灣雖有「病人報告之醫院品質調查」,但無大規模定期的執行調查,相關研究也尚有不足。
研究目的:本研究欲比較主觀評價與客觀的照護結果評估的關聯性,爰透過探討「病人住院經驗」與「照護結果指標」的相關性以獲得解釋。同時,藉由分析研究對象就醫醫院的特質、人口學特徵及疾病狀況等,瞭解影響病人經驗的因子。
研究方法:本研究為橫斷性調查研究。透過健保署於2018-2019年在全國進行的「住院病人就醫經驗調查」委託計畫,獲得研究對象在住院期間的病人經驗資料,包含對醫院的整體評分及推薦程度等。接著,與健保申報資料連結,瞭解研究對象出院後的醫療利用情形,包含3日內再急診及30日內再入院,做為照護結果的指標。透過檢定及迴歸分析,驗證病人經驗與照護結果的關聯性。
研究結果:最終納入研究N=3,244。羅吉斯迴歸的結果顯示,在控制醫院特質和病人特質等變項後,醫院整體評分給予高分者,30日內再入院的OR=0.728、中等組OR=0.804,顯示相較於低分組再入院的風險較低,但相關性未達統計上顯著。在推薦意願方面,願意推薦醫院者再入院OR=1.169 (95%CI=0.736-1.857),兩者間無顯著的關聯性。此外,其他特質包含醫院層級、教育程度、調查方式、入院管道、就醫科別、是否接受手術及住院天數,經統計與整體評分和推薦意願顯著相關,為病人評價可能的影響因子。
結論:雖然本研究顯示病人住院經驗調查結果與專業面照護指標無顯著相關,卻也象徵病人觀點的醫療品質測量是重要且無可取代的。建議衛生主管機關應定期辦理病人經驗調查,並做為醫療院所費用給付的參考,以改善病人觀點的醫療品質,提升以病人為中心照護。
Objectives: Delivering patient-centered care is an important issue of health care system worldwide. Meanwhile, patient experience is thought to be a key quality metric that represents patients’ perception of healthcare quality. The purpose of this study is to determine whether patients’ perception of their care correlates with healthcare outcomes, and what are the key characteristics of hospitals and patients that associated with better experience.
Methods: A cross-sectional study was conducted using the Patient Experience of Hospital Care survey (PEHC) in 2018-2019. Among patients aged 20 or older, data of two overall ratings: global rating and recommendation of the hospital were collected. Then, 3-day emergency department visit and 30-day readmission were examined as the indicators of the quality of hospital care. A multivariable logistic regression analysis was performed to determine the association between patient-reported measures and short-term healthcare outcomes.
Results: The sample included 3,244 patients. In adjusted analyses, the odds of 30-day readmission were lower among patients in the highest global rating group relative to the least, although the association was not significance (Odds ratio [OR] for readmission, 0.728; 95% confidence interval [CI], 0.454-1.168). On the other hand, the odds of readmission were higher in patients who would recommend the hospital, but there’s no significant association (OR, 1.169; 95% CI, 0.736-1.857). In addition, the results revealed that patient-reported overall ratings were associated with hospital accreditation levels, education level, survey modes, admission route, medical department, surgery and length of stay.
Conclusions: Since there’s no significant association between patient experience and objective outcomes, this finding suggests that patients’ perception information can be a meaningful and unique healthcare quality indicator. We are hopeful that regular reporting of patient experience survey will improve patient-centered care.
目錄
口試委員會審定書 I
謝 辭 II
摘 要 III
Abstract IV
第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 2
第三節 研究目的 3
第二章 文獻回顧 4
第一節 病人就醫經驗調查 4
第二節 影響病人就醫經驗之因素 9
第三節 病人評價與照護結果之關聯性研究 13
第四節 文獻回顧小結 21
第三章 研究方法 22
第一節 研究設計 22
第二節 研究架構及研究假說 23
第三節 研究材料 24
第四節 變項操作型定義 26
第五節 統計分析方法 33
第四章 研究結果 34
第一節 描述性統計 34
第二節 雙變項分析 41
第三節 多變項分析 55
第五章 討論 69
第一節 研究結果討論 69
第二節 研究假說驗證 77
第三節 研究限制 78
第六章 結論與建議 80
第一節 結論 80
第二節 建議 82
參考文獻 84
附 錄 94
圖目錄
圖3-1 研究架構圖 23
圖4-1 樣本篩選流程圖 35
表目錄
表2-1 病人就醫經驗之影響因素文獻整理 11
表2-2 病人評價與照護結果之關聯性文獻整理 18
表3-1 研究變項之操作型定義 31
表4-1 描述性統計:樣本特性分析(N=3,244) 39
表4-2-1 雙變項分析:3日內再急診與病人評價、醫院及病人特質(N=3,244) 47
表4-2-2 雙變項分析:30日內再入院與病人評價、醫院及病人特質(N=3,244) 49
表4-2-3 雙變項分析:醫院整體評分與醫院特質、病人特質(N=3,244) 51
表4-2-4 雙變項分析:推薦意願與醫院特質、病人特質(N=3,244) 53
表4-3-1 多變項分析:30日內再入院之羅吉斯迴歸分析(N=3,244) 59
表4-3-2 多變項分析:出院櫃台發放─30日再入院之羅吉斯迴歸(N=1,510) 61
表4-3-3 多變項分析:郵寄問卷─30日內再入院之羅吉斯迴歸分析(N=1,734) 63
表4-3-4 多變項分析:郵寄問卷─整體評分之羅吉斯迴歸分析(N=1,734) 65
表4-3-5 多變項分析:郵寄問卷─推薦意願之羅吉斯迴歸分析(N=1,734) 67
附錄二 原始問卷總樣本的特性分析(N=11,202) 101
附錄三 串聯健保資料庫後樣本的特性分析(N=4,992) 103
附錄四 調查方式之次群體分析結果(N=4,992) 105
附錄五 多變項分析:3日內再急診之羅吉斯迴歸分析(N=3,244) 107
附錄六 出院櫃台發放(整體評分)-30日再入院之羅吉斯迴歸分析(N=1,510) 109
附錄七 出院櫃台發放(推薦意願)-30日再入院之羅吉斯迴歸分析(N=1,510) 111
附錄八 郵寄問卷-整體評分之複迴歸分析(N=1,734) 113
附錄九 雙變項分析:出院後不良照護結果(再急診或再入院)(N=3,244) 115
附錄十 多變項分析:出院後不良照護結果(再急診或再入院)(N=3,244) 117
附錄十一 樣本特性分布比較表 119
附錄十二 共線性檢定:變異數膨脹因子(Variance Inflation Factor, VIF) 121
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