| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 89 === The National Health Insurance program of Taiwan was started in March,1995. Due to the fee for services payment system, the annual medical expenditure is increasing to become deficit until 1999. The balanced point between quality and expenditure is under investigation by many authors. The Taiwan Joint Commission on Hospital Accreditation (TJCHA),which was established in April,1999,has introduced Quality Indicator Project(QIP) into Taiwan in August, 1999. The Taiwan Quality Indicator Project (TQIP)is derived from the Quality Indicator Project（QIP） Maryland Medical Association(MMA). The impacts and influences of TQIP on the health care quality in Taiwan is concerned by the health care profession.
The purposes of this study are (1) to find out the changes of quality indicators after joining the TQIP and (2) how the clinician’s acknowledgement and understanding of TQIP will affect the indicators of quality and (3)to compare the differences of TQIP quality indicators among Taipei Municipal Hospitals , all TQIP district regional hospitals, and all TQIP hospitals in Taiwan, and all the TQIP hospitals in the world.
The study group includes five Taipei Municipal General Hospitals, they have the same structure style and all they belong to the same district level hospitals. We chose the three quality indicators i.e. total Cesarean rate, hospital mortality rate and unscheduled readmission rate they were routinely collected monthly by the Department of Health of Taipei City Government in recent three years (1998 to 2000)
and those three indicators were happened to have the same definition as in TQIP.
Totally 180 indicator observations were analysed in each indicator by using SPSS version 10.0 for computerization. The comparative group data including district hospitals in Taiwan except the study group hospitals, all Taiwan hospitals and worldwide hospitals which joined the TQIP.
The results of descriptive analysis reveals the average rates of total Cesarean section and admission mortality does not show any significant changes after joining the TQIP, but the unscheduled readmission rate has significant increase after joining the project. But the variation of the data shows significant reduction in these three indicators after joining the TQIP. The study also reveals the average Cesarean section rates in Taiwan area are much higher than those hospitals not in Taiwan. But the admission mortality and unscheduled readmission rate are the same with those hospitals other than in Taiwan by statistics. More than 60% clinicians in Taipei Municipal General Hospitals never heard about TQIP, but most of them have positive attitude to this program.
The spline regression analysis of Cesarean rate, admission mortality and unscheduled readmission rate reveals significant changes in 1998, 1999 and 2000 and most of the hospital differences are also significant in both Cesarean and admission mortality rates.
Multiple regression analysis of these three indicators shows the lower total admission days and the fewer number of clinician made the higher Cesarean rate, the lesser hospital beds the higher Cesarean rate. The higher admission mortality and
unscheduled readmission rate are related to the high total admission days and the fewer hospital beds.
According to the results of this study, the following suggestions are given. In
order to improve the healthcare quality, hospitals should 1) provide everyobstetrician the Cesarean rate data of different medical groups for reference and 2) provide sufficient manpower of clinicians in order to lower the Cesarean rates. 3) increase the medical resources or improve management efficiency and promote the quality of long term care unit to reduce the admission mortality and unscheduled readmission rates. 4) The cause of high Cesarean rate in Taiwan area and the methods to reduce Cesarean rate may need further study.
To TJCHA, hospital grouping and minimal requirement of reported data set for comparison are suggested and The National Department of Health may establish a healthcare quality indicator committee to improve the quality project of healthcare and develop some native indicators such as OPD indicators which are quite different with the other developed countries.
In conclusion, most authors using quality indicators as an effective tool to evaluate the healthcare quality but how to choose suitable and correct indicators and evaluate its efficacy and validity to ensure the medical personnel willing to improve their medicare quality are expected by all healthcare facilities and hospitals.
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