An Analysis of Hospital Cancer Care Resources and Contentsfor Cancer Inpatients in Taiwan

• Main Authors: Ya-Yun Lu, 呂雅雲
• Other Authors: Kuo-Piao Chung
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/31759125187229670474

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 95 === 　　Ensuring cancer care quality is an international concern of cancer control. In England, NHS structured the cancer care network and published guidances to improve the cancer survival rate and reduce the delay between diagnosis and treatment. The Institute of Medicine considered that most cancer patients in the United States do not receive appropriate cancer care, and the providers should take responsibility for ensuring quality cancer care. In Taiwan, “Cancer Control and Prevention Centers” were set up to provide comprehensive cancer care and collect detailed clinical data since year 2001, and the Cancer Control Act was promulgated in year 2003. The hospital-based cancer care data is lacking and could be applied to the evaluation of cancer care provided from specific hospital types. 　　The purposes of this study include: (1) To understand the description of hospital cancer care in Taiwan, including the cancer care volume, organization, specialties, equipment, and the cancer care contents for cancer inpatients. (2) To analyse the diversity of cancer care volume among hospitals with different characteristics or cancer care contents. 　　All hospitals of research interests are accredited above district hospitals in Taiwan and provide at least six kinds of cancer including the breast, cervical, liver, colonrectal, lung and oral cancer care. A structural questionnaire was developed and mailed to 297 hospitals. The total response rate is 25.59 percent ( 76/297 ) , and response rate at medical centers and regional hospitals is 42.86 percent ( 36/84 ). Hospital characteristics and the cancer care volume including the number of inpatients, days of stay and average length of stay were calculated from National Health Insurance Research Database, and the number of new diagnostic patients was calculated from Taiwan Cancer Registry Database. 　　The major findings of this study are as follows: (1) The rate hospitals managing cancer patients by multidisciplinary teams was 59.09% ; the rate hospitals providing clinical trials information and accruing patients was 56.82% ; the rate hospitals formulating or adhering to cancer clinical practice guidelines was 68.18% ; the rate hospitals with cancer support group was 62.79%, and breast cancer support group is the most general one ; the rate hospitals offering cancer-related educational activities was 90.91% ; the rate hospitals with follow-up , mortality and survival documents were in sequence 45.45% , 47.73% , and 43.18% . (2) Cancer care volume was significantly related to hospital characteristics, such as accredited level, teaching status, ownership, submitting cancer care data to Taiwan Cancer Data Base (TCDB) , membership of Taiwan Cooperative Oncology Group (TCOG) and the arrangement of specialty division. It was also significantly related to cancer care contents inclusive of clinical trials, clinical practice guidelines and documents of patients’ follow-up and surveillance. (3) The distribution of the cancer care volume was skewed to the right. Hospital cancer care service was concentrated at medical centers and regional hospitals but spread around. After the Cancer Control Act came into effect, hospitals are paying more attention to cancer care contents and improving the quality of cancer care. 　　According to the research results, we recommended that the health authorities should monitor the quality of cancer care, approve well-performed hospitals and announce to the public the function of cancer centers. The health care providers should enhance the practical operation of clinical practice guidelines, multidisciplinary teams, and the documents of patients’ follow-up and surveillance. Future researchers could explain the cancer care service in Taiwan by other source of data, for instance using Taiwan Cancer Data Base (TCDB) to attain the stage data and explore the patterns of cancer care, and using the accreditation data to attain more hospital characteristics.