The research of health care structure quality and outcome quality in health care markets

• Main Authors: Ta-Wei Luo, 羅大維
• Other Authors: Shou-Hsia Cheng
• Format: Others
• Language: zh-TW
• Online Access: http://ndltd.ncl.edu.tw/handle/01019674182853154913

碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 97 === Objective: The objective of this paper is to examine the relationship between the structural measures of quality and outcome measures of quality. Methods: This study was a cross-sectional design. The data used in this study came from two sources: the 2002 and 2004 Hospital Discharged Patient Surveys and the National Health Insurance Research Databases (NHIRD) in Taiwan. We included patient discharged from hospital accredited as district teaching hospital and above and included patients with a diagnosis of diabetes mellitus, stroke, asthma or pneumonia. The structural measures of quality included physician-to-bed ratio, nurse-to-bed ratio, the percentage of registered nurse, the number of high-tech equipments, the number of acute beds and the number of ICU beds. The outcome measure of quality was divided into two parts: subjective and traditional objective quality of care measures. Subjective patient-perceived quality of care was measured by ratings of interpersonal skill and clinical competence. The traditional objective quality of care was measured by the readmission within 30 days of index discharge. The linear regression and logistic regression were applied to examining the relationship between the structural measures of quality and outcome measures of quality. Results: Results indicated that (1) hospitals with high nurse-to-bed ratios and with high hi-tech equipments were associated with significantly better interpersonal skill scores than those with low nurse-to-bed ratios and with low hi-tech equipments. (2) In addition, we also found that hospitals with higher structural measures of quality (including physician-to-bed ratio, nurse-to-bed ratio, the percentage of registered nurse, the number of high-tech equipments, the number of acute beds and the number of ICU beds) were associated with significantly better clinical competence scores that those with low structural measures of quality. (3) We found that the negatively association between the percentage of registered nurses and readmission within 30 days of discharge. Conclusion: Hospital with higher structural measures of quality is associated with higher outcome measures of quality, in terms of either subjective quality or traditional objective quality. According to our findings, we suggested that the government should incorporate the quality of hospital staff in the hospital accreditation system.