| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 99 === The well-known Institute of Medicine (IOM) report “ To Err is Human--Building a Safer Health System” has documented that nearly 44,000 to 98,000 persons were dead annually in USA due to preventive medical adverse events. This report raise the serious concern of “Patient Safety” in the developed countries and researchers began to indulge in the investigations of relevant issues.
In recent years, several medical errors relentlessly occur in Taiwan. The researches related to “Patient Safety” are rapidly growing. Most of these studies are based on reporting system and Safety Culture Surveys. In addition, most of these investigations are limited to the experience of a single institute, which cannot be generally applied to other organizations. Indeed, the Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Research and Quality (AHRQ) has tried to tackle this limitation. The PSI indicators use the hospital administrative data to screen the potential problems of Patient Safety. Until now, there have been mounting literature using AHRQ PSIs as a tool to assess patient safety situations in several countires. However, there is no investigation using AHRQ PSIs as a measurement of Patient Safety in Taiwan. In addition, there is minimal research to apply our National Health Insurance claims of service to evaluate the current Patient Safety and its trend in Taiwan.
This aims of this study were using the claims data of our National Health Insurance (2000 ~2006) to assess patient safety performance of hospitals in Taiwan by using AHRQ PSI indicators; to compare the effects of medical adverse events on the length of stay, costs and mortality rate; and to compare with UK and US.
Our results show that the index of comorbidity related operation or post-operation increased over time. The medical adverse events increased the average length of stay (0.03~14.89 days), the cost of medical expense (166~132,064 NTD), and the rate of mortality (0.11~13.41%). Compared to UK and US, most Patient Safety indicators of Taiwan were better. The excess length of stay due to the adverse events in Taiwan was similar to these two countries although the increased cost was higher than them. Regarding to the mortality due to Patient Safety problems, Taiwan was lower.
We suggest the central health agencies should using ICD-10 as the code for the National Health Insurance as soon as possible because it has more clear disease classification and codes and they should also expend the number of diagnostic codes and management to have more accurate presentations of patients’ conditions.
AHRQ PSIs is a convenient, inexpensive, and comprehensive measurement to evaluate the Patient Safety. We suggest the Health agencies to apply AHRQ PSIs as a screening tool in the monitoring of medical adverse events, and use it to set goals for medical organizations according to their changes of tendency in this measurement and monitor their efforts on Patient Safety.
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