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題名：基層醫師對實施品質報告卡之意願與相關因素
書刊名：臺灣公共衛生雜誌
作者：蔡文正／陳慧珊 引用關係／龔佩珍／吳守寶／楊志良
作者(外文)：Tsai, Wen-chen／Chen, Hui-shan／Kung, Pei-tseng／Wu, Shou-bao／Yang, Chin-liang
出版日期：2007
卷期：26:2
頁次：頁149-160
主題關鍵詞：品質報告卡；醫療品質；基層診所；Quality report card；Quality of care；Primary care physician
原始連結：連回原系統網址new window
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  • 共同引用共同引用:38
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目標：本研究希望能了解基層醫師對健保實施品質報告卡之參與意願及相關態度與認知，同時瞭解醫師對品質報告卡相關指標重要性之看法。 方法：針對臺灣具健保特約之基層診所醫師，依各縣市家數比例隨機抽取4000位開業醫師。以結構式問卷藉由郵寄方式進行調查，有效回收問卷574份。除了描述性分析外，利用羅吉斯迴歸分析探討影響基層開業醫師是否贊成實施品質報告卡之相關因素。 結果：69%的基層開業醫師贊成實施品質報告卡，61%的基層開業醫師願意加入，84%的基層開業醫師表示應以自由加入的方式，並有73%的基層開業醫師認為需要分科別。希望由醫師相關公會來舉辦與公告，並透過網路作為公告管道，而資料更新的週期以一年為佳。對於是否贊成實施品質報告卡之影響因素，包含「小兒科醫師」(勝算比0.54) 與「實施後會造成壓力」愈高者 (勝算比0.77)，其贊成實施品質報告卡的機率顯著較低；醫師對「實施後醫師對病患更用心」 (勝算比1.38)、「實施後對醫療或服務品質有助益」 (勝算比2.61)、「以品質報告卡的結果為依據給予實質獎勵」 (勝算比2.96) 之認同程度愈高，其贊成實施品質報告卡的機率顯著較高。 結論：由本研究結果可知大部分基層開業醫師贊成實施品質報告卡，認為品質報告卡對醫療服務品質有正面影響認知之基層開業醫師愈贊成實施品質報告卡。
Objectives: This study aimed to understand the willingness, attitudes, and perceptions of primary care physicians toward implementing a quality report card program and associated factors. We also investigated physicians’ opinions about the importance of quality-related indicators. Methods: The studied population comprised primary care physicians who had contracted with the Bureau of National Health Insurance. Four thousand primary care physicians were randomly sampled according to numbers of clinics in counties/cities. Structured questionnaires were mailed out and a total of 574 valid questionnaires were returned. Besides description statistics, we used multivariate logistic regression to analyze underlying factors affecting attitudes of primary care physicians toward supporting implementation of a quality report card program. Results: Sixty nine percent of physicians agreed that a quality report card program should be implemented, and 61% agreed to participate in the proposed program. Eighty four percent agreed that physicians should have free choice to participate. Furthermore, 73% thought the quality report card should be designed based on different medical departments and that the program should be administered by physician associations with reports updated annually and published on the Internet. Regarding associated factors supporting implementation of the quality report card program, pediatricians (OR=0.54) and physicians who agreed that implementation would increase stress (OR=0.77) were less supportive. Physicians who agreed that implementing a quality report card program would influence doctors to pay more attention to patients (OR=1.38), or who believed that program implementation would improve the quality of care and services (OR=2.61), or who agreed to receive financial incentives according to results of quality report cards (OR=2.96) were more supportive. Conclusions: Most primary care physicians agreed with implementing a quality report card program. Physicians with positive perceptions of the influence of quality report cardson medical service quality tend to be more supportive of implementing the quality report card program.
期刊論文
1.Hibbard, Judith H.、Stockard, Jean、Tusler, Martin(2003)。Does Publicizing Hospital Performance Stimulate Quality Improvement Efforts?。Health Affairs，22(2)，84-94。  new window
2.Epstein, A.(1995)。Performance reports on quality--prototypes, problems, and prospects。N Engl J Med，333，57-61。  new window
3.Bodenheimer, T.(1999)。The American health care system--physicians and the changing medical marketplace。N Engl J Med，340，584-588。  new window
4.Slovensky, D. J.、Fottler, M. D.、Houser, H. W.(1998)。Developing an outcomes report card for hospitals: a case study and implementation guidelines。J Healthc Manag，43，15-35。  new window
5.Longo, D. R.、Land, G.、Schramm, W.、Fraas, J.、Hoskins, B.、Howell, V.(1997)。Consumer reports in health care: Do they make a difference in patient care?。JAMA，278，1579-1584。  new window
6.Harris, N.(1994)。Report cards, part 2: how hospitals measure up。Bus Health，12，20-24。  new window
7.Epstein, A. J.(2006)。Do cardiac surgery report cards reduce mortality? Assessing the evidence。Med Care Res Rev，63，403-426。  new window
8.龔善美(20050300)。專業醫療服務品質報告。全民健康保險，54，11-13。  延伸查詢new window
9.Scanlon, D. P.、Chernew, M.、Mclaughlin, C.、Solon, G.(2002)。The impact of health plan report cards on managed care enrollment。J Health Econ，21，19-41。  new window
10.黃明和、吳尤君、張筱雯、楊朝欽、顏裕庭(20010200)。醫療費用的上昇。臺灣醫界，44(2)，55-58。  延伸查詢new window
11.勞寬、張文麗、林恆慶(20021200)。品質報告卡簡介。醫院，35(6)，38-46。  延伸查詢new window
12.Hibbard, J. H.、Stockard, J.、Tusler, M.(2005)。Hospital performance reports: impact on quality, market share, and reputation。Health Affairs，24，1150-1160。  new window
13.陳楚杰、楊銘欽、林恆慶(20040100)。門診病人對醫院品質報告卡需求之初探。醫護科技學刊，6(1)，29-42。new window  延伸查詢new window
14.Hochhauser, M.(1998)。Why patients have little patience for report cards。Managed Care，7，31-34。  new window
15.Mukamel, D. B.、Mushlin, A. I.(2001)。The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation。Jt Comm J Qual Improv，27，20-27。  new window
16.Schauffler, H. H.、Mordavsky, J. K.(2001)。Consumer reports in health care: do they make a difference?。Annu Rev Public Health，22，69-89。  new window
17.陳楚杰、林恆慶、楊銘欽(20040300)。住院病人對醫院品質報告卡需求之初探。醫學教育，8(1)，62-77。new window  延伸查詢new window
18.陳楚杰、葉瑞垣、張嘉莉、林詠蓉、林恆慶(20060600)。總額支付制度下醫院推行品質報告卡的意願、能力與可行方案。中臺灣醫學科學雜誌，11(2)，111-121。  延伸查詢new window
19.吳敬堂、鍾國彪、苗迺芳、王佳惠、許怡欣、張金堅、郭乃文(20050600)。影響醫師實施臨床指引意願之因素探討--針對臨床指引本身之特性。醫務管理期刊，6(2)，153-172。new window  延伸查詢new window
20.邱瓊萱、鍾國彪、陳端容、魏中仁、楊志良(20010800)。主治醫師價值觀契合度與組織承諾關係的探討--以六家醫學中心為例。臺灣公共衛生雜誌，20(4)，275-290。new window  延伸查詢new window
21.Hibbard, J. H.、Stockard, J.、Tusler, M.(2005)。It Isn't Just about Choice: The Potential of a Public Performance Report to Affect the Public Image of Hospitals。Medical Care Research and Review，62(3)，358-371。  new window
22.Cheng, S. H.、Ho, Y. C.、Chung, K. P.(2002)。Hospital quality information for patients in Taiwan: can they understand it?。Int J Qual Health Care，14，155-160。  new window
23.謝慧欣、鄭守夏、丁志音(20001200)。住院病患對就醫選擇資訊之需求：初步調查發現。中華公共衛生雜誌，19(6)，437-445。new window  延伸查詢new window
24.Hibbard, Judith H.、Jewett, Jacquelyn J.(199705)。Will Quality Report Cards Help Consumers?。Health Affairs (Millwood)，16(3)，218-228。  new window
25.AbuAlRub, R. F.(2004)。Job stress, job performance, and social support among hospital nurses。Journal of Nursing Scholarship，36(1)，73-78。  new window
26.林惠雯、薛亞聖(20030200)。醫療消費者及醫療提供者對全民健保新制門診藥品部分負擔的認知、態度及行為之研究。臺灣公共衛生雜誌，22(1)，33-42。new window  延伸查詢new window
27.蔡文正、龔佩珍、翁瑞宏、石賢彥(20041200)。基層醫師與民眾之服務品質認知落差分析。醫務管理期刊，5(4)，385-402。new window  延伸查詢new window
研究報告
1.蔡文正(2004)。實施西醫基層品質報告卡可行性研究 (計畫編號：DOH-93-NH-1011)。台北。  延伸查詢new window
學位論文
1.宋欣怡(2001)。民眾就醫選擇資訊的潛在需求研究(碩士論文)。國立臺灣大學。  延伸查詢new window
2.謝慧欣(1999)。民眾對健康資訊需要之初探(碩士論文)。國立臺灣大學。  延伸查詢new window
圖書
1.Patrice, L. S.(1999)。Provider Report Cards: A Guide for Promoting Health Care Quality to the Public。Chicago, IL：AHA。  new window
2.盧瑞芬、謝啟瑞(2000)。醫療經濟學。學富文化事業有限公司。  延伸查詢new window
其他
1.Office of the Patient Advocate。The 2003-04 Quality of Care Report Card，http://www.opa.ca.gov/， 2004/11/10。  new window
2.中央健康保險局(2002)。全民健康保險西醫基層總額支付制度實施成效報告，http://www.nhi.gov.tw/information/news_detail.asp?menu=1&menu_id=&News_ID=278， 2003/03/02。  延伸查詢new window
 
 
 
 
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