醫療品質評估的發展－從專業評鑑到報告卡系統

The Evolution of Healthcare Quality Assessment: From Accreditation to Report Card System

10.6288/TJPH2005-24-04-01

魏玉容(Yu-Jung Wei)；鍾國彪(Kuo-Piao Chung)；鄭守夏(Shou-Hsia Cheng)

醫療品質 ； 評鑑 ； 評估 ； 報告卡 ； quality of care ； accreditation ； assessment ； report card

台灣公共衛生雜誌

24卷4期（2005 / 08 / 01）

275 - 283

繁體中文

醫療品質向來是醫療服務體系中的核心價值之一，品質的評估、確保與持續改進也是各國政府十分重視的工作。本文主要在整理與比較美國與台灣在醫療品質的確保與品質測量的各種努力。從過去發展的演進來看，醫療品質的確保是由醫院評鑑制度開始，其間持續不斷的發展測量指標，來評估、監測醫療品質。接著是醫療專業在成本控制壓力下的自我提升，包括引進企業管理的制度與技術，並訂定以實證為基礎的臨床作業準則，進一步提升醫療品質。最近則發展到讓醫療消費者參與品質的評估以及醫療品質資訊的公開，希望透過資訊提供讓消費者能做明智的選擇，促使醫療專業可以加速品質改善，更符合病人的期望。最後本文亦提出建議供政策參考。

Quality of health care is one of the core values in the healthcare delivery system. Many nations have made essential efforts in the assessment, assurance, and improvement of healthcare quality. The purpose of this article is to describe the evolution in healthcare quality improvement and assessment in the United States and in Taiwan. Evidence shows that quality assurance was initially established by implementing a hospital accreditation mechanism; accompanied by continuous development of quality indicators to monitor the quality of healthcare. As the cost-containment pressure increased, health professionals began to adapt industrial management tools and create evidence-based practice guidelines to improve the quality of healthcare. Recent developments include consumer involvement in quality assessment and public disclosure of quality information. It is hoped that the quality information provision will facilitate consumers choice among providers and accelerate the process of professional quality improvement. Finally, the article provides several recommendations for policy consideration.

1. Facts about the JCAHO
2. Agency for Healthcare Research and Quality
3. Accreditation Programs
4. 衛生署中央健康保險局：醫療品質指標資訊
5. Adab P,Rouse AM,Mohammed MA,Marshall T.(2002).Performance league tables: the NHS deserves better.BMJ.
6. Baker DW, Einstadter D, Thomas C(2003).The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals.Med Care.
7. Baker DW,Einstadter D,Thomas C(2003).The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals.Med Care.
8. Bodenheimer T(1999).The American health care system--the movement for improved quality in health care.N Eng J Med.
9. Bodenheimer T.(1999).The American health care system--the movement for improved quality in health care.
10. Brook RH, Kamberg CJ, McGlynn EA(1996).Health system reform and quality.JAMA.
11. Brook RH,Kamberg CJ,McGlynn EA.(1996).Health system reform and quality. JAMA.
12. Chassin MR, Hannan EL, Debuono BA(1996).Benefits and hazards of reporting medical outcomes publicly.N Engl J Med
13. Chassin MR,Hannan EL,Debuono BA(1996).Benefits and hazards of reporting medical outcomes publicly.N Engl J Med.
14. Cheng SH, Ho YC, Chung KP(2002).Hospital quality information for patients in Taiwan: Can they understand it.Int J Qual Health Care.
15. Cheng SH, Song HY(2004)。Physician performance information and consumers' choice: A survey of subjects with the freedom to choose between doctors。Qual Saf Health Care
16. Cheng SH,Ho YC,Chung KP.(2002).Hospital quality information for patients in Taiwan: Can they understand it?.
17. Cheng SH,Song HY.(2004).Physician performance information and consumers` choice: A survey of subjects with the freedom to choose between doctors.Qual Saf Health Care.
18. Cleary PD, Edgman-Levitan S(1997).Health care quality.Incorporating consumer perspectives. JAMA.
19. Cleary PD, Mcneil BJ(1988).Patient satisfaction as an indicator of quality care.Inquiry
20. Cleary PD,Edgman-Levitan S.(1997).Health care quality. Incorporating consumer perspectives. JAMA.
21. Cleary PD,Mcneil BJ(1988).Patient satisfaction as an indicator of quality care.
22. Cleary PD,Mcneil BJ(1988).Patient satisfaction as an indicator of quality care.AHRQ.
23. Crofton C, Lubalin JS, Darby C(1999).Consumer Assessment of Health Plans Study (CAHPS)[Foreword].Med Care
24. Crofton C,Lubalin JS,Darby C.(1999).Consumer Assessment of Health Plans Study (CAHPS)[Foreword].Med Care.
25. Docteur E(2001).Measuring the quality of care in different settings.Health Care Financ Rev
26. Docteur E.(2001).Measuring the quality of care in different settings.Health Care Financ Rev.
27. Doherty EC(1994).The JCAHO Agenda for Change: what changes in pharmacy and P & T activities do you need to prepare for in 1994.Hospital Formulary
28. Donabedian A(1988).The quality of care: How can it be assessed.JAMA.
29. Donabedian A.(1988).The quality of care: How can it be assessed? JAMA.
30. Epstein A(1995).Performance reports on quality--prototypes, problems, and prospects.N Engl J Med
31. Epstein A.(1995).Performance reports on quality--prototypes, problems, and prospects.
32. Epstein AM(1998).Rolling down the runway: the challenges ahead for quality report cards.JAMA.
33. Farley DO, Short PF, Elliott MN(2002).Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries.Health Serv Res
34. Farley DO,Short PF,Elliott MN(2002).Effects of CAHPS health plan performance information on plan choices by New Jersey Medicaid beneficiaries.Health Serv Res.
35. Finkelstein BS, Harper DL, Rosenthal GE(1999).Patient assessments of hospital maternity care: a useful tool for consumers.Health Serv Res.
36. Finkelstein BS,Harper DL,Rosenthal GE.(1999).Patient assessments assessments of hospital maternity care: a useful tool for consumers?.Health Serv Res.
37. Fraser I, Mcnamara P, Lehman GO(1999).The pursuit of quality by business coalitions: a national survey.Health Aff
38. Fraser I,Mcnamara P,Lehman GO(1999).The pursuit of quality by business coalitions: a national survey.Health Aff.
39. Ginsberg C, Sheridan S(2001).Limitations of and barriers to using performance measurement: Purchasers̀ perspectives.Health Care Financ Rev.
40. Ginsberg C,Sheridan S.(2001).Limitations of and barriers to using performance measurement: Purchasers` perspectives..Health Care Financ Rev.
41. Ginsburg PB, Hammons GT(1988).Competition and the quality of care: the importance of information.Inquiry
42. Ginsburg PB,Hammons GT.(1988).Competition and the quality of care: the importance of information. Inquiry.
43. Goldstein E, Fyuck J(2001).Reporting of CAHPS quality information to Medicare beneficiaries.Health Serv Res.
44. Goldstein E,Fyuck J.(2001).Reporting of CAHPS quality information to Medicare beneficiaries.Health Serv Res.
45. Grol R.(2001).Improving the quality of medical care: building bridges among professional pride, payer profit, and patient satisfaction. JAMA.
46. Guadagnoli E, Epstein AM, Zaslavsky A(2000).Providing consumers with information about the quality of health plans: the Consumer Assessment of Health Plans demonstration in Washington State.J Comm J Qual Improv
47. Guadagnoli E,Epstein AM,Zaslavsky A(2000).Providing consumers with information about the quality of health plans: the Consumer Assessment of Health Plans demonstration in Washington State.J Comm J Qual Improv.
48. Hannan EL,Kilburn H Jr,Racz M(1994).Improving the outcomes of coronary artery bypass surgery in New York State.JAMA.
49. Hibbard JH, Jewett JJ(1996).What type of quality information do consumers want in a health care report card.Med Care Res Rev
50. Hibbard JH, Jewett JJ, Legnini MW, Tusler M(1997).Choosing a health plan: do large employers use the data.Health Aff.
51. Hibbard JH, Stockard J, Tusler M(2003).Does publicizing hospital performance stimulate quality improvement efforts.Health Aff
52. Hibbard JH,Jewett JJ(1996).What type of quality information do consumers want in a health care report card? Med Care Res Rev.
53. Hibbard JH,Jewett JJ.(1997).Will quality report cards help consumers?.Health Aff.
54. Hibbard JH,Jewett JJ,Legnini MW,Tusler M.(1997).Choosing a health plan: do large employers use the data?.Health Aff.
55. Hibbard JH,Stockard J,Tusler M.(2003).Does publicizing hospital performance stimulate quality improvement efforts?.Health Aff.
56. Huang P(1996).Quality assurance in Taiwan, the Republic of China.Int J Qual Health Care
57. Huang P.(1996).Quality assurance in Taiwan, the Republic of China.Int J Qual Health Care.
58. Kadzielski MA, Reynolds MB(1991).Special report on licensure, accreditation and con. JCAHO adopts shorter, more concise standards for 1992.Health Care Law Newsletter.
59. Kadzielski MA,Reynolds MB.(1991).Special report on licensure, accreditation and con.JCAHO adopts shorter, more concise standards for 1992.
60. Kazandjian VA, Lawthers J, Cernak CM, Pipesh FC(1993).Relating outcomes to processes of care: the Maryland Hospital Associatioǹs Quality Indicator Project (QI Project).J Comm J Qual Improv.
61. Kazandjian VA,Lawthers J,Cernak CM,Pipesh FC(1993).Relating outcomes to processes of care: the Maryland Hospital Association's Quality Indicator Project (QI Project).J Comm J Qual Improv.
62. Marshall MN, Shekelle PG, Leatherman S, Brook RH(2000).The public release of performance data: what do weexpect to gain.A review of the evidence. JAMA.
63. Marshall MN,Shekelle PG,Leatherman S,Brook RH(2000).The public release of performance data: what do we expect to gain? A review of the evidence.JAMA.
64. Mcglynn EA(2003).An evidence-based national quality measurement and reporting system.
65. Mehrotra A, Bodenheimer T, Dudley RA(2003).Employers̀ efforts to measure and improve hospital quality: determinants of success.Health Aff
66. Mehrotra A,Bodenheimer T,Dudley RA(2003).Employers' efforts to measure and improve hospital quality: determinants of success.
67. Mukamel DB, Mushlin AI(2001).The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation.J Comm J Qual Improv
68. Mukamel DB,Mushlin AI(2001).The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation.J Comm J Qual Improv.
69. Robinson S, Brodie M(1997).Understanding the quality challenge for health consumers: the Kaiser/AHCPR Survey.J Comm J Qual Improv.
70. Robinson S,Brodie M.(1997).Understanding the quality challenge for health consumers: the Kaiser/AHCPR Survey.J Comm J Qual Improv.
71. Rosenthal GE, Shannon SE(1997).The use of patient perceptions in the evaluation of health-care delivery systems.Med Care
72. Rosenthal GE,Shannon SE.(1997).The use of patient perceptions in the evaluation of health-care delivery systems.
73. Sangl JA, Wolf LF(1996).Role of consumer information in todaỳs health care system.Health Care Financ Rev
74. Sangl JA,Wolf LF(1996).Role of consumer information in today's health care system.Health Care Financ Rev.
75. Schneider EC,Epstein AM.(1998).Use of public performance reports: a survey of patients undergoing cardiac surgery.JAMA.
76. Shaw CD(2003).Evaluating accreditation.Int J Qual Health Care.
77. Shaw CD.(2003).Evaluating accreditation.
78. Silver MH(1997).Patients̀ rights in England and the United States of America: The Patient̀s Charter and the New Jersey Patient Bill of Rights: a comparison.J Med Ethics
79. Silver MH.(1997).Patients' rights in England and the United States of America: The Patient's Charter and the New Jersey Patient Bill of Rights: a comparison. J Med Ethics.Health Aff.
80. Zaslavsky AM,Beaulieu ND,Landon BE,Cleary PD(2000).Dimensions of consumer-assessed quality of Medicare managed-care health plans.
81. THIS簡介
82. 江東亮(2003)。醫療保險政策－台灣經驗。第二版。台北:巨流圖書。
83. 江東亮(2003)。醫療保險政策 －台灣經驗。台北:巨流圖書。
84. 吳肖琪(1999)。評估醫院醫療品質指標，臺北:
85. 吳肖琪(1999)。評估醫院醫療品質指標。台北:行政院研究發展考核委員會。
86. 宋欣怡(2001)。民衆就醫選擇資訊的潛在需求研究，台北:
87. 宋欣怡(2001)。台北，台灣大學衛生政策與管理研究所碩士論文。
88. 林淑琴(2002)。消費者特定求醫途逕之探尉－以台北市某地區醫院全膝關節置換消費者爲例，台北:
89. 林淑琴(2002)。消費者特定求醫途逕之探討－以台北市某地區醫院全膝關節置換消費者爲例。
90. 邱培源(2002)。病患健康資訊需求與尋求行爲之研究，台北:
91. 邱培源(2002)。病患健康資訊需求與尋求行爲之研究。
92. 邱瓊萱、魏中仁、楊志良、鍾國彪(2000)。醫院。
93. 邱瓊萱、魏中仁、楊志良、鍾國彪(2000)。醫療産業品質保證與品質管理思潮演進－以美國與台灣爲例。醫院
94. 徐慧娟、薛亞聖(2001)。醫院。
95. 徐慧娟、薛亞聖(2001)。醫院管理指標的性質與應用
96. 醫療品質指標計書
97. 張淳茜(2000)。台中，中國醫藥大學醫務管理所碩士論文。
98. 張淳茜(2000)。病患健康資訊來源及其相關因素之研究，台中:
99. 陳秀玲、鍾國彪、洪幼珊(1999)。醫院。
100. 陳佩妮、鄭守夏、鍾國彪、林王美園(1997)。台灣地區醫療品質指標適用性之探討。中華雜志，16，133-42。
101. 陳佩妮、鄭守夏、鍾國彪、林王美園(1997)。台灣地區醫療品質指標適用性之探討。中華衛誌。
102. 陳琇玲、鍾國彪、洪幼珊(1999)。臨床品質指標簡介
103. 楊哲明、王鳳君、洪啓宗、邱文達(2001)。區域醫院推動馬里蘭醫療品質指標計書之實證經驗
104. 楊哲明、王鳳君、洪啓宗、邱文達(2001)。醫院。
105. 醫療品質指標資訊
106. 謝慧欣(1999)。民衆對健康資訊需要之初探，台北:
107. 謝慧欣(1999)。台北，台灣大學衛生政策與管理研究所碩士論文。
108. 謝慧欣、鄭守夏、丁志音(2000)。住院病患對就醫選擇資訊之需求：初步調查發現。中華雜志。
109. 鍾國彪(1997)。全民健康保險的整體醫療品質之評估，台北:
110. 鍾國彪(1997)。全民健康保險的整體醫療品質之評估。
111. 藍忠孚、態惠英、胡澤芷、葉佳禧(2000)。臺灣地區醫療機構品質管理現況分析。醫療品質
112. 藍忠孚、熊惠英、胡澤芷、葉佳禧(2000)。臺灣地區醫療機構品質管理現況分析。醫療品質。

1. Lee, Su-Shin,Lai, Chung-Sheng,Kuo, Yen-Hung,Chen, Ling-Sui,Chen, Chien-Li(2012).Application of Healthcare Matrix to Hospital Accreditation in Taiwan: A Clinical Management Perspective.醫務管理期刊,13(4),295-311.
2. 劉滄梧、劉湫美、黃國哲、許怡欣、邱昌芳、李莉鈺(2009)。醫院人員對癌症診療品質認證試評計畫之認知探討—以八家試評醫院爲例。醫務管理期刊，10(3)，201-219。
3. 劉慧俐(2012)。評論：影響護理之家評鑑結果之因素研究：以2009年台灣首次全國護理之家評鑑為例。臺灣公共衛生雜誌，31(2)，133-134。
4. 嚴玉華、楊鎮維(2013)。醫院治理機制與效能之研究。臺大管理論叢，23(S1)，57-82。
5. 鄭仁翔,陳宛琪,郭年真(2022)。醫院評鑑等級與醫療品質相關性之探討－以醫療品質資訊公開指標為例。台灣公共衛生雜誌，41(4)，398-410。
6. (2007)。醫院品管圈活動之推動成效探討。亞東學報，27，133-144。