醫院策略與急性心肌梗塞照護品質之關係

Association of hospital strategies with quality of care for acute myocardial infarction

10.6288/TJPH.201812_37(6).107056

廖思詠(Szu-Yung Liao)；游宗憲(Tsung-Hsien Yu)；董鈺琪(Yu-Chi Tung)

急性心肌梗塞 ； 醫院策略 ； 照護品質 ； acute myocardial infarction ； hospital strategies ； quality of care

台灣公共衛生雜誌

37卷6期（2018 / 12 / 17）

651 - 663

繁體中文

目標：台灣醫院近年持續改善急性心肌梗塞（acute myocardial infarction, AMI）的照護品質，不過未有研究探討那些醫院策略與AMI照護品質有關，本研究目的係探討醫院策略與AMI照護品質的相關性。方法：本研究為橫斷性研究，以收治全台灣大部分AMI住院病人之96家醫院，以郵寄問卷方式進行普查，測量醫院2015年至2016年醫院策略實施的情況，問卷回收率為73.96%，再與中央健康保險署全民健康保險AMI照護品質資訊公開之照護品質指標資料合併，採用複線性迴歸模式，在控制醫院特性與病人特性後，探討醫院策略與AMI照護品質（血脂低密度脂蛋白檢查、阿斯匹靈、腺嘌呤二磷酸接受體拮抗劑、乙型阻斷劑及血管收縮素轉化酶抑制劑或血管收縮素接受體阻斷劑使用率）之相關性。結果：醫院所推行的三項策略與較高AMI藥品治療使用率有關。結論：隨時（含假日及夜間）有心臟專科醫師於醫院輪值處置病人、監測出院病人7或14日回診之百分比、臨床人員與緊急醫療救護人員定期開會與較佳的AMI照護品質有關。

Objectives: In recent years in Taiwan, hospitals have continuously improved quality of care for acute myocardial infarction (AMI). However, no study has examined which hospital strategies are associated with quality of care for AMI. This study investigated the association of hospital strategies with quality of care for AMI. Methods: This cross-sectional study was conducted in hospitals in which most patients with AMI throughout Taiwan are admitted. A structured questionnaire was developed and mailed to 96 hospitals to examine the implementation of hospital strategies between 2015 and 2016. The response rate was 73.96%. The data of quality measures for AMI care were obtained from the report titled ＂Public Reporting for Quality of Care for AMI,＂ which is provided by the National Health Insurance Administration. Multivariate linear regression models were used to examine the association of the implementation of hospital strategies with AMI quality of care measures (rate of low-density lipoprotein cholesterol testing and rates of aspirin, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, adenosine diphosphate receptor inhibitor, and beta-blocker use). Results: Three hospital strategies were found to be associated with high rates of AMI medication use. Conclusions: Having cardiologists always on site, monitoring percentages of 7- or 14-day outpatient follow-up, and holding regular meetings between hospital clinicians and emergency medical service providers are associated with better quality of care for AMI.

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