觀察世界各國健康照護體系之發展趨勢，以及國內健保制度的演變，可以看出基層醫療服務在整體醫療體系中所扮演的角色，將越來越重要，如何提供具有良好品質的基層醫療服務及如何評估基層醫療服務的品質，亦逐漸受到重視。行政院衛生署於民國九十年六月六日公告，並自同年七月一日起，依時程執行「全民健康保險西醫基層總額支付制度品質確保方案」，希望藉由此方案建立具體的基層醫療品質評估指標，由此可見建立基層醫療照護品質評估指標，是目前醫療政策急需完成的重要課題之ㄧ。 本研究之主要目的，為利用Campball & Fiske所建立之「多特質－多方法」矩陣（Multitrait-Multimethod Matrix），來探討使用中文版「基層醫療照護品質評估工具」，收集以民眾認知為基礎的基層醫療照護品質評估結果，與以醫師診療行為為基礎之「病歷記錄摘要表」，所測得之基層醫療照護品質結果間之相關。並同時比較醫院及診所基層醫療照護品質的差異。 本研究於民國九十二年七月至八月間，在中國醫藥大學附設醫院家醫科及曾於前述單位服務且願意加入本研究之基層開業醫診所，以中文版「基層醫療照護品質評估工具」訪問18歲及以上之就醫民眾，並以「病歷記錄摘要表」摘要完成受訪者之病歷記錄；本研究於中國醫藥大學附設醫院家醫科訪問400位受訪者（共109人拒訪，拒訪率為21.41%），另於基層開業醫診所訪問401位受訪者（共67人拒訪，拒訪率為14.32%），共計801位受訪者。 中文版「基層醫療照護品質評估工具」與「病歷記錄摘要表」各分數之相關和預期相關符合的構面，在醫院樣本中有：第一線接觸－利用與就醫率、進行中照護與周全訊息數及照護協調性與有無轉診間的相關；在診所樣本中，除進行中照護與周全訊息數外其餘均未呈現預期之相關。評估工具與「病歷記錄摘要表」間呈現顯著負相關的構面及基層醫療照護分數及基層醫療照護外展分數，與「病歷記錄摘要表」的家庭照護及周全性照護的周全訊息數，則呈現非預期的相關。 本研究結果顯示：中文版「基層醫療照護品質評估工具」具有良好的建構效度，且本研究所使用之「病歷記錄摘要表」，是一有系統且實際可行的基層醫療照護品質評估方法。故建議同時以中文版「基層醫療照護品質評估工具」及「病歷記錄摘要表」，分別從診療行為面及病患認知面監測基層醫療照護品質，以提供完整的基層醫療照護品質現況，供未來衛生政策或健保制度改革之參考。未來研究方向，則建議可嚐試結合中文版「基層醫療照護品質評估工具」與「病歷記錄摘要表」，建立單一的基層醫療照護品質評估指標，以利不同基層醫療照護機構間，照護品質的比較。; As observing the international trend of health care delivery system and the National Health Insurance program in Taiwan, It is found the role of the primary care in the health care system becomes more important. Thus, the issues about how to assess the quality of primary care become more important, as well. Department of Health, Executive Yuan, Taiwan R.O.C. circularized “Plan For Ensuring Care Quality For Western Medicine Global Budget Payment Method Of National Health Insurance“ in June 2001 and executed in July 2001. This plan hopes to develop feasible indexes to assess quality of primary care. Thus it is seen that to develop indexes to assess quality of primary care is one of the important issues of health policy at present. The primary objective of the study is to examine the association between outcomes for quality of primary care based upon physician’s behavior, assessed by “Medical record abstract form” (MRAF) and based upon patients’ perception, assessed by Chiness-version Primary Care Assessment Tool (PCAT) using “multitrait-multimethod matrix”. We hypothesize that the similar concept of domains measured by Chiness-version PCAT and MARF should be related to each other. The secondary objective is to compare quality of primary care, assessed by Chiness-version PCAT and MARF between hospital and primary clinics. For these purposes,a total of 400 patients aged over 18 years old at the department of family medicine of the China Medical University Hospital and 401 outpatients from clinical setting of the primary care physicians who had practiced at front place were recruited from July 2003 to August 2003. Face-to-face interviews were administered and we abstracted these patients’ medical record with MRAF. The respondent rate is 78.59% at the department of family medicine of the China Medical University Hospital and 85.68% at clinical setting. The results show that the expected association between Chiness-version PCAT and MRAF are scale of first contact-utilization and patient visit rate to the primary physician, the scale of ongoing care and comprehensive information, and scale of coordination of care and referral for hospital sample, and scale of ongoing care and comprehensive information, and scale of coordination of care and referral for the clinical sample. Other hypothesized associations didn’t observed. All sidnificant negative relationship between Chiness-version PCAT and MRAF are out of expectation. The significant associations of primary care score and primary care expend score of Chiness-version PCAT that we don’t expect are family history score and comprehensive information of the MRAF. The expected significant associations observed in the study imply that Chiness-version PCAT has good construct validity. In addition, MRAF can be a systematic method to collect
