| 摘要: | 背景與目的：重視培養醫療專業人員核心能力是近年醫學教育發展主要趨勢，而使用健康照護矩陣進行醫事人員核心能力及醫療品質訓練是國內外新趨勢。本研究探討個案醫院應用健康照護矩陣現況，藉由矩陣資料進行數據統計及質性分析，瞭解其醫療團隊臨床表現反映在核心能力及醫療品質之差異。
方法：收集2009年中部某醫學中心之每月病例討論會應用健康照護矩陣之個案，共計60件作為樣本來源。量性分析採克拉斯卡-瓦立斯檢定及魏克森等級和檢定照護提供者特質、病患基本特質及照護結果、住院醫師對醫療品質及其核心能力之差異。以質性研究之資料檔案回顧方式，參考財團法人醫院評鑑暨醫療品質策進會公告之99-100年度醫療品質及病人安全工作九大目標為架構作為資料編碼依據。
結果：內外婦兒科在醫療品質之「及時服務」構面其表現呈顯著差異；個案報告者在醫療品質之「效率工作」構面之表現呈顯著差異。整體醫療品質問題嚴重程度與「照護科別」、「病患性別」、「死亡病例」及「急診途徑入院」有關。質性研究結果發現：「專業知能」、「臨床照護」、「醫病溝通」、「醫療體制與政策」、「醫學人文素養」主項目為案例中常見之問題。
結論：兒科自我檢討之「及時的服務」其待改善問題程度相較於他科呈顯著差異；住院醫師所自我檢討之「效率的工作」之尚待改善之評值較高，未來可加強訓練當科或住院醫師多留意臨床照護及時性及醫療資源使用有效性。質性研究結果發現，矩陣表中所提出的待改善事件之其一為「專業知能」，意即知識、技能及儀器操作使用之熟悉程度仍是檢討病患處置過程的重點；其二則為「臨床照護」，良好的臨床照護品質基於醫事人員核心能力之表現。鑒於各職類醫事人員其臨床任務不同，未來可依各職類人員及其執業年資分別檢定在核心能力表現之變化。
Background and Objectives
Developing the core competency of health care professionals has been a major trend in the recent medical education programs. The Healthcare Matrix is an innovative tool widely adopted worldwide in advancing the core competency of health care professionals and conducting medical quality training. The present research discussed the current status of the Healthcare Matrix applications within a domestic hospital, analyzed the matrix with quantitative and qualitative data, and sought to examine the performance differences of the core competency and medical quality among clinical team members.
Methods
60 samples of Healthcare Matrix from monthly case conferences in a central medical center were collected. Quantitative analyses including Kruska-Wallis Test and Wilcoxon Rank-Sum Test were utilized to investigate the differences of the core competency and medical quality among care-givers, patients, treatment outcome, and residents. Framed from “Nine Goals of Medical Quality and Patient Safety in Year 2010-2011” released by Taiwan Joint Commission on Hospital Accreditation, a qualitative method of document review was also conducted.
Results
In regard to medical quality, medical departments showed significant differences in Timely and case reporters presented signicant differences in Efficient. The severity of overall medical quality problem was related to medical department, male, mortality, and emergency. Qualitative results indicated that professional capability, clinical care, patient communication, health care system and policy, and medical humanity were most common issues in the cases.
Conclusions
Based on the self-review results, Timely is the top priority for improvement in Pediatrics. Residents assessed Efficient as the key area for improvement. Future training for medical department or resident may emphasize on timeliness of clinical care and efficiency of medical resources use. There are two findings from the qualitative results. Firstly, professional capability, including knowledge, skills, and mastery of devices, is the top priority in the improvement of patient treatment. Secondly, quality of clinical care reflectes the core competency of health professional. In consideration of different clinical tasks across health professionals, future evaluations of core competency should be stratified by specialty and tenure. |
