A Pilot Study of Healthcare Quality in Asthma Inpatients
Date Issued
2005
Date
2005
Author(s)
Ho, Hsin-Lei
DOI
zh-TW
Abstract
Abstract
Background:
Although the convenience and access to healthcare have been greatly improved since the implementation of National Health Insurance in Taiwan, the quality of healthcare is still a crucial issue. Take asthma care as an example; the national clinical guideline on the management of asthma was published by DOH (department of health) Taiwan in 2001. The rate of guideline adherence is still poor and the quality among hospitals varys significantly from patients’ perspective. In this study we try to explore the structure, process and outcome perspectives of care quality for asthma inpatients in Taiwan and analyze the relationships among these 3 dimensions of quality measure.
Method:
We conducted 2 surveys of asthma inpatients service to investigate patients’ satisfaction and process of care in 2002 and 2004. To measure the process of care, we established 7 indicators in accordance with asthma clinical guidelines. Furthermore, we intergrated the self-reported hospital accreditation data for descriptive and inference analyses.
Results:
There are significantly differences of patient satisfaction scores on hospitals with distinctive accreditation level and ownership. Among the 7 indicators of guideline adherence, the highest rate of adherece is “systemic steroid given” (83.13%), while the rate of “PEF measurement” is the lowest. The average items (score) of guideline suggested treatment received by patients are 3.42 out of 7. In addition, the rate of readmission for the same disease was associated with the degree of adherence to the guideline suggested treatment.
In correlation and regression analyses, there are significant correlations between (1) guideline aherence score and patient satisfaction score (2) guideline adherence score and proportion of nurses with undergraduate or higher degree. The average of ICU lenth of stay, the proportion of nurses with undergraduate or higher degree and the ownership of hospital are significant independent variables to the guideline adherence score in the multiple regression model, while the hospital accreditation level, the guideline adherence score, and the average LOS and deathrate of ICU are significant independent variables to patient satisfaction score.
Conclusion:
Patient satisfaction scores of asthma inpatients vary among hospitals with different accreditation level and ownership. Moreover, the condition of asthma guideline adherence is not satisfactory. Further studies should be done to investigate the comprehensive measure of quality of asthma care.
Keywords: asthma, quality of care, clinical guideline, patient satisfaction
Subjects
氣喘
醫療品質
臨床指引
病人滿意度
asthma
quality of care
clinical guideline
patient satisfaction
Type
thesis
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