Assessment on monitoring antibiotic prophylaxis for abdominal hysterectomy
Date Issued
2005
Date
2005
Author(s)
Tsai, Su-Ling
DOI
zh-TW
Abstract
The purpose of this study is to evaluate the effects of monitoring medical care quality through the indicators of antibiotic prophylaxis, using abdominal hysterectomy as an example for the hospitals that were participating in the Taiwan Quality Indicator Project (TQIP) from 2000 to 2002. This study is composed of three parts, (1) to evaluate the outcomes of all sub indicators of antibiotic prophylaxis for abdominal hysterectomy by descriptive analysis, (2) to examine the relationship between the trends of those indicators and the utilization of medical resources, (3) to understand the influential factors for the use of antibiotic prophylaxis for abdominal hysterectomy by the focus-groups method.
The major finds are as the following: (1) the use of antibiotic prophylaxis for abdominal hysterectomy has been highly agreed (i.e., as high as 95%) among the practitioners in Taiwan, the surgical wound infection rate of this operation has been kept steady at 0.5% along the study years, (2) the rate of recriving antibiotic prophylaxis within two hours of incision has been risen from 44% to 82%, the rate of receiving antibiotic prophylaxis within 30 minutes of incision has been risen from 40% to 54% in one year (i.e., from 2000 to 2001) and this rate has exceeded the international level from year 2002, (3) as for the rate of receiving antibiotic prophylaxis for a duration of 24 hours or less has been risen significantly from 17% to 41%, however, there are still 60% participant hospitals do not meet the standard which indicates there is still room for improvement, (4) for all the indicators analyzed, the performance among medical centers are better than other hospitals and public hospitals are better than private hospitals, (5) the drug cost for the case payment of antibiotic prophylaxis for abdominal hysterectomy has been reduced largely, the reduction is mainly from the reduction of antibiotics, on average, the reduction is NT$796 per case which is 44% of the drug cost, and the reduction is larger when the rate of receiving antibiotic prophylaxis for abdominal hysterectomy within 24 hours or less is higher. The non experimental hospitals have a slight reduction in the drug cost during the study period.
Based on the findings of this study, appropriate use of antibiotic prophylaxis can improve the quality of medical care and control medical cost at the same time. The performance of monitoring quality depends on organization behavioral change for the process of administering antibiotics prophylaxis in the hospital, as well as changes of prescribing behavior of the physicians. It is useful to use contingency theory to form evidence based bench marking and the intervention of relevant policies from within and outside the hospital. TQIP has provided this mechanism through voluntary participation and provision of reference information from Taiwan and international bench marking. The hospitals are motivated and learned from each other through Hawthorne effect and incentive effects which lead to improvements in the quality of medical care.
The author suggests hospitals should continue to monitor the timing and duration of administering antibiotic prophylaxis, also, hospitals should monitor the surgical wound infection rate and create environment for improvement and bench marking. Policy makers and authorities should expend the scope of evaluation for the performance of antibiotic prophylaxis, and should establish related guidelines and principals for management of medical care quality.
Subjects
開腹式子宮切除術
預防性抗生素
品質指標
成效評估
醫療資源耗用
組織行為
antibiotic prophylaxis for abdominal hysterectomy
antibiotic prophylaxis
quality indicator
assessment of performance
utilization of medical resources
organization behavior
Type
other
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