https://scholars.lib.ntu.edu.tw/handle/123456789/109778
標題: | 總額制度下醫院醫療管理措施與醫師自評對醫療決策之影響 Medical Management Practices of Hostpitals under Global Budget System and Their Effect on Physicians’ Medical Decisions |
作者: | 陳怡穎 Chen, Yi-Ying |
關鍵字: | 醫療管理措施;醫療決策;medical management practices;medical decisions | 公開日期: | 2005 | 摘要: | 研究目的:探討醫院醫療管理措施的種類與使用頻率以及醫師個人特質、任職醫院特質、自覺之醫療非自主性對於醫師自評管理措施對醫療決策之影響。 研究材料與方法:本研究為次級資料分析,資料來源為台大醫管所陳端容副教授於民國93年底至94年初,針對任職於地區教學醫院以上之醫師所進行之醫療管理結構式問卷調查,母群體共為16414人。問卷結果以SPSS 12.0軟體進行描述性統計以及雙變項、多變項統計分析。 研究結果:問卷經由31家合作醫院發放2310份,回收率24.37%,郵寄個別醫師共5519份,回收率13.71%,整體回收率為16.86%。填答的醫師中男性佔86.2%,年齡集中在30到49歲,管理職者佔三成。在醫療管理措施中,以病歷書寫品質管理的頻率最高,有72.2%的填答醫師表示有管理,其餘超過半數有管理的依序為處方金額、藥品品項、住院天數、藥品數目。在醫療非自主性方面,以「在既有療法之外選擇新的療法」受限最多。填答醫師認為醫療管理措施對自己的醫療決策有正面影響的比例為30.1%。多變項回歸精簡模式的結果中,影響醫師對管理措施持正面評價的因子包括:曾經擔任健保審查醫師、每週臨床工作時數小於40小時、每週行政工作時數為11-30小時、沒有住院病人、醫院提供醫學資訊檢閱、自覺付出與報酬公平、自覺考績制度適當、院內可協助醫療決策的醫師數大於六人、同仁間經常分享經驗、自覺醫療非自主性低等。 結論與建議:由本研究結果建議醫院管理者應給予醫師合理的工作負荷、提供檢閱醫學資訊的資源、對各種管理項目選擇適當的管控方式、重視薪資報酬及績效考核的公平與適當、建立組織內同仁互相討論、信任協助、以及經驗分享的文化、並保留醫師的醫療自主性,可以有助醫師認同管理措施對醫療決策的正面影響。後續的研究者,可以結合醫院層次的管理措施調查,與醫師層次的醫療決策實際影響程度調查,以了解特定管理措施對醫療決策的影響。 Objectives: To understand current medical management practices of hospitals and to investigate the influence of (1)personal characteristics, (2)hospital characteristics, and (3)perceived lack of clinical autonomy on physicians’ self-reported effect of management practices on their medical decisions. Material and Methods: The study is a secondary data analysis from the survey of Prof. Duan-Rung Chen on medical managements. The survey was conducted between late 2004 and early 2005 with structured questionnaires to a population of 16414 physicians practiced in hospitals accredited as district teaching hospitals or higher. SPSS 12.0 was used for descriptive statistics as well as bivariate crosstable analyses and multivariate logistic regression. Results: 2310 questionnaires dispensed through 31 participating hospitals had a response rate of 24.37% and 5519 questionnaires were mailed to individual physicians with a response rate of 13.71%. The overall response rate was 16.86%. Most respondents were male physicians aged between 30 to 49 years and 30.3% of them held an administrative position. Management on quality of medical records was reported by 72.2% of respondents and more than half of them also reported management on the price of one single prescription, the items and amount of medication prescribed, and the length of hospital stay. A lack of freedom in “Use new treatments even when established ones are still available” was reported by 1/3 respondents. 30.1% of respondents stated that the overall effect of medical management practices on their medical decisions was positive. The result of multivariate logistic regression revealed that factors contributing to self-reported positive effect of management practices on medical decisions included: ever served for the National Health Insurance peer-reviewing, clinical working hours less than 40 hours per week, administrative working hours 11-30 hours per week, no inpatients, hospitals providing medical database search resources, perceived balance between effort and reward, perceived appropriateness of performance appraisal, more than 6 physicians to aid in medical decisions within hospital, frequent sharing of experiences between colleagues, and a lower level of lack of clinical autonomy. Conclusions: We suggest that in order to enhance physicians’ positive thinking on management practices to their medical decisions, hospital administrators should assign reasonable job loading, provide resources for medical database search, choose appropriate measures to manage different medical practices, take account of effort-reward balance and performance appraisal, develop an organizational culture of trust, mutual support, and experience sharing, and preserve physicians’ clinical autonomy. We also suggest that future studies may integrate the survey of management practices on hospital level and compare the results with physician level survey to further define the effect of individual management practice on physicians’ medical decisions. |
URI: | http://ntur.lib.ntu.edu.tw//handle/246246/60143 | 其他識別: | zh-TW |
顯示於: | 健康政策與管理研究所 |
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ntu-94-P92843011-1.pdf | 23.31 kB | Adobe PDF | 檢視/開啟 |
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