2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646218摘要：研究背景：癌症自1982 年躍居國人十大死因之首，為防治癌症及提升癌症照護品質，衛生相關單位做了很多努力，除了要求各癌症照護中心申報六大癌症診療明細於癌症診療資料庫外，更建立量性、可靠且有科學根據之核心測量指標以衡量抽象的癌症照護品質，2006 年透過癌症核心測量組合試辦癌症照護品質認證計畫，未來將納入醫院評鑑項目中。但對於核心測量組合之使用者與接受者端尚未有相關研究加以探討，影響核心測量組合遵從因素及對於病患結果之間的關係仍待釐清，而由於醫療科技日新月異，核心測量指標需要建立汰換與更新機制以符合醫療環境。研究目的：本研究欲藉乳癌核心測量組合為例，於三年計畫中了解醫療服務提供者對核心測量組合之知識、態度及應用情形；從機構層級、醫師層級或病患層級探討影響遵從核心測量組合之因素；並探討乳癌核心測量組合遵從度對病患存活或其生活品質之預測力，及癌症照護品質認證政策介入後對臨床人員、患者與醫療環境之影響，並試圖建立核心測量指標汰換與更新機制以作為其他照護品質測量指標之參考。研究方法：測量方法包括問卷調查、專家座談會以收集初級資料，分析健保資料庫及癌症登記資料庫；分析分法包括修正型德爾菲法、分析層級程序法、複回歸分析、Cox比例危害模式、及階層線性模式等。<br> Abstract: Background：Cancers had been the top of ten leading cause of diseases since year 1982.Government tried very hard to prevent cancer and improve quality of cancer care. In additionto report treatment and diagnosis data of six kinds of cancer to CRS, it is essential to buildup quantitative, reliable and evidence-based indicators, such as core measures, for internalimprovement and external monitoring purpose. These indicators could be applied tocertification and classification of hospital in providing cancer care as well as to hospitalaccreditation in the future. However, research about core measures in provider and patientside is limited. It is necessary to explore factor affecting adherence to core measures and toelaborate the relationship between adherence to core measures and outcome of care. Inaddition, core measure indicators need to have mechanism to revise and rotate to meet thechanging health care environment and the progress in science and technology.Objective：This study aim to take the breast cancer for example to investigate thephysicians’ knowledge, attitude, and behavior of the breast cancer core measure set; tounderstand the factors related to the core measure adherence rates from the cancer careinstitutions, physicians or patient level; to realize whether the core measure set adherencerates predict the patients survival or quality of life; to find the influence of the interventionof cancer care quality accreditation to the clinicians, patients and the medical environment;to build the quality indicators renew or eliminate mechanisms during the three-year program.Method：We’ll use primary and secondary data collected by questionnaire survey, paneldiscussion, National Health Insurance Database Research (NHIDR), Taiwan Cancer DataBase (TCDB). The Analysis method included modified Delphi, Analytic hierarchy process(AHP), Multiple regression model, Cox proportional hazard model (Cox PHM), andhierarchical linear model (HLM) and so on.核心測量組合遵從度組合分數醫師知識態度行為生活品質乳癌照 護指標更換淘汰Core measure setAdherence ratecomposite scorePhysician knowledgeattitudebehaviorQuality of lifeBreast cancer careIndicators revise or retire