14卷1期

• Link 其他 Others
• 廿一世紀的環境衛生政策廿一世紀的環境衛生政策
• 王秋森 ； 林宜長 ； 林嘉明 ； 李芝珊
  Chiu-Sen Wang, Yi-Chang Lin, Chia-Ming Lin, Chih-Shan Li
• 環境衛生 ； 環境衛生問題 ； 環境衛生政策
  none
• 台灣地區在二十世紀前半葉以農業為主的時代，環境衛生的問題主要為飲水、廢污、病媒及食品子傳統問題。六十年代以徒台灣的經濟結構逐漸改以出口貿易為主，隨著製造業和養殖業的大幅擴展、人口的快速膨脹，以及個人消費的激增，出現了嚴重的廢氣、廢水、土壤污染、噪音、輻射、毒性化學物質以及固體廢棄物等環境污染問題。由於農業時代傳統的環境衛生工作未臻完喜，又因在都市化與工業化過程中缺乏有關環境韓于生的長遠性及全盤性規劃，因此在即將進入廿一世紀的前夕，台灣地區同時面臨嚴重的傳統環境衛生問題以及產業結構轉型後的環境污染問題。二、三十年來環境品質的持續惡化已經嚴重影響國民的生活品質與身心健康。特別嚴重的環境衛生問題包括： 1．約有15%的人口尚無法享用良好水質的飲用水。 2．在50條主要及次要河川中已有60%下游河段受到污染。 3．現有21座水庫的水質約有40%被評定為不良。 4．空氣污染指標PSI大於100（對健康有不良影響）的每年日數百分率十年來均在15%左右。 5．台北市及高雄地區均能音量大於65分貝（不適合人類生活及居住）目前仍在10%以上。 6．截至1993年底已發現二百多戶房屋受到輻射污染。 7．根據官方統計，近年來每年發生70件以上的食品中毒事件，中毒人數每年超過2000人。實際中毒發生率可能要比官方登記數字多出數倍。 8．食品衛生檢驗不合格者每年均在10%以上。 9．食品廠商衛生檢查不合格者超過20%。 10．食品販賣場所衛生檢查不合格者超過10％%。 11．以台灣地區總面積計算，每平方公里每年使用農藥高達1.25公噸。 12．登革熱於1988年在南部大流行後仍未完全根除，1994年仍有超過126個病例。 13．每人每日平均生產1.09kg的一般廢棄物，其中尚有30%沒有妥善處理，往往導致二次公害。 14．約有三萬公頃的土壤受到嚴重的重金屬污染，已劃為鎘污染休耕農地計約106公頃，可能尚有許多未及調查清楚之處。 15．化學災變仍甚頻繁。 16．營業衛生之管理尚未立法，因此對與環境衛生相關之營業場所的衛生檢查在執行上倍感困難。 目前台灣環境衛生問題的種類複雜，範圍龐大，而程度又極嚴重，之所以導致目前的嚴重程度，並不僅源自產業結構與生活型態的轉型，行政管理與預防教育兩項工作未能在環境衛生逐漸惡化的過程中及時有效推動也是重要原因。因此在訂定廿一世紀環境衛生政策時應從科技、管理與教育三個層面同時考慮。 一、環境衛生科技政策 1．強調科技研究的深度：培養專業研究人才進行持續性的長期研究，以求對問題的特性與解決方法有整體及深入的了解。 2．強調科技研究的整合：培養專業研究人才進行整合性的研究融入污染預防的觀念，以謀求根本解決污染問題。 3．強調科技的本土化：在引進環境衛生科技時應考量台灣地區環境條件所引起的特殊性，以確認其適用性。 二、環境衛生管理政策 1．整合地方環境保護主管單位：地方環境保護主管單位不應依照行政區域設置，而應依照自然環境區域（如空氣流域、水流域）予以整合，以提高行政管理效率，並可藉向管理面積之擴大增加人力及經費。 2．加速嚴重污染地區的整治：對嚴重污染的河川和土壤應全面訂定整治計劃，安排整治日程，務期於2010年以前完成整治工作，以提供一個符合健康生活的環境。 3．加強環境保護法規的執行與修訂；環境保護主管單位的人力與預算都應增加，才能有效執行各項法規，並在執行過程中根據經驗以及新的觀念持續對法規加以修訂。 三、環境衛生教育政策 1．在國民教育加強衛生教育，在現有課程中融入相當份量的環境衛生教材，使學童能及早建立正確觀念，並能在學校活動及日常生活中實踐減少污染、預防污染的行為。 2．建立繼續教育體系以推動環境衛生教育。 3．獎勵大眾傳播媒體宣傳環境衛生觀念。
  none
• 1-12
• 10.6288/CJPH1995-14-01-01

• Link 其他 Others
• 廿一世紀的心理健康促進政策廿一世紀的心理健康促進政策
• 鄭泰安
  Andrew T.A. Cheng
• 無
  none
• 無
  none
• 13 - 22
• 10.6288/CJPH1995-14-01-02

• Link 原著 Original Article
• 烏腳病病患及盛行地區健康對照下泌尿道癌之長期世代追蹤研究A Cohort Study on Lower Urinary Tract Cancers in the Endemic Area of Blackfoot Disease
• 廖崑富、洪申發、林莉茹、薛玉梅、邱弘毅、江明禧、陳建仁
  Kuen-Fu Liaw, Shon-Fa Horng, Li-Ju Lin, Yu-Mei Hsueh, Hung-Yi Chiou, Ming-His Chiang, Chien-Jen Chen
• 無機砷暴露 ； 下泌尿道癌 ； 鳥腳病 ； 皮膚癌
  Arsenic exposure ; Lower urinary tract cancers ; Blackfoot Disease ; Skin cancer
• 本研究為長期世代追蹤研究，於民國七十四年自北門、學甲、布袋、義什四鄉鎮選取烏腳病病例257名及健康對照753名為研究對象，以探討無機砷及其他危險因子和下泌尿道癌症的關孫；並且分析烏腳病和皮膚砷病變（包括色素沉著症、角化症、皮膚癌）息者罹患下泌尿道癌症的危險性是否高游健康對照。經七年的追蹤調察，結果發現烏腳病及健康對照之膀胱癌死亡率顯著高於台灣地區一般人口，其年齡性別標準化死亡比為台灣地區的49倍和14倍。居住於烏腳病高盛行里年數愈長，飲用深井水年數愈長以及累積砷暴露量愈高者，罹患下泌尿道癌的危險性愈高。烏腳病病患、皮膚砷病變患者羅患下泌尿道癌症的危險性，顯著的高於其健康對照，其年齡性別調整化相對危險性分別為5.40、2.61。吸菸、飲酒、喝茶、蔬菜攝食頻率和職業與羅患下泌尿道癌無顯著相關。
  This prospective study was followed-up BFD-control cohort including 257 blackfoot disease cases and 753 age-sex-residence matched healthy controls. This study was carried out to examine the relationship between long-term exposure to ingested inorganic arsenic and lower urinary tract cancers. This cohort had a significantly higher age-sex-standardized mortality ratio (SMR) from bladder cancer than the general population in Taiwan. Compared with the general population in Taiwan as the standard population (SMR=100), the SMR from bladder cancer was 4897 for the BFD cases. Cox's proportional hazards regression analyses of multiple risk facters associated with bladder cancer showed a statistically significiant association between arsenic exposure and risk of lower urinary tract cancers. A significant dose-response relationship was observed between lower urinary track cancers and arsenic exposure indices including duration of residing in the BFD-endemic area, duration of consuming artesian well water, and cumulative arsenic exposure dose in ppm-years. BFD patients had a significantly increased risk of lower urinary tract cancers than non-BFD controls with age-sex-adjusted relative risk of 5.40. Patients affected with arsenic related skin lesions including hyperpigmentation, hyperkeratosis and skin cancers also had an increased lower urinary tract cancers risk showing an age-sex-adjusted relative risk of 2.61 compared with unaffected controls. None of cigarette smoking, alcohol drinking, tea drinking, vegetable consumption frequency and occupation was significantly associated with the risk of lower urinary tract cancers.
• 23 - 31
• 10.6288/CJPH1995-14-01-03

• Link 原著 Original Article
• 烏腳病盛行地區居民肺癌之長期世代追蹤研究A Cohort Study on Lung Cancer in the Endemic Area of Blackfoot Disease
• 廖崑富、洪申發、林莉茹、薛玉梅、邱弘毅、江明禧、陳建仁
  Kuen-Fu Liaw, Shon-Fa Horng, Li-Ju Lin, Yu-Mei Hsueh, Hung-Yi Chiou, Ming-His Chiang, Chien-Jen Chen
• 世代研究 ； 肺癌 ； 砷暴露 ； 烏腳病 ； 皮膚癌
  cohort study ; lung cancer ; arsenic exposure ; blackfoot disease ; skin cancer
• 台灣西南沿海烏腳病盛行地區自從裝設自來水後，烏腳病新病例已大為減少，但當地之肺癌死亡率，卻比台灣地區一般人口為高。本研究之目的即在於瞭解烏腳病病人及其健康對照組的肺癌死亡率；並且探討砷暴露與肺癌的關係，以及當地居民罹患肺癌的危險因子。本研究採用世代追蹤研究法，進行研究世代之追蹤研究，其中有257名烏腳病病人，以及753名性別年齡、居住鄉鎮匹配之健康對照者，追蹤時間為7年。結果發現本世代之肺癌標準化死亡比顯著高於台灣地區一般人口；羅患烏腳病、砷皮膚癌者，其標準化死亡皆比其健康對照組偏高。與肺癌之相關達統計顯著意義的危險因子，包括年齡、吸菸習慣、砷相關疾病及飲水砷暴露。在經過多變項調整之後，砷暴露量與肺癌相對危險性仍呈顯著的劑量效應關係。砷暴露與吸菸習慣之間，對於肺癌的發生有交互作用存在。
  Since the tap water system was implemented in the endemic area of blackfoot disease along the southwest coast of Taiwan Island, the incidence of newly developed cases of blackfoot disease has been decreasing. However, the mortality from lung cancer in the endemic area remains higher than that of the general population in Taiwan. The purposes of this study includes: (1) To assess the lung cancer mortality of blackfoot disease patients, and their age-sex-residence-matched healthy controls. (2) To explore the relationship between chronic arsenic exposure and lung cancer. (3) To evaluate the risk factors associated with lung cancer in this area. The subject was followed up in this long-term prospective study, including 257 blackfoot disease patients and 753 age-sex-residence-matched healthy contols. The analysis of mortality from lung cancer found that the lung cancer mortality of this cohort was significantly higher than that of the general population in Taiwan. The standardized mortality ratio (SMR) was 7.39 (95% confidence interval=3.39-14.05) for blackfoot disease patients. Analysis of multiple risk factors associated with lung cancer were carried out using Cox's proportional hazards model. The risk factors significantly associated with lung cancer mortality included age, cigarette smoking, arsenic related disease, and ingested arsenic exposure. After adjusting for multiple risk factors, there was still a significant dose-response relationship between chronic arsenic exposure and lung cancer. There was also an interactive effect on lung cancer between arsenic exposure and cigarette smoking.
• 32 - 40
• 10.6288/CJPH1995-14-01-04

• Link 原著 Original Article
• 桃園地區醫師實施健康促進行為之探討The Preliminary Study of Practicing Health Promotion Lifestyle among the Physician
• 陳美燕、王明城、 邱獻章、吳運東
  Mei-Yen Chen, Edward K. Wang, Hsien-Jane Chiou, Yung-Tung Wu
• 健康促進 ； 生活方式 ； 醫師
  Health promotion ; lifestyle ; physician
• 本研究之目的為探討桃園地區醫師實施健康促進行為之一般狀況及影響其執行的因素。以橫斷面問卷調查方式，針對在桃園縣醫師公會登記之所有醫師為母群體，以隨機抽樣方式抽出1000名（回收率41.1%）樣本。以經中文版修訂之“健康促進的生活方式量表”為工具。得以下結果：以基層醫療院所之醫師問卷回收率最高(58.6%)。從6個層面來看，自我實現得分排名第一，而運動行為得分是最低的。在52項健康促進行為中，多數醫師之行為出現頻率偏向“有時”至“經常”有實行。若以身為健康專業人員應有角色模範行為之觀點而言，頻率出現在“經常”以上可能較好，則只有10項達此標準。且整個得分分佈範圍相當大(26-142)，有18位樣本總得分低於48分，表示有些樣本生活方式過得相當不健康。本研究另外的發現是有60%的樣本描述他們至少有一種經常不適的身體部位，其中以頭痛和胃部不適的現象居多數。
  Teaching and counseling strategies to facilitate the health promotion lifestyle for people have been more emphasized in physicians' intervention, especially in the primary care. It is easier to provide the contents of health promotion to clients if physicians perform the role model of health promotion behaviors. The data presented here were collected in a mail-questionaire survey of a stratified sample of physicians in medical centers, community hospitals or primary care units, who were members of Physician's Association in Taoyuan. This study investigated 1000 (respod rate 41.1%) physicians to explore the practicing health promotion behaviors. The Chinese version of Health Promotion Lifestyle Profile was developed by the author. The results showed that the 6 dimensions from the lowest to highest score were exercise, health responsibility, stress management, nutrition, interpersonal suportive and self actulization behaviors. In 52 items, most of the frequency of the health promotion behaviors the subjects distribute from ”sometimes” to ”usually”. In the authors' professional point of view, health promotion behaviors of medical personels are required to distribute from ”usually” to ”always”. However, only 10 items reached the criteria in this study. And there is a wide range of score (26-142), moreover, there are 18 samples which score lower than 48, which shows that some subjects had unhealthy lifestyles. Additionally, this study found that 60% of the subjects described having often had headaches and stomachaches. This phenomenon needs to be further investigated.
• 41 - 50
• 10.6288/CJPH1995-14-01-05

• Link 原著 Original Article
• 台北市老年病患的住院壓力感受之調查研究Elderly Patients' Perception of Stresses Associated with Hospitalization in Taipei City
• 郭素娥、藍忠孚、馬鳳歧
  Su-Er Guo, Chong-Fu Lan, Fung-Chi Ma
• 老年病患 ； 住院壓力 ； 感受
  Elderly patient ; hospitalized stress ; Perception
• 本研究目的乃調查臺北地區三所醫學中心的老年住院病患，冀求明瞭其主要的壓力感受及其相關因素。本研究採問卷訪談法，以老人住院壓力量表為研究工具，向研究者親自訪談，共收取91位老年病患。所得資料使用SPSS/PC(上標 +)與SAS等統計套裝軟體進行平約值、t檢定、變異數分析、積差相關等統計方法進行分析，其研究結果如下： 1．老年病患的整體住院壓力平約值是0.57（最高3分，最低0分），其中以疾病及治療措施的壓力類別最大，平均值為1.07，而醫院環境的壓力類別最小，平均值為0.21。 2．老年病患的前十項住院壓力大部份是屬於疾病和治療措施，以及缺乏資訊等二大類別的壓力。 3．性別、教育程度、婚姻狀況、自費與否、科別、疾病嚴重度，是住院壓力的影響因素。 本研完結果可提供醫護人員瞭解老年住院病患的感受及其前後順序，並作為擬定醫療照顧計劃的參考。
  The purpose of this study was to investigate perceptions of hospital stress and their related factors on the elderly in three hospitals in the Taipei area using an Elderly Hospital Stress Scale. Interviews were used to collect data from 91 elderly patients. The results are as follows: 1. The mean of the Elderly Hospital Stress Scale was 0.57 (on a scale from 0 to 3); and among them, the stress items for disease and therapy were the highest with a mean of 1.07; while the stress item for ”hospital environment” was the lowest with a mean of 0.21. 2. The ten most stressful items associated with for the hospitalized elderly were related to their illness, therapy and to a lack of information. 3. Gender, education, marital status, health insurance status, ward, and severity of the illness were factors which influenced hospitalized stress. The results of this study show that the perceived stress of elderly patients in-patients and their priorities. It could provide doctors and nurses insight into how the elderly perceive stress and how better care can be provided to reduce this stress.
• 51 - 61
• 10.6288/CJPH1995-14-01-06

• Link 原著 Original Article
• 南市老人預防腦血管疾病的認知、態度與行為調查The KAP Survey of CVD on Tainan City Elder
• 魏美珠、楊美雪、吳聰慧
  Mei-Chi Wei, Meei-Shieu Yang, Tsong-Huey Wu
• 腦血管疾病 ； 知識、態度與行為 ； 盛行率
  CVD ; KAP ; Prevalenc
• 本研究旨在探討台南市老年人對於預防腦血管疾病的認知、態度與實際行為，並調查該市老人腦血管相關疾病的盛行情形。以多步驟抽樣法先抽樣出30個樣本里，再抽出500戶為樣本戶，最後再以戶內抽樣法決定每戶內的老人樣本。研究資料以問卷訪視法來收集，資料分析以SPSS/PC+統計程式庫進行。 研究結果發現老人對於「醣類攝取過多」、「糖尿病」、「固定運動或散步」這三項因素之認知較低約只有50%。確實知道腦血管疾病在國人十大死因排名第二位的老人只占3.4%。 調查老人實際預防腦血管疾病的行為發現，每三個月內固定量一次血壓的老人只占23.8%；每天或每星期固定作一次以上運動或散步的老人只占48.9%，健康行為仍嫌不足。 受訪老人自述有高血壓、糖尿病、心臟病、腦中風的比率分別為23.7%、10.8%、10.6%與3.8%。且分別有8.1%高血壓老人、4.5%糖尿病老人、20.5%心臟病老人與6.3%腦中風老人沒有接受治療。 研究建議衛生主管機關加強老人瞭解「糖尿病」、「醣類攝取過多」對於腦血管疾病的影響，以及「固定運動、散步」對預防腦血管疾病的助益；並強化老人定期測量血壓的行為，提高公共衛生護士人力以幫助老人監視健康情形，藉以提昇老人生活品質。
  The study sought to ascertain the KAP (knowledge, attitude and practice) of Tainan city elders on CVD (cerebrovascular disease), and to survey the prevalence in related disease of CVD. Study data was obtained through an interview with the sampled elders. SPSS/PC+ statistic program was used to analyze the acquired data. The Knowledge of visited population on the three CVD related factors-”over carbohydrate regimen”, ”diabetes mellitus”, and ”regular exercise” was not enough. And, insufficient exercise, negligence to blood pressure limited the prevention of CVD. Again, above 41% of visited population failed to releasing their psychosomatic syndrome. It was suggested that strengthen elder education and practice on prevention of CVD was necessary. Futhermore, promotion of public nursing manpower was required to monitor elderly health behavior
• 62 - 77
• 10.6288/CJPH1995-14-01-07

• Link 原著 Original Article
• 台灣省衛生所護理相關人員工作評價及滿意度之調查Appraisal and Satisfaction among Staff Nurses in the Health Stations of Taiwan Province
• 張峰嗚、林綽娟、郭憲文、鄧玉貴、李俊年
  Feng-Ming Chang, Chouh-Jiaun Lin, Hsien-Wen Kuo, Yu-Kuei Teng, Jiunn-Nian Lee
• 護理相關人員 ； 工作評價 ； 工作滿意度
  Staff Nurses ; Job Appraisal ; Job Satisfaction
• 本研究之目的在調查本省衛生所護理相關人員對其組織與工作內容之評價，以作為衛生機關未來改善基層衛生工作模式之參考。本研究係以郵寄問春式調查法，問卷表參考國內外相關調查報告製訂之。調查表經預試、專家效度及內在一致性信度測定（係數為0.86）等到試後使用。研究對象包括台灣省338所衛生所所有護理相關人員，包含護產人員（為衛生所中護士、公共衛生護士及助產士之總稱）、家計佐理員（以下簡稱家計員）、慢性病防治員（以下簡稱慢防員）等。總共寄出2,486份，實際回收2,359份問卷，回收率為94.9%。所得結果如下： 在工作評價方面，其日常主要工作項目的順序不同，急須謀求改善。而且研究對象認為工作項目中應加強的項目包括為「心理衛生」、「慢性病篩檢與防治」及「營養衛教」；且認為「接生服務」、「簡易手術」及「夜間門診」等項目應考慮予以取消。在組織氣候方面，護理相關人員與主管的互動以「偶而」最多，尚嫌不足，故應加強彼此間互動的關係。在工作滿意度的四個層面中以人際關係總分最高為3.44分，薪資福利及工作環境最低為2.7分，整體工作滿意度得分接近「尚可」。而影響工作滿意度之因素依序為組織氣候、工作倦怠感、年齡、職稱、及婚姻等五個變項，其中以組織氣候影響最大，其解釋力達35%。 因此建議衛生機關應適時檢討基層衛生單位之工作職責，並針對工作人員較不滿意的事項，包括與單位主管間互動及個人福利等，均應及早改善。
  The purpose of this study was to investigate the appraisal and satisfaction among staff nurses in the health station of Taiwan Province. 2,486 staffs, mainly performed the primary health care in 338 health stations, were investigated by a mailing questionnaire which has approved by reliability and validity test. The questionnaire contained the issues of basic personal data, job appraisal and satisfaction personal planning for the future etc. The coefficient of reliability was 0.86; the response rate was 94.9%; and collected data was analyzed by package of SAS/PC 6.04. Our result indicated that the mental health, health care for elderly and chronic diseases, and public education for healthy diet appraised as items to be improved yet the items of maternal delivery care, surgical care, and nighttime clinic were appraised the worst among job items of health station. As for the general appraisal of the satisfaction on daily job, most of these nurses rated to be ”fair”, however, satisfaction on specific issues was showed variously response. Using multiple regression analysis, the significant variables of job satisfation, the climate of institution, age, marital status and the present of working. The coefficient of determination was 35.0%. We suggested to adjust the present job items of in the health station of Taiwan Province and to improve the situations which elicited most of the dissatisfaction of the staffs nurse, i.e.: ability of director; pertinance of communication with director; personnel appraisal system, etc. These are remained as important topics for further administrative intervention.
• 78 - 87
• 10.6288/CJPH1995-14-01-08

• Link 原著 Original Article
• 長庚醫院實施門診醫囑電腦化管理實證研究The Development and Implementation of a Computerized Operation System for Ambulatory Service in Chang-Gung Memorial Hospital
• 莊逸洲、郭煇煌、楊雯媛
  Yi-Chou Chuang, Huei-Huang Kuo, Wen-Yuan Yang
• 管理系統 ； 門診 ； 電腦化 ； 效率 ； 效益 ；
  Management System ; Ambulatory ; Computerized ; Efficiency ; Effectiveness
• 在醫療環境快速變化與同業競爭日益急劇的狀況下，有效率的醫療管理，必須以病患為中心，針對病患的需要，將有限的醫療資源作最有效的分配運用。近年來，由於電腦資訊系統與人工智慧的發展，輔助行政及醫療人員的工作，對醫院之經營管理帶來了重大影響。除行政人員外，醫療人員亦可透過診療行為的改變，採用更具效率之作業方式，達到品質與成本持續性的改善目標。本研究係從病患在診室看診開始，將醫師看診、醫囑輸入、檢驗（查）、回診預約、批價收費、配藥領藥等均納入電腦管理系統，其中最重要的改變是醫師亦加入管理改善的行列。為協助醫師能更有效、方便地使用電腦輸入醫囑，除在制度及軟、硬體方面依其需求規劃設計外，並建議醫師訂定標準診療計劃以輔助看診，據以執行。研究結果，比較醫囑電腦作業實施前後之效益，實施前批價作業人員每日服務208人次，實施後增加為364人次，藥品處方錯誤率由0.60%降低為0.07%，而病患對等候繳費時間之滿意度，採用電腦醫囑作業為47.5%，採用手寫作業為29.0%；對等候領藥時間之滿意度，採用電腦醫囑作業為56.2%，採用手寫作業為30.0%：統計均有顯著差異。
  The health care environment is under drastic changes with a lot of competitions within the business. A pre-requisite for effective and efficient management is that health care providers must be aware of the needs of their patients; and that limited resources have to be distributed efficiently. In order to minimize cost and at the same time maintaining good quality of medical care, a variety of strategies have to be adopted. In recent years, the impact of rapid development of computer information and artificial intelligence systems on hospital administration has been enormous. It is worth bearing in mind that behavioral habits of both administrative personnel and medical specialists could also be changed. This study aims to evaluate the effect of implementing a complete computerized system from registration to the collection of medicine. The most important point is that medical doctors are also involved in management improvement. In order to assist medical doctors in using the system, they were invited to participate in development all the way, from choice of hardware and software, to the design of standard diagnostic procedures. Complete implememtation was carried out only when medical doctors were satisfied with the system. Results show that the mean number of persontimes served per day per service person increased from before 208 to 364 after the implemention of the computer system. On the other hand, rate of incorrect medicines discovered by pharmacists dropped from 0.6% to .07%. In addition, degree of satisfaction of patients is 47.5% by computerization and 29.0% by writing on waiting to pay for fees. On wainting for medicines, degree of satisfaction of patient is 56.2% by computerization and 30.0% by writing.
• 88 - 102
• 10.6288/CJPH1995-14-01-09

• Link 原著 Original Article
• 住院中病歷同期同儕審查之探討－以某醫學中心為例A Summary Report of Concurrent Peer Review of Inpatient Medical Records in a Medical Center
• 陳琇玲、黎憶萍、楊伸崇、吳巧雲
  Hsiu-Ling Chen, Yie-Ping Lea, Shen-Chung Young, Cheau-Yun Wu
• 病歷 ； 同儕審查 ； 同期審查 ； 醫學中心
  medical record ; peer review ; concurrent review ; medical center
• 病歷常作為衡量一家醫院醫療水準的基本工具，其要求的是提供即時、完整、正確、一致的醫療行為紀錄。現今台灣醫療機構病歷審查仍多半從事事後審查，尚未有同期審查之研究報告出現。再加上病歷品質有量的審查及質的審查二方面重點，量的審查透過病歷管理人員進行足足有餘。但限於醫療的專業性，質的審查則最好透過同儕進行審查，方能公正的判定。本研究即對病歷同期審查方法進行探討，針對數種基本病歷設計“住院中病歷審查表”，並在台北市某醫學中心進行二次住院中病歷抽樣同儕審查。研究結果顯示，入院記錄(Admission Note)方面，其品質以主訴(Chief Complaint)、現在病況(Present Illness)一般外表評估(General Appearrance)、身體檢查(Physical Examination)、及初步診斷(Impression)較佳，家族史(Family History)、過往病史(Past History)、生命徵象(Vital Sign)、特殊發現(specific Finding)較差。但入院記錄(Admission Note)於24小時內完成之時效控制良好。在住院摘要(Admission Summary)審查結果，缺乏率高，其填寫品質除了家族史(Family History)及處理計劃(Case Plan)外，其餘良好，且24小時完成率高。病程記錄(Progress Notes)方面，2天以上未寫比率仍高，但病程記錄記載簡略之病歷比率卻低。手術記錄(Operating Room Record)填寫品質良好，但應加強改進檢體(Specimen)及估計失血量(Estimated blood loss)欄位空白情況。文末並針對本研究之缺失及可能改進方向進行探討。
  Medical records review is a basic tool for evaluating the quality of a hospital. Major criteria includes timeliness, completeness, accuracy, and consistency of completing the medical records. Currently in Taiwan, most medical records review is retrospective-oriented, and there are scarecely any research reports concerning concurrent review. Furthermore, in reviewing the quantity of medical records, it is usually done via MRA (Medical Record Administor) or MRT (Medical Record Technician). However, because medical service is highly technical, it is better to monitor quality through peer review rather than by MRA. The purpose of this study is to design a ”Medical Record Concurrent Review Form” and then test it in a medical center. Inpatient charts were sampled during two specific periods. Physicians, including the superintendent and several senior physicians, were recruited as the peer reviewers. Eventually, the statistic data were presented for four basic categories of medical records: Admission Note, Admission Summary, Progress Note, and Operating Room Record. At the end of the article, limits of this study are stated and possible topics for future research are suggested.
• 103 - 110
• 10.6288/CJPH1995-14-01-10