44卷1期

• Link 政策論壇 Policy Forum
• 台灣無菸環境的現況與願景Current status and vision of a smoke-free environment in Taiwan
• 黃瑜盈、李中一
  Yu-Ying Huang, Chung-Yi Li
• 無none
  無none
• 台灣自1997年施行菸害防制法後，吸菸率與禁菸場所二手菸暴露率雖有下降，但新興菸品及境外平台刊登、販售等仍對菸害防制政策帶來挑戰。未來應評估調整菸稅及菸捐之可能性。
  Since the implementation of the Tobacco Hazards Prevention Act in Taiwan in 1997, both the smoking rate and secondhand smoke exposure in smoke-free places have decreased. However, emerging tobacco products and the listing and sale of such products on overseas platforms continue to pose challenges to tobacco control policies. In the future, the possibility of adjusting tobacco taxes and tobacco health and welfare surcharges should be evaluated.
• 001-003
• 10.6288/TJPH.202502_44(1).PF01

• 綜論 Review Article
• 美國包裹式支付照護改善計畫之發展Development of bundled payment initiatives for care improvement in the United States
• 吳肖琪、劉越萍、朱育增、賴宜華、高嘉妤
  Shiao-Chi Wu, Yueh-Ping Liu, Yu-Tseng Chu, I-Hua Lai, Jia-Yu Kao
• 包裹式支付制度、急性後期照護、前瞻式支付制度
  bundled payment, post-acute care (PAC), prospective payment system
• 美國聯邦醫療保險和聯邦醫療補助計劃服務中心 (Centers for Medicare & Medicaid Services, CMS) 自2013年至2018年實施全國性包裹式支付照護改善計畫 (Bundled Payments for Care Improvement, BPCI)，將急性住院或處置與急性後期照護 (post-acute care, PAC) 服務包裹於一筆前瞻性定額支付，發展四種模式，包括模式一（急性住院）、模式二（急性住院加PAC加再住院）、模式三（PAC加再住院）、模式四（急性住院加再住院），朝向以價值為基礎的照護(value-based care)，在維持同等照護品質下，降低醫療費用支出。BPCI初始版計畫實施後，病程照護醫療費用支出有減少，但因支付調整(reconciliation)僅分享節餘(shared savings)，未執行分擔成本(shared costs)，致Medicare虧損；因此2018年至2025年改採BPCI進階版(BPCI Advanced)計畫，BPCI進階版僅保留BPCI初始版中的模式2，該模式是BPCI初始版實施期間，參與單位最多且費用控制最好之模式，且不再計算出院後30日與出院後60日，僅採包裹出院後90日；亦即進階版的模式是包括當次急性住院以及出院日起90天內之PAC與再住院；且目標價之訂定亦納入多項醫院實際照護後之因素，並將照護品質指標作為支付調整之參考；BPCI進階版實施後，至2020年進行的評估，發現可維持照護品質且讓醫療費用支出上升逐漸趨緩。為因應我國快速高齡少子化與醫療費用逐年上升，建議政府可借鏡美國包裹式支付制度的經驗，參考美國挑選的BPCI項目，針對需要PAC的個案，將住院和處置與PAC及長照2.0復能之服務包裹於定額支付，輔以照護品質監測機制，以提供患者連續性與高品質的照護。
  In 2013, the US Centers for Medicare and Medicaid Services implemented the nationwide Bundled Payments for Care Improvement (BPCI) initiative. The BPCI initiative comprised four case models, namely Model 1, Acute Care Hospital Stay Only; Model 2, Acute & Post-Acute Care Episode; Model 3, Post-Acute Care Only; and Model 4, Prospective Acute Care Hospital Stay Only. The goal of the BPCI initiative was to transition from a traditional fee-for-service model to value-based care through bundling acute inpatient or outpatient procedures with post acute care (PAC) services into a single prospective payment, reducing health-care expenditures while maintaining quality of care. This initiative successfully reduced payments for discrete care episodes but incurred net losses due to the cancellation of shared costs, despite the presence of shared savings in payment reconciliation. Therefore, in 2018, the BPCI Advanced program was initiated as a continuation of the BCPI Model 2, which had the most participants and the best cost control. The BCPI program focused solely on bundling services from the time of an inpatient or outpatient procedure to 90 days after discharge. Additionally, the program incorporated the individual composite quality score of each participant into adjustments to target pricing methodology and payment reconciliation to slow the rise in health-care expenditures while maintaining quality of care. Given increasing health-care costs in Taiwan (due to a rapidly aging population and declining birth rate), the government should consider implementing a prospective payment program for hospitalization and PAC. Acute care can also be bundled with PAC and rehabilitation services under the Long-Term Care Plan 2.0 into fixed payments. This program should monitor care quality indicators to reduce national health expenditures while maintaining high-quality care for patients.
• 004-017
• 無none

• Link 綜論 Review Article
• 急診推展安寧緩和醫療之困境與挑戰：系統性文獻回顧 Barriers to integrating hospice and palliative care into emergency units: a systematic review
• 雷忠騰、莊舜惟、黃茱楹、趙從賢、林承霈
  Chung-Teng Lei, Shun-Wei Chuang, Chu-Ying Huang, Chung-Hsien Chaou, Cheng-Pei Lin
• 急診、安寧緩和醫療、困境、挑戰
  emergency department, hospice and palliative care, obstacles, challenges
• 人口迅速老化使重症及瀕死的病人之安寧緩和醫療需求上升，如何在急診環境中提供安寧緩和醫療以改善病人及家屬的生命末期照護品質成為一大挑戰。本研究旨在以系統性文獻回顧探討急診推展安寧緩和醫療之困境與挑戰。依循PRISMA指引進行文獻回顧，運用「急診」、「安寧緩和療護」、「困境」與「挑戰」等關鍵字，檢索PubMed、CINAHL、Embase、華藝線上圖書館等資料庫，納入條件：(1)中、英文原著質量性研究；(2)發表年份不限；(3)族群為急診就醫病人(年齡≥18歲)、家屬或醫療人員；(4)介入或主題與安寧緩和醫療相關。以QualSyst tool進行文獻品質評讀，採敘事統合法統整與分析結果，共收錄8篇研究，品質評讀總分介於90~95.5%。常見困境為(1)疾病嚴重度差異與家屬的不理解，使複雜的健康問題無法快速解決；(2)醫護人員對安寧緩和醫療的知識不足及溝通困難，導致識別病人需求及決策困難；(3)急救室空間不足且未設置安寧專區，致使提供照護受限；(4)缺乏決策資源系統整合，造成查詢與聯繫困難。建議增加具安寧緩和醫療專長的醫護人員，優化急診工作流程，改善硬體設施，並設立安寧緩和醫療獨立空間，使病人及家屬獲得支持與陪伴。強化健保系統整合，推動統一且即時的健康資訊系統，使醫療機構跨專業間能有效共享資訊，以提升急診病人安寧緩和醫療品質。
  Rapid population aging has increased the demand for palliative care for critically ill and end-of-life patients. Improving quality of end-of-life care for patients and their families in emergency settings is a major challenge. This study aims to investigate barriers to integrating adult hospice and palliative care in emergency units. A systematic literature review was conducted following PRISMA guidelines. Relevant keywords, including “emergency department/unit,” “hospice/palliative care,” “obstacles/difficulties,” and “challenges,” were searched in the PubMed, CINAHL, Embase, and Airiti Library databases. Articles were included for analysis if they (1) were original qualitative or quantitative studies in Chinese or English, (2) included patients aged ≥18 years, their families, and healthcare staff in emergency units, and (3) primarily focused on hospice and palliative care interventions. No restrictions on publication year were applied. The QualSyst tool was used for study quality assessment. Narrative synthesis was applied to consolidate and analyze the results. A total of eight studies with quality assessment scores ranging from 90% to 95.5% were included. The following obstacles were identified: (1) variations in disease severity and a lack of understanding from family members, hindering quick resolution of complex health concerns; (2) insufficient knowledge of hospice and palliative care, and poor communication skills among healthcare staff, complicating decision-making and identification of patient care needs; (3) limited space in emergency units and the absence of dedicated areas for hospice and palliative care, restricting the ability to provide appropriate care, and (4) lack of integrated decision-making resources, creating difficulties in information access and sharing. Emergency units should increase the number of health professionals specialized in palliative care, optimize emergency department workflows, improve infrastructure, and establish dedicated space for hospice and palliative care provision to provide support and companionship for patients and their families. Strengthening the integration of the healthcare system and promoting a unified, real-time health information system will enable effective interprofessional information sharing among medical institutions, thereby enhancing the quality of hospice and palliative care for emergency patients.
• 018-031
• 10.6288/TJPH.202502_44(1).113090

• Link 綜論 Review Article
• 靈性關懷在醫療體系之專業發展回顧與展望 A retrospective and prospective on the professional development of spiritual care
• 申玉微、張家臻、吳佳霓、董貞吟、杜侑倫、蔡兆勳
  Yuh-Wei Seng, Chia-Chen Chang, Jia-Ni Wu, Chen-Yin Tung, Yu-Lun Tu, Jaw-Shiun Tsai
• 靈性關懷、同理心、溝通、反思
  spiritual care, empathy, communication, reflection
• 本文關注的議題是靈性關懷在醫療體系中的專業發展，回顧多個國家靈性關懷專業發展的政策框架、實踐經驗及專業認證體系，包括英國、歐盟、美國、加拿大、澳洲和日本等地。透過結構化的方式整理各國靈性關懷的發展情況，並分析其背後的政策支持、教育體系以及實踐成效，理解不同國家在靈性關懷專業化過程中的成功經驗與失敗教訓，目的是對於台灣未來靈性關懷發展提出建言。靈性關懷專業發展可分為幾個階段：初步的宗教支持階段、逐漸專業化的過程，以及當前的制度化與跨領域合作階段。這些發展方向不僅顯示出靈性關懷逐步被納入醫療體系的重要性，也強調了其在滿足患者心理與情感需求方面的潛力。針對台灣的狀況，借鑒其他國家的成功經驗，分析了以下四個面向做為台灣靈性關懷專業發展的借鑑，分別為一、法規與政策面向；二、教育與專業培訓面向；三、跨文化與宗教多樣性面向；四、靈性關懷評估與介入模式實證研究面向。台灣應加強靈性關懷的專業培訓，並推動跨領域合作，以提升醫療人員的靈性關懷能力。此外，應鼓勵政策制定者制定更明確的法規，促進靈性關懷的資源投入，從而能夠更有效地滿足病人的全人需求。這樣的措施將有助於台灣靈性關懷的專業化發展，並提升整體醫療服務的品質。
  The present paper aims to explore the professional development of spiritual care within healthcare systems. It reviews the practical experiences of spiritual care professional development in several countries, including the policy frameworks, practices, and professional certification systems in the UK, the EU, the USA, Canada, Australia, and Japan. By structuring the information, this study organizes the development status of spiritual care in different countries and analyzes the underlying policy support, educational systems, and practical outcomes. The goal is to understand the successful experiences and lessons learned in the process of professionalizing spiritual care in various countries, thereby providing recommendations for the future development of spiritual care in Taiwan. The analysis indicates that the professional development of spiritual care can be divided into several stages: an initial phase of religious support, a gradual process of professionalization, and the current stage of institutionalization and interdisciplinary collaboration. These development directions highlight the importance of integrating spiritual care into healthcare systems and emphasize its potential to meet patients’ psychological and emotional needs. Based on Taiwan’s context and drawing on the successful experiences of other countries, the following four aspects have been analyzed as references for the professional development of spiritual care in Taiwan: 1. Regulations and Policy: establishing clear legal and policy frameworks; 2. Education and Professional Training: strengthening specialized training programs for spiritual care practitioners; 3. Cross-Cultural and Religious Diversity: promoting understanding and inclusion of diverse cultural and religious contexts; and 4. Evidence-Based Research on Spiritual Care Assessment and Intervention Models: developing and applying proven models in practice. Taiwan should enhance professional training in spiritual care and foster interdisciplinary collaboration to improve the spiritual care competence of healthcare professionals. Additionally, policymakers should be encouraged to establish clearer regulations and allocate more resources to spiritual care, thereby enabling a more effective fulfillment of patients' holistic needs. These measures will contribute to the professional development of spiritual care in Taiwan and improve the overall quality of healthcare services.
• 032-045
• 10.6288/TJPH.202502_44(1).113038

• Link 原著 Original Article
• 腦中風病人急性後期復健照護連續性與照護結果及醫療費用之關係 Associations of postacute rehabilitation continuity with care outcomes and medical expenses among patients with stroke
• 鄭昀瑄、郭玟妤、董鈺琪
  Yun-Xuan Zheng, Wen-Yu Kuo, Yu-Chi Tung
• 腦中風、急性後期照護、照護連續性、照護結果、費用
  stroke, post-acute care, continuity of care, outcomes of care, expenses
• 目標：腦中風病人急性後期照護不足導致失能情形與醫療費用不斷增加，過去研究顯示，照護連續性可改善病人照護結果並降低醫療費用，然而對於急性後期復健病人之研究仍屬缺乏。本研究針對缺血性腦中風急性後期復健病人，探討其從急性醫院轉銜至急性後期照護院所的照護連續性對照護結果及醫療費用之影響。方法：使用衛生福利資料檔，以首次於急性期出院後30天內接受住院或門診復健照護之缺血性腦中風病人為研究對象。依其所住的急性醫院與急性後期復健院所間前一年度的轉銜集中度(referral concentration)計算照護連續性，分為無、低、高三組。利用多變項迴歸分析照護連續性與出院後90天內再住院及總醫療費用之相關性。結果：共納入10，445位病人，高急性後期復健照護連續性，與缺血性腦中風病人出院後90天內再住院勝算較低相關，但轉銜集中度與病人出院後90天內總醫療費用無關。結論：高轉銜集中度可降低缺血性腦中風病人90天再住院，未來政策應該鼓勵院所間建立緊密合作關係，以提升照護結果。
  Objectives: Inadequate postacute care for patients with stroke increases both disability rates and medical expenses. Studies have suggested that continuity of care can improve patient outcomes and reduce medical expenses. However, research specifically focused on postacute rehabilitation for patients with stroke remains limited. In the current study, the effects of care continuity during the transition from acute hospitals to postacute rehabilitation facilities on 90-day readmission and on medical expenses were examined for patients with ischemic stroke. Methods: This study considered data from the Health and Welfare Data Science Center, Taiwan, for patients with ischemic stroke who received inpatient or outpatient rehabilitation within 30 days after discharge from the acute phase of treatment. Continuity of care was assessed on the basis of the referral concentration between acute hospitals and postacute rehabilitation facilities in the year preceding evaluation; the concentration was categorized as none, low, or high. Multivariate regression analysis was conducted to explore the association between continuity of care, 90-day readmission, and total medical expenses. Results: A total of 10,445 patients were included. The findings indicated that high continuity of postacute rehabilitation care was associated with reduced odds of 90-day readmission, but referral concentration was not associated with 90-day total medical expenses. Conclusions: A higher referral concentration was associated with reduced 90-day readmission for patients with ischemic stroke. Future policies should encourage closer collaboration between acute hospitals and postacute rehabilitation facilities to improve care outcomes.
• 046-056
• 10.6288/TJPH.202502_44(1).113063

• Link 原著 Original Article
• 糖尿病患加入論質計酬方案對髖關節置換術後照護結果及相關因素探討 Effect of participation in pay-for-performance program on postoperative care outcomes in patients with diabetes undergoing hip replacement surgery
• 郭娓吟、龔娟玉、龔佩珍、李安琪、周文鈺、黃秀玲
  Wei-Yin Kuo, Chuan-Yu Kung, Pei-Tseng Kung, An-Chi Li, Wen-Yu Chou, Hsiu-Ling Huang
• 糖尿病、論質計酬方案、髖關節置換術、再急診、再住院
  diabetes, pay-for-performance, hip replacement, return visits to emergency department, readmission
• 目標：糖尿病的高盛行率，已成為世界各國重視的慢性病之一。本研究探討糖尿病患加入論質計酬(pay-for-performance， P4P)方案對髖關節置換術後3日內再急診及14日內再住院風險及相關因素。方法：本研究為回溯性世代研究，利用健保資料庫篩選出研究對象，以傾向分數1：3配對(P4P vs. Non-P4P)，取得基本特質與健康狀態相似之2組研究對象，共計12，440人(3，110 vs. 9，330)。除了描述性統計及雙變項分析外，利用廣義估計方程式(Generalized estimating equations， GEE)探討研究對象出院後再急診及再住院之勝算比及相關因素。結果：在未配對前，加入P4P者平均年齡較年輕(72.31±10.28 vs. 73.83±11.47， p<0.05)。配對後，加入P4P者較未加入者，有較低之再急診勝算比(aOR： 0.92)，但未達顯著差異；有加入P4P者較未加入者，有較低之再住院勝算比(aOR： 0.7， 95% CI： 0.63-0.88)，進一步分析發現，所有相關變項之各組別間，有加入P4P者均有較低之再住院率(p<0.05)。結論：加入P4P者有較佳之術後照護結果，建議糖尿病患均應積極加入P4P方案。本研究結果可作為糖尿病照護及P4P方案政策之參考。
  Objectives: The increasing prevalence of diabetes worldwide represents a major chronic health concern. In this study, the effects of participation in a pay-for-performance (P4P) program on return visits to the emergency department within 3 days and readmission within 14 days after discharge were assessed in patients with diabetes undergoing hip replacement surgery. Related variables were also identified. Methods: This retrospective cohort study incorporated data from Taiwan’s National Health Insurance Research Database. Propensity score matching (1:3) was employed to create two groups (P4P and non-P4P) with similar baseline characteristics and health status. The final analysis included 12,440 patients (P4P, 3,110; non-P4P, 9,330). Descriptive statistics, bivariate analyses, and generalized estimating equations were used to identify odds ratios and factors linked to readmission and return visits to the emergency room after discharge. Results: Prior to matching, the P4P group had a younger average age than did the non-P4P group (P4P: 72.31 ± 10.28 vs. non-P4P: 73.83 ± 11.47 years; p < 0.05). After matching, the P4P group was less likely to return to the emergency department (aOR: 0.92) than was the non-P4P group, although this difference was nonsignificant. Notably, the P4P group had a significantly lower readmission rate (aOR: 0.7, 95% CI: 0.63–0.88) than did the non-P4P group. Further analysis confirmed that across all relevant variables, the P4P group consistently exhibited a lower readmission rate (p < 0.05). Conclusions: Participation in the P4P program resulted in better postoperative care outcomes. All patients with diabetes are recommended to join this program. The findings of this study can serve as a reference for diabetes care and P4P program development.
• 057-070
• 10.6288/TJPH.202502_44(1).113081

• Link 原著 Original Article
• 我們之間：探討主要家庭照顧者與失智者的溝通 Between us: an investigation of communication between primary family caregivers and individuals with dementia
• 盧鴻毅、羅彥傑、葉蓉慧、陸曉耘
  Hung-Yi Lu, Yen-Chieh Lo, Jung-Hui Yeh, Hsiao-Yun Lu
• 主要家庭照顧者、失智者、溝通
  primary family caregiver, persons with dementia, communication
• 目標：本研究探討主要家庭照顧者如何與失智者溝通。方法：從2023/10/01至2024/11/7期間，招募18位主要家庭照顧者，進行一對一深度訪談。結果：失智者在溝通過程中經常不按牌理出牌，年長的主要家庭照顧者比較寬容面對，以不激怒他們為要，即便受到失智者的語言傷害，也會選擇隱忍，彼此之間相依相守；但年輕的主要家庭照顧者則有不同的對待方式，即便知道孝順很重要，面對失智者的「花格格」個性，不排除大吵一架。討論：受到傳統儒家思想影響，即便失智者在溝通過程中不斷拋出難題，有些主要家庭照顧者選擇壓抑自己的情緒，有些選擇「直球對決」。未來應該提供主要家庭照顧者溝通訓練，特別是針對不同年齡層提供不同的照護及溝通思維，以建立彼此對等的溝通地位，讓主要家庭照顧者可以在照顧過程中保有自我，達成雙贏的局面。
  Objectives: This study explored communication between primary family caregivers and individuals with dementia. Methods: A total of 18 primary family caregivers were recruited for in-depth one-on-one interviews conducted between October 1, 2023, and November 7, 2024. Results: The primary family caregivers reported that individuals with dementia in the process of memory loss often behaved unpredictably during communication. Caregivers tended to be lenient toward their family members with dementia, seeking to avoid angering them during interactions. Older caregivers typically chose to silently endure verbally hurtful language from family members with dementia and hoped for a mutually supportive relationship. By contrast, younger caregivers chose to express themselves during conflicts with family members with dementia, despite considering filial piety to be a crucial tradition in their culture. The study results suggested that communication between primary family caregivers and individuals with dementia is influenced by traditional Confucian values in Taiwan. When experiencing challenges during communication with such individuals, the primary family caregivers in this study often suppressed their own emotions, which may be a suboptimal approach to communication for both parties. Conclusions: Communication training should be provided to primary family caregivers of all ages. Such training can enable them to maintain their sense of self while caring for individuals with dementia, which can ultimately result in a win–win situation.
• 071-084
• 10.6288/TJPH.202502_44(1).113086

• Link 原著 Original Article
• 初探居家服務督導員之安寧照顧職能：經驗與挑戰 Competencies of in-home palliative care supervisors: experiences and challenges
• 李依臻
  I-Jhen Lee
• 居家式照顧、安寧療護、居家服務督導員、職能
  home-based care, palliative care, supervision, competencies
• 目標：隨著長期照顧政策延伸銜接至安寧居家療護，居家式長期照顧團隊的安寧療護能力也需要相應提升。本研究旨在探討居家服務督導員的安寧照顧職能，以提升個案在生命末期接受安寧居家療護的照顧品質。方法：本研究為探索性質性研究，透過立意取樣方法，取樣單位涵蓋北部、中部、南部及東部地區的居家式長期照顧機構，邀請曾協助個案末期照顧的居家服務督導員參加焦點團體，共計25位。結果：居家服務督導的安寧照顧職能包含三面向與十項核心能力：(一)案家面向：提早導入安寧療護理念，且先確認案家安寧共識與準備度，以能進行瀕死評估與專業協作，並提供哀傷陪伴以及追蹤關懷；(二)居服面向：派案與人力媒合首重居服專業性與準備度，且應具備維護居服權益、危機支援與同理陪伴的能力，並能於實務學習與培力居服員；(三)網絡面向：具備跨機構協作與資源整合，以及組織內跨專業團隊合作的能力。結論：居家服務督導員的安寧照顧職能主要通過實務經驗來學習，這過程中強調與案家達成共識、居服員的準備度以及跨專業協作的重要性。這些要素的融合有助於推動居家長照與安寧療護的合作，從而全面提升照顧品質。本研究建議：提供居家長照團隊適切安寧療護訓練與心理支持，透過實務演練與定期舉辦系統化培訓，以促進職能發展。
  Objectives: Home-based palliative care has become an increasingly crucial aspect of long-term care plans, and therefore, home care teams must develop greater palliative care capabilities. In this study, the capacity to improve care transitions for individuals receiving home-based end- of-life care was assessed among home care supervisors. Methods: In this exploratory qualitative study, 25 home care supervisors with experience in end-of-life care participated in focus groups. These supervisors were selected through purposive sampling from home-based long-term care institutions across the northern, central, southern, and eastern regions of Taiwan. Results: Three key competencies were identified for home care supervisors, with each involving specific skills: (1) case-family competency, encompassing advocacy for early palliative care to ensure family agreement and readiness and abilities related to end-of-life assessment, professional collaboration, grief support, and follow-up care; (2) home care competency, encompassing case assignment and personnel matching based on professionalism and readiness, protection of home care workers' rights, availability of crisis support and compassionate companionship, and practical training and empowerment; and (3) network competency, encompassing cross-institutional collaboration, resource integration, and effective work within interdisciplinary teams. Conclusions: Home care supervisors play a crucial role in initiating in-home palliative care, promoting integration between general home care and palliative care. Training workshops should be developed to facilitate knowledge exchange among home-based long-term care teams and strengthen the palliative care competencies of home care supervisors in family and community settings.
• 085-098
• 10.6288/TJPH.202502_44(1).113087

• Link 實務 Public Health Practice
• 新冠肺炎疫情衝擊下醫院環境作業安全之影響 Impact of the COVID-19 pandemic on hospital workplace safety
• 
  
• 新冠肺炎、環境安全巡檢、廣義估計式(GEE)、醫院安全管理
  COVID-19 pandemic, environmental safety inspection, generalized estimating equation model, hospital safety management
• 目標：新冠肺炎(COVID-19)疫情爆發對醫院環境安全產生重大的影響，導致職場傷害和危害增加。本研究之目的在調查疫情期間威脅醫院環境安全的危害因素。方法：本研究對象為台灣北部某大型醫學中心醫院，依環境安全巡檢查核結果及場所用途屬性，分析COVID-19爆發前後環境安全巡檢定期檢查結果，並使用ANOVA檢定和廣義估計式(GEE)模型進行重複測量分析。結果：分析結果顯示，隨著COVID-19疫情警戒升級，“用電安全及設施”和“易燃物管理”缺失率有增加，而“緊急應變”缺失率呈現下降。研究還發現，急診部門在環境安全管理表現似乎比加護病房和手術室較不理想，這突顯環境安全管理要考慮特定部門或設施的重要性。結論：環境安全巡檢有助於監測醫院潛在危害因子，未來新興傳染病情期間，醫院環境安全管理建議特別注意易燃性酒精乾洗手液的管理、確保用電安全、醫院出入口及疏散逃生動線管理，及防疫臨時措施之變更管理，以塑造更安全的醫療照護環境。
  Objectives: COVID-19 had a major effect on hospital environmental safety, leading to an increase in workplace accidents and hazards. This study explored the hazardous factors that compromised hospital environmental safety during the pandemic. Methods: This study was conducted at a large medical center in northern Taiwan. Data from environmental safety inspections and hospital premises were used to compare safety inspection outcomes before and during the COVID-19 outbreak. Statistical analyses were conducted using an analysis of variance and a generalized estimating equation model for repeated measures. Results: When the levels of domestic COVID-19 alerts increased, an increase was observed in the deficiency rates for “electricity safety and facilities” and “flammable materials management.” By contrast, the deficiency rate for “emergency response” decreased. Additionally, the emergency department demonstrated lower performance in environmental safety management compared with the intensive care units and operating rooms, underscoring the need for department-specific considerations in safety management. Conclusions: Environmental safety inspections are essential for identifying potential hazards in hospitals. In cases of future outbreaks of infectious diseases, hospitals should prioritize monitoring the use of flammable alcohol-based hand sanitizers, ensuring electrical safety, monitoring hospital entrances and evacuation routes, and managing changes in temporary measures. These efforts are essential for fostering a safer health-care environment.
• 099-113
• 10.6288/TJPH.202502_44(1).113071