32卷3期

• Link 綜論 Review Article
• 診斷關聯群附加支付的發展與應用The Development and Application of Add-On Payments in a DRG System
• 李卓倫、洪錦墩、陳文意、蔡梓鑫、紀駿輝
  Jwo-Leun Lee, Chin-Tun Hung, Wen-Yi Chen, Tzu-Hsin Tsai, Chun-Huei Chi
• 診斷關聯群 ； 附加支付 ； 新興醫療科技 ； 健康保險
  DRGs ; add-on payment ; new medical technology ; health insurance
• 新興醫療科技通常會先應用在住院病人身上，當新科技已經上市但還未納入健保給付時，這項新科技不會在診斷關聯群的支付名單內，因此醫院比較不願意使用。理想上，經政府核准的新興醫療科技必須先經過醫療科技評估，以確定其用途、療效、及成本效果後才能正式由全民健保給付，但目前在缺乏醫療科技評估機制的情況下，新醫療科技與現有醫療科技的相對優勢，仍處於模糊的階段。在論量計酬支付制度使用新醫療科技通常會讓醫療支出上升，而導入診斷關聯群可能同時減緩醫療費用上漲和新科技的引進速度。這當中最大的挑戰，在如何透過支付制度設計，來達到一方面控制醫療支出，同時也提供足夠的誘因來促進醫療科技進步的雙重目標。本文之主要目標在描述介紹主要工業化國家對於社會健康保險或國民醫療服務為引進新興醫療科技時，在診斷關聯群支付制度上所做的誘因安排，進而提出其對台灣實施診斷關聯群支付制度的政策啟示。本文介紹的國家包括美國、德國、法國、義大利、和英國。這些國家附加支付的共同性包括制度的銜接、強調醫療自主性、以主診斷碼為依據、建構協商公式、及以科技評估為依據（義大利除外）。同時這些國家的制度也在下列方面有差異：以費用控制為目標（德、法、義）、對申請資格的限制（德、法）、以委員會議為審查機構（德、法）、建構醫療科技成本基準（美、德、英）、及強調資訊透明（美、德、英）。由這些國家實施附加支付經驗之分析，本文歸納出附加支付制度對台灣全民健保的重要啟示包括有助於支付制度的銜接、長期醫療費用控制、及控制家戶自付醫療費用占率。此外，為使附加支付制度達成其政策目的，台灣有必要建構醫療科技評估制度，及標準化客觀的醫療成本估算方式。
  New medical technologies have often been applied to inpatient care; however, when a new medical technology becomes available in the market but is not yet covered by national health insurance, such a technology is excluded from the Diagnosis-Related Group (DRG) list. Consequently, hospitals may be reluctant to use it. Ideally, once a new medical technology is approved by the government, it should undergo a health technology assessment (HTA) to ascertain its applicability, effectiveness, and cost-effectiveness before it is covered by a national health system. At present, however, the lack of HTAs makes the relative advantage of a new medical technology unclear. The adoption and use of a new technology in a fee-for-service payment system usually leads to increased medical expenditure. This is where the introduction of DRG add-ons plays an important role in regulating the rates of adoption of technology and rising expenditures. The major challenge in dealing with a new medical technology is how to design a payment system that will achieve the goal of controlling expenditure while providing adequate incentives for technological improvement. The purpose of this article is to compare how several industrialized nations designed their DRG add-on payment incentives in order to regulate the adoption of new medical technologies by their national health care systems, and to provide policy implications for Taiwan. We summarized the DRG add-on payment systems implemented in the United States (U.S.), Germany, France, Italy, and the United Kingdom (U.K.). Their systems share several common features in that they are consistent with the existing payment system, emphasize professional autonomy, use primary diagnostic codes as the foundation, provide formulas for negotiation, and are based on technology assessment (except Italy). There are unique features in some countries, such as an emphasis on cost control (Germany, France and Italy), restrictions on who can apply (Germany and France), setting up review committees (Germany and France), a cost-based foundation for medical technology (U.S., Germany and U.K.), and an emphasis on transparency (U.S., Germany and U.K.). For Taiwan, the lessons we learned from these countries include the importance of DRG add-on payments in providing consistency in the payment system, control of long-term health care costs and control of household out-of-pocket payments for health care. In order for DRG add-ons to achieve policy goals, Taiwan needs to establish systems for medical technology assessment and standardized medical cost accounting.
• 205 - 219
• 10.6288/TJPH2013-32-03-01

• Link 原著 Original Article
• 台灣工時規範之法規執行度－從法律規範之「應然」到「實然」The Effective Regulation Index for Working Hours in Taiwan-The Gap between Regulations and Reality
• 蔡奉真
  Feng-Jen Tsai
• 工作時數 ； 健康權 ； 勞動基準法 ； 法規執行 ； 全球化
  working hours ; decent work ; labor law ; effective regulation ; globalization
• 目標：本文就我國歷年之勞工每周平均工時、我國工時規範之法規嚴格度、法規遵守度與法規有效度進行分析與了解。方法：法規嚴格度指數係以工時規範中之每週工作時數為量測對象，法規遵守度指標則係以各國勞工實際工作時數低於每週工時標準之比例為量測對象，法規有效度指數則為法規嚴格度指標及法規遵守度指標的平均。本文以行政院主計處所發布之人力資源調查資料庫從1978年至2010年止之資料及台灣歷年工時規範之變化為材料，就台灣勞工歷年實際每周平均工時、法規嚴格度、法規遵守度及法規有效度進行分析。2004年之資料另被特別分析，以與其他國家相較。結果：我國全體工作者之每周平均工時普遍偏高，在2000年前，全體工作者每周平均工時高達46小時以上，在2000年後除於2009年時降至43小時外，其餘年份之每周平均工時均高於44小時．我國之法規嚴格度（數值範圍為0-10）於2000年時明顯自0提升至4.6，而法規遵守度（數值範圍為0－10）則從1978年的6.4緩慢上升到1999年的8.6，但在2000年時遽降到1.6，此後2001到2010年間則維持在5上下。法規有效度（數值範圍為0－10）在2000年之前大致維持在2.9到4.3之間，其後則一直維持在4.7～5.3間。2004年時我國的法規遵守度僅有5.2，而法規有效度為4.9。結論：台灣工時規範之實然與應然間落差極大，代表我國工時規範成效不彰，本文建議增加勞工法律保障意識，並改變勞動檢查制度，以增強法規執行之成效。
  Objectives: This study was conducted to evaluate the average yearly working hours of workers, the Statutory-hour Strictness, the Observance Degree, and the Effective Regulatory Index for working-hours in Taiwan. Methods: The Effective Regulation Index was defined as the average of Statutory-hour Strictness and the Observance Degree. The dataset of the Human Resource Survey from 1978 to 2010 compiled by the Directorate-General of Budget, Accounting and Statistics, Executive Yuan was used in the study. The changes in regulations for working hours in Taiwan were determined. Then the average yearly working hours of workers, the Statutory-hour Strictness, the Observance Degree and the Effective Regulation Index for working hours in Taiwan were calculated. Information from 2004 was further analyzed for comparison with other countries. Results: The average working hours of workers in Taiwan were comparatively high. Before 2000, the average working hours per week were above 46. After 2000, average working hours per week were still above 44, except for 43 hours in 2009. The Statutory-hour Strictness rose from 0 to 4.6 in 2000. The Observance Degree slowly increased from 6.4 in 1978 to 8.64 in 1999; although it dropped to 1.6 in 2000, it remained stable around 5 after 2000. The Effective Regulation Index for working hours in Taiwan was between 2.9 and 4.3 before 2000, but remained between 4.7 and 5.3 in the 21st century. In 2004, the Observance Degree of the working regulations was 5.2, and the Effective Regulation Index was 4.9. Conclusions: The huge gap between regulations and reality in working hours in Taiwan showed the ineffectiveness of working-hours regulation. We suggest increasing workers' awareness of regulations and strengthening enforcement of the working regulations by improving the labor inspection system in Taiwan.
• 220 - 230
• 10.6288/TJPH2013-32-03-02

• Link 原著 Original Article
• 台灣慢性病人醫療利用之探討－以慢性腎臟病、糖尿病及高血壓為例Medical Utilization by Patients with Chronic Diseases in Taiwan: Chronic Kidney Disease, Diabetes and Hypertension
• 李曉伶、吳肖琪
  Hsiao-Ling Lee, Shiao-Chi Wu
• 慢性腎臟病 ； 糖尿病 ； 高血壓 ； 醫療利用
  chronic kidney disease ; diabetes ; hypertension ; medical utilization
• 目標：人口老化導致慢性病人及醫療利用增加，實施論量計酬導致多重疾病病人至不同專科看病，探討慢性病人之醫療利用及其照護適用情形有其重要性。方法：以健保門住診資料定義2006年底仍存活之20歲以上慢性病人（患慢性腎臟病、糖尿病、高血壓）為對象，計算2006年底慢性病盛行情形，排除2007年死亡者追蹤其2007年醫療利用，探討慢性病型態對門住診醫療利用之影響。結果：2006年底20歲以上至少罹患一種慢性病者共2,539,137人，盛行率為14.83%；合併三種慢性病者之門診及住院利用最高，平均門診次數、科別數、醫師數、院所數分別為33.20次、5.41科、8.46位、4.57所，平均住院次數、天數、院所數分別為0.71次、7.37天、0.43所；合併三種慢性病、合併慢性腎臟病及高血壓者之門診利用顯著較僅罹患高血壓者高，合併三種慢性病、合併慢性腎臟病及糖尿病者之住院利用顯著較僅罹患高血壓者高。結論：慢性病型態會影響門診和住院利用。建議衛生主管機關提供適度之支付誘因，鼓勵及引導醫師提供多重慢性病人整合性照護，給予病人較佳之治療建議。
  Objectives: An aging population has more individuals with chronic diseases and greater medical utilization. In a fee-for-service payment system, patients tend to visit different specialists for their various conditions. This study analyzed the impact of patterns of chronic disease on medical utilization. Methods: This study used the National Health Insurance database to identify patients who had been diagnosed with chronic kidney disease, diabetes or hypertension, were aged 20 or older, and were alive at the end of 2006. The study measured the prevalence of chronic diseases in 2006 after excluding the patients who died in 2007. The study then analyzed current medical utilization by patients with chronic diseases. Results: There were 2,539,137 patients with at least one chronic disease in 2006, and the prevalence rate was 14.83%. The highest medical utilization was by patients with all three chronic diseases. For outpatient care, the numbers of visits, different departments, different physicians, and different hospitals/clinics were 33.20, 5.41, 8.46 and 4.57, respectively. For inpatient care, the average numbers of visits, hospital days, and hospitals/clinics were 0.71, 7.37 and 0.43, respectively. Outpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and hypertension were significantly higher than those of patients with hypertension alone. Inpatient utilization by patients with three chronic diseases and patients with chronic kidney disease and diabetes was significantly higher than that of patients with hypertension alone. Conclusions: Patterns of chronic diseases influence medical utilization. We suggest that health authorities provide appropriate financial incentives to encourage physicians to provide services and better treatment recommendations for patients with multiple chronic conditions.
• 231 - 239
• 10.6288/TJPH2013-32-03-03

• Link 原著 Original Article
• 高危險妊娠因素與出生體重對新生兒住院醫療費用的影響The Influence of High-Risk Pregnancy Factors and Birth Weight on Newborn Inpatient Expenditure
• 楊雅淑、黃偉堯
  Ya-Shu Yang, Wei-Yao Huang
• 高危險妊娠因素 ； 出生體重 ； 住院醫療費用 ； 診斷關聯群
  high-risk pregnancy factors ; birth weight ; inpatient expenditure ; diagnosis-related groups
• 無
  Objectives: The aim of this study is to investigate the influence of high-risk pregnancy factors and birth weight on newborn inpatient expenditure. Methods: The study design is that of a secondary cohort study. The subjects are admitted patients with ages of 28 days or less from the 2008 National Health Insurance Research Database. This study analyzed the influence of high-risk pregnancy factors and birth weight on newborn inpatient expenditure by t-test, ANOVA and multiple regression. Results: The multiple regression results showed that a maternal age of 35 years or more at delivery (ß=0.078), alcohol consumption during pregnancy (ß=1.004), diabetes mellitus (ß=0.181), renal disease (ß=0.761), lung disease (ß=0.599), anemia (ß=0.119), giving birth to three or more babies (ß=0.323), undergoing prolonged labor (ß=0.176), suffering from oligohydramnios or polyhydramnios (ß=0.290), having meconium stained amniotic fluid (ß=0.259), having a prolapsed cord (ß=0.414), undergoing a caesarean section (ß=0.308), having a gestational age of less than 37 weeks (ß=0.354), having a birth weight of less than 1,500g (ß=1.428) and having a birth weight of 1,500-2,499g (ß=0.432) increases newborn inpatient expenditure significantly (p<0.05). Conclusions: Certain risk conditions associated with highrisk pregnancies as well as low birth weight increase newborn inpatient expenditure. This study suggests that when the Bureau of National Health Insurance modifies the Taiwan Diagnosis- Related Groups classification framework of Newborns and Other Neonates with Conditions Originating in the Perinatal Period (MDC 15), they should take into consideration various risk conditions that are associated with high-risk pregnancy in addition to birth weight.
• 240 - 250
• 10.6288/TJPH2013-32-03-04

• Link 原著 Original Article
• 台灣民眾對居家服務的貨幣價值評估：假設市場評價法的應用The Monetary Value of Home Care Service: An Application of the Contingent Valuation Method
• 曾妙慧
  Miao-Huei Tseng
• 居家服務 ； 假設市場評價法 ； 願付價格 ； 願接受價格
  home care service ; contingent valuation method ; willingness to pay ; willingness to accept
• 目標：了解台灣民眾對於居家服務的貨幣價值評估，並檢視影響民眾貨幣價值評估之因素。方法：利用假設市場評價法之開放式直接詢價法，以台灣地區年滿20歲及以上之民眾為對象進行電話訪問，搜集民眾對於居家服務的貨幣價值評估，包括「願付價格」與「願接受價格」，共取得1,083份有效樣本。結果：當受訪者的家人有照顧的需求發生時，願意支付平均每小時新台幣107元（N=685）雇用照顧服務員照顧家人；當未來家人需要照顧時，受訪者願意犧牲自己的自由時間、或是辭去工作在家照顧家人，所能接受政府支付的最低補償價格，即「照顧津貼」為平均每小時新台幣144元（N=624）；做為一個居家照顧服務員提供非親屬居家服務時，受訪者願意接受的最低薪資為平均每小時新台幣166元（N=547）。結論：在政策意涵上，本研究所得的平均願付價格每小時107元可作為未來社會長期照護保險訂定部份負擔的上限參考值；社會長期照護保險制度下若設計照顧津貼，其額度設定可以低於實物給付的水準；在訂定社會長期照護保險的給付標準時，可將每小時166元做為考量定價的起始點。
  Objectives: To investigate how much monetary value people in Taiwan put on home care service, and to examine the factors that affected public assessment of the monetary value of home care service. Methods: Using the open-ended contingent valuation method, this study determined the monetary values of home care service, including willingness to pay and willingness to accept, by telephone interviews. A total of 1,083 telephone interviews targeted people aged 20 and older in Taiwan. Results: If a need for home care occurred, then the respondents were willing to pay an average of NT$ 107 per hour (N= 685) to employ a care worker to take care of their family member. The minimum compensation that the respondents wanted in order to sacrifice their free time or to quit their jobs to take care of a family member at home averaged NT$ 144 per hour (N= 624). As a care worker to care for non-relatives, the minimum wage that respondents were willing to accept averaged NT$ 166 per hour (N= 547). Conclusions: These results have the following policy implications: First, the average willingness to pay, 107 NT dollars per hour, can serve as a reference value for the upper limit of the deductible in long-term care insurance. Second, if a care allowance is built into the long-term care insurance system, then it can be set at a lower level than payment in kind. Third, 166 NT dollars can be used as the starting value for long-term care insurance benefits.
• 251 - 263
• 10.6288/TJPH2013-32-03-05

• Link 評論 Commentary
• 評論：台灣民眾對居家服務的貨幣價值評估：假設市場評價法的應用Commentary: The Monetary Value of Home Care Service: An Application of the Contingent Valuation Method
• 郎慧珠
  Hui-Chu Lang
• 無
  none
• 無
  none
• 264 - 264
• 10.6288/TJPH2013-32-03-06

• Link 評論 Commentary
• 作者回覆：台灣民眾對居家服務的貨幣價值評估：假設市場評估法的應用Response: The Monetary Value of Home Care Service: An Application of the Contingent Valuation Method
• 曾妙慧
  Miao-Huei Tseng
• 無
  none
• 無
  none
• 265 - 265
• 10.6288/TJPH2013-32-03-07

• Link 原著 Original Article
• 探討醫學中心護理人員情緒勞務對工作滿意度與工作倦怠之影響The Impact of Hospital Nurses' Emotional Labor on Job Satisfaction and Burnout
• 朱正一
  Cheng-I Chu
• 情緒勞務 ； 工作滿意度 ； 工作倦怠 ； 情緒智力
  emotional labor ; job satisfaction ; burnout ; emotional intelligence
• 無
  Objectives: The purpose of this study was to investigate the impact of nurses' emotional labor on job satisfaction and burnout. We also investigated the moderating effect of emotional intelligence in order to understand the associations among study variables. Methods: The purposive sampling method was adopted to select two medical centers in Taiwan. In each of these, 20% of the nurses were randomly selected to receive a questionnaire. A total of 236 questionnaires were distributed, and 219 valid questionnaires (92.8%) were returned. These were analyzed by using descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation analysis, regression analysis, factor analysis and Structural Equation Modeling (SEM) techniques. Results: The results showed that emotional labor was positively correlated with both job satisfaction(r=0.769, p<0.01) and burnout(r=0.413, p<0.01); nevertheless, burnout was negatively correlated with job satisfaction(r=-0.708, p<0.01). A moderating effect of emotional intelligence was not found. Conclusions: As hypothesized, emotional labor was positively correlated with both job satisfaction and burnout; but, burnout was negatively correlated with job satisfaction. More studies are needed to investigate other factors that may affect the overall model and to clarify the role of emotional intelligence.
• 266 - 278
• 10.6288/TJPH2013-32-03-08

• Link 原著 Original Article
• 台灣中高齡人口不同世代所得相關死亡率不平等之年齡變化趨勢Aged-Related Patterns of Income-Related Inequality in Mortality among the Middle-Aged and the Elderly in Taiwan by Different Cohorts
• 李妙純、劉亞明
  Miaw-Chwen Lee, Ya-Ming Liu
• 死亡率不平等 ； 集中指數 ； 相對不平等指數
  mortality inequalities ; concentration index ; relative index of inequality
• 目標：本研究使用「台灣地區中老年身心社會生活狀況長期追蹤調查」資料，應用集中指數（concentration index, CI）及相對不平等指數（relative index of inequality, RII）檢視中高齡人口與所得相關之死亡率不平等情形。方法：使用1999及2003年兩波資料及其2000－2003及2004－2007死亡與否為死亡情形之測量。所得測量乃受訪者及其配偶各項年所得總和，分為九組：自年所得36000元以下，至最高所得組年所得一百萬元以上。實證分析之樣本分三世代：1928年底以前、1929年初～1946年3月底出生及1946年4月～1953年底出生世代。結果：台灣中高齡人口與所得相關死亡率不平等集中於低所得組；例如2003及2007年年齡標準化死亡率CI為-0.1222及-0.1201；RII為-0.7496及-0.7355。相對於年長世代（1928年以前及1929－1946），年輕世代（1946－1953）之與所得相關死亡率不平等程度較大。世代內2007年之不平等比2003年小，亦說明不平等隨著年齡的增加而減少，符合「年齡平準假說」（age-as-leveler hypothesis）。結論：台灣中高齡人口呈現與所得相關之死亡率不平等，而且人口老化促使死亡率呈現年齡平準趨勢。此項趨勢雖可能是死亡選擇的結果，但也顯示若要預防老年人口之健康不平等，除要重視老年人口相關福利政策之制定，似乎亦應關注於從年輕或中年人口所衍伸之健康不平等相關議題。
  Objectives: Data from the Survey of Health and Living Status of the Middle-aged and the Elderly in Taiwan and the concentration index (CI) and relative index of inequality (RII) were used to examine inequalities in income-related mortality among the elderly in Taiwan. Methods: Survey data on the 60 and over population in 1999 and 2003 were linked to 2003-2007 data from a national death registry. Participants had been requested to provide information regarding annual income (including that of the respondent and his/her spouse). The income variable included nine categories ranging from below NTD 36000 to 1 million NTD and above. The sample was divided into three birth cohorts: before 1928, 1929-1946, and 1946-1953. Results: Results indicated that mortality was more pronounced among lower income groups of Taiwan's elderly. For example, age-adjusted CIs were -0.1222 and -0.1201 in 2003 and 2007, respectively, while age-adjusted RIIs were -0.7496 and -0.7355, respectively. In 2003, the CIs for the cohorts before 1928 and 1929-1946 were -0.1010 and -0.1301, while the RIIs were -0.6217 and -0.8023. In 2007, the CIs for the cohorts 1928, 1929-1946, and 1946-1953 were -0.0823, -0.0686 and -0.2887, respectively; while the RIIs were -0.5142, -0.4206 and -1.8061. These results indicated that the extent of inequality in mortality in the younger cohort was greater than that in the older cohorts. The decreased inequalities among the cohorts before 1928 and 1929-1946 also supported the age-as-leveler hypothesis. Conclusions: Income-related inequalities in mortality exist among the elderly in Taiwan, but health inequalities increase with age. Policy efforts are needed to reduce the social disparities in health among the elderly and in the young or middle aged as well.
• 279 - 288
• 10.6288/TJPH2013-32-03-09

• Link 原著 Original Article
• 醫院照護過程品質與急性心肌梗塞病人死亡之相關性The Association between Hospital Quality of Care and Short-Term Mortality of Acute Myocardial Infarction Patients
• 譚家惠、譚醒朝、楊銘欽
  Chia-Hui Tan, Sing-Chew Tam, Ming-Chin Yang
• 照護品質 ； 急性心肌梗塞 ； 醫院照護過程 ； 廣義階層線性模式
  quality of care ; acute myocardial infarction (AMI) ; hospital process performance ; hierarchical generalized linear model (HGLM)
• 目標：評估急性心肌梗塞6項醫院照護過程品質測量與病人出院後30天內死亡情形之相關性。方法：採橫斷性研究，以2007年1月至2009年11月住院主診斷為急性心肌梗塞病人（ICD-9 CM: 410.xx），排除後續治療者（ICD-9 CM: 410.x2），以廣義階層線性模式（HGLM）分析醫院層次的6項照護過程品質測量，對於病人出院後30天內死亡情形之相關性。結果：約85.5%的病人在住院期間曾接受aspirin治療、38.32%曾接受beta-blocker治療、46.75%曾接受ACE inhibitor for LVSD治療、43.91%曾接受低密度膽固醇檢查、41.37%曾接受血管再通術。經病人特質與醫院特質校正後，醫院住院期間beta-blocker使用情形（OR, 0.87; 95% CI, 0.83-0.92）、ACE inhibitor for LVSD使用情形（OR, 0.93; 95% CI, 0.87-0.99）、低密度膽固醇檢查執行情形（OR, 0.87; 95% CI, 0.81-0.93）、血管再通術使用情形（OR, 0.87; 95% CI, 0.81-0.93），以及6項品質測量的綜合分數（OR, 0.84; 95% CI, 0.76-0.92），對於病人出院後30天內死亡風險有顯著影響。結論：醫院照護過程品質測量對於急性心肌梗塞病人出院後30天內死亡風險有顯著影響，且醫院層次照護過程品質測量的應用與改善，將有助於急性心肌梗塞病人照護結果。
  Objectives: To evaluate the association of six hospital-level process of care measures and the 30-day mortality. Methods: This is a cross-sectional study. Patients admitted with a principal diagnosis of AMI (ICD-9CM: 410.xx, excluding 410.x2) (n=1,416) between January 2007 and November 2009. Aspirin use during hospitalization, ß-blocker use during hospitalization, ACE inhibitor for LVSD use during hospitalization, LDL-c testing, lipid lowering medication, and reperfusion therapy. Outcome included the 30-day mortality of AMI patients. Data were analysed by using a hierarchical generalized linear model (HGLM) to examine whether the 30-day mortality at the patient level varied among different hospital performance adjusted for patient and hospital characteristics. Results: Among those patients, 88.50% received aspirin therapy during hospitalization, 38.32% received ß-blocker therapy, 46.75% received ACE inhibitor for LVSD, 43.91% received LDL-C testing, 41.37% received lipid lowering medication, and 40.97% received reperfusion therapy. Overall the 6 quality of care measures were 53.7% of ideal instances. After risk adjustment, ß-blocker use during hospitalization (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.83-0.92), ACE inhibitor for LVSD (OR, 0.93; 95% CI, 0.87-0.99), lipid lowering medication (OR, 0.91; 95% CI, 0.86-0.96), reperfusion therapy (OR, 0.87; 95% CI, 0.81-0.93) and composite score of six measures (OR, 0.84; 95% CI, 0.76-0.92) were significantly correlated with 30-day mortality. Conclusions: A significant association between hospital's process performance and patient outcome was found. The outcome of AMI patients could be enhanced by improving process performance.
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• 10.6288/TJPH2013-32-03-10