Continuous Quality Improvement of Nursing Care: Case Study of a Clinical Pathway Revision for Cardiac Catheterization

護理照護之持續性醫療品質改善－以Tw-DRGs125之臨床路徑為例

嚴玉華(Yu-Hua Yan) ； 陳怡(Yi Chen) ； 龔志銘(Chih-Ming Kung) ； 彭麗蓉(Li-Jung Peng)

《The Journal of Nursing Research》 19卷3期 (2011/09) Pp. 181-189

https://doi.org/10.1097/JNR.0b013e318228cf46

摘要

Background: Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.Purpose: This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.Methods: BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre-and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk.Results: Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p＜.05) after revision implementation.Conclusions: Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.

關鍵字

臨床路徑修正 ； 診斷關聯群 ； 持續性醫療品質改善

並列摘要

Background: Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.Purpose: This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.Methods: BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre-and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk.Results: Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p＜.05) after revision implementation.Conclusions: Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.

並列關鍵字

clinical pathway revision ； Taiwan diagnosis related groups Tw-DRGs ； continuous quality improvement

參考文獻

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