臺北市立聯合醫院推動臨床路徑資訊化之成效

Effectiveness of the Clinical Path Information System in Taipei City Hospital

高木榮(Mu-Jung Kao) ； 林儀芬(Yi-Fen Lin) ； 陳福隆(Fu-Lung Chen) ； 江淑珍(Shwu-Jen Chiang) ； 賴怡君(Yi-Chung Lai) ； 王祖琪(Tsu-Chi Wang) ； 劉秀雯(Shiow-Wen Liou) ； 廖麗文(Li-Wen Liao)

《北市醫學雜誌》 4卷9期 (2007/12) Pp. 861-869

https://doi.org/10.6200/TCMJ.2007.4.9.10

摘要

臨床路徑的推動目的除了醫療費用的控管外亦希望達到品質的監控。本文的目的是介紹臺立聯合醫院推動臨床路徑整合，建置費用管理即時化功能與品質監控自動化的資訊系統經驗，並分析推動後達到的成效。臺立聯合醫院臨床路徑資訊管理系統包括五個子系統：臨床路徑變異登錄系統、執行率統計系統、超額費用統計系統、變異個案統計系統及變異原因統計系統。該資訊管理系統係建置於院內網站，透過內網或虛擬私人網路，提供醫療人員進行變異登錄。系統提供變異指標警示功能，並提供線上查詢功能包括臨床路徑執行費用、執行項目明細等。而管理者則可藉由線上查詢，瞭解醫師執行臨床路徑及變異狀況，並了解費用控管情形，以利費用及品質的控管。推動臨床路徑資訊化的結果顯示，費用控制略見成效。比較94年與95年的資料顯示，在超額個案比率、超額費用、費用超額率及平均住院日方面均有改善情形。總利潤費用及平均利潤費用均增加，亦即對於醫院的收支已有實質貢獻。另外因臨床路徑資訊管理系統之便利性及執行率的管理，使得臨床路徑在變異的控管方面也有建樹，變異登錄比率上昇以及變異原因的統計數字，具體提供各醫療部科檢討及擬訂改善措施的參考。因此，推動臨床路徑資訊化系統對臺立聯合醫院不但得到經濟效益的改善，同時對醫療品質的提昇也具有實質有助益。

關鍵字

臨床路徑 ； 論病例計酬 ； 成果評估 ； 資訊管理系統

並列摘要

Clinical path implementation is an effective way to control resource utilization, and to maintain the quality of medical services. The purpose of this article is to document that the Clinical Path Information System developed in Taipei City Hospital improves clinical path efficacy. This system integrated five subsystems including a variance recording system, an executive rate monitoring system, a cost control monitoring system, and the statistic systems for path variances and the causes of variance. Use of the system provides a warning function for variances, and offers an online inquiry function. The Administrator can view the doctor’s implementation of clinical paths, and can determine how expenses impact the situation. The results show that expense control is more effective after deployment of the system. Comparing data between 1994 and 1995 demonstrates a reduction in expense cost through appropriate use, and a decrease in average days of hospital stay. Increases in profit, are a result of increasing hospital revenue and controlling expenditures. The convenience of the system and its effective execution allows improvement in variance monitoring of clinical paths and increases the variation recording rate and the statistical data about variation causes; and, offers each medical department a detailed reference to review for improvement. The development of the Clinical Path Information System in Taipei City Hospital provided both improvement of economic profit and medical excellence.

並列關鍵字

Clinical Paths ； Case payment ； Efficacy ； Hospital Information System