臨床路徑比較系統

Clinical Pathway Comparison System

于還莒(Hwan-Jeu Yu)

指導教授 ： 賴飛羆

國立臺灣大學/電機資訊學院/資訊工程學研究所/博士(2013年)

https://doi.org/10.6342/NTU.2013.10842

摘要

臨床路徑是在醫療執行過程中遵循共用診斷及治療程序，是醫護機構用來確保健康照護品質的方法之一，如何有效地獲取不同醫護機構的臨床路徑並建構一套比較的方法進行比較是個問題。
此研究目的是要設計及發展一套臨床路徑比較系統，使醫護人員或醫護機構管理階層可以方便地比對並指出醫院彼此之間臨床路徑的相似及差異之處，以協助其提昇自我機構的健康照護服務品質。
此研究提出兩種比較方式，第一種方式是以醫令類別為比較基礎，適用於比較來自不同健康照護體系不同格式的臨床路徑；第二種方式是以頻繁醫令集為導向進行比較，是從臺灣全民健保研究資料庫已申報的實際醫療紀錄中萃取出各醫院的頻繁醫令集進行比較。
第一種方式已應用於臺灣及蒙古兩家醫院的肝癌外科手術臨床路徑比較，發現兩家醫院的抗生素及止痛策略有差異，並對差異可能原因進行探討；第二種比較方式則發現低復發率與高一致性指標的頻繁醫令集相關，一致性指標數值70%被發掘可作為品質追求的基準。
總結，此研究設計並發展了一套臨床路徑比較系統，使其能同時滿足不同健康照護體系之間比較及實際醫療紀錄導向比較的需求，醫護人員及醫護機構管理階層能運用此系統方便地比較出臨床路徑之間彼此的差異，進而做出必要的調整，以提昇其臨床醫護的品質。

關鍵字

臨床路徑 ； 醫令集 ； 比較

並列摘要

Clinical pathway is one of the ways to assure quality of health care by following common diagnostic and therapeutic procedures in clinical practice. How to effectively collect clinical pathways of different care providers and determine methods to compare them can be a problem.
The objective of this study was to develop a clinical pathway comparison system for physicians and care provider management to conveniently identify the similarity and difference among hospitals and help improve their health care quality.
Two approaches were designed. One was physician order category-based, which was designed to compare different format clinical pathways from different health care systems. Another one was frequent physician order set oriented, which was designed to compare the frequent physician order sets derived from the evidence records of National Health Insurance Research Database (NHIRD) in Taiwan.
The first approach has been used to compare the hepatocellular carcinoma (HCC) surgical clinical pathways of Taiwan and Mongolia—resulting in differences of antibiotics and anti-pain being found, for which possible causes were discussed. Another approach showed that low recurrence rate associated with high consistency frequent physician order adherence. A consistency index 70% was found to be seen as a reference benchmark to pursue.

並列關鍵字

Clinical Pathway ； Physician Order Set ； Comparison

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