- 學位論文
整合實證醫學與專家經驗之知識管理系統-以椎間盤突出疾病為例
Integrating Evidence-Based Medicine and Expert’s Experience for Knowledge Management System
摘要
面對醫療環境的變遷，醫療專業人員如何在浩瀚的文獻中快速獲得所需的參考資料以保護病患安全及維持醫療品質水準，因此造成實證醫學的衍生，而實證醫學確實也在講求證據的時代中扮演重要的角色，實證醫學的過程相當嚴謹，需要花費許多時間成本與人力資源，在執行上確實有其困難度，而相對地在醫院中長期所累積大量的敘述型文字病歷，潛藏著豐富的臨床資訊與知識。如果能將這些豐富大量的病歷資料，拿來做有效的利用，即以實證醫學及臨床相關紀錄作基礎建立醫療知識管理架構，必定具一定效益。在本研究中就是將寶貴臨床經驗紀錄的匯整，利用文字探勘的工具，與醫療專家討論修正後，勾勒出醫療知識地圖，將實證醫學與專家臨床經驗結會，建立醫療知識管理系統，給予醫療人員判斷及處理醫療問題的參考來源。發展一套資源共享的管理機製，引進知識管理的導入架構，應能促使醫療資源投入的邊際效用最大化。藉以臨床經驗知識管理系統，彌補實證醫學不足的部分，即將臨床上的經驗加以分類、整合而轉換成有利的依據，建立一個臨床經驗分類準則，配合實證醫學的強力研究證據，相信對於初學的臨床醫師一定能提供更能正確且可用性的醫療判斷，並且從這些以前的經驗中找出錯誤的存在，維護病患安全及提升醫療品質的水準等。
並列摘要
As the changing of the medical environment, relations between patients and physician become more challenge. Many medical treatments need lots of correct medical information to reduce the unnecessary medical dispute and to increase the cure rate as the trend of more medical information being opened to public. Therefore, Evidence-Based Medicine (EBM) become an important basis when people doing medical. The target of this research is to build a mechanism to integrate Evidence- Based Medicine and the data of clinical activity and clinical experience recorder. By using Delphi Method and expert’s discussion doing exploration study, we giving different level scores to the data of clinical experience records and then produce the trustable evidence of clinical. We study the value of hidden experience by using Text Mining technology to transfer the tacit experience knowledge of the structured and un-structured documents into explicit experience knowledge. The clinical experience method can be the supplement to the insufficient of EBM. Integrating Evidence-Based Medicine and expert’s clinical experience, we build patient safety guide to help physician making proper medical judgment, which makes the patient safety and health care quality, are increased.