醫療資訊系統的應用對肝炎個案管理 的成效分析---以某區域醫院為例

An Analysis On The Effect Of The Application Of Medical Information System On Hepatitis －Based on a regional hospital as example

史月丹(Yueh-Dan Shih)

指導教授 ： 王秉鈞

元智大學/資訊學院/資訊管理學系/碩士(2006年)

摘要

台灣是Ｂ型肝炎之流行區，一般成人中百分之九十五以上感染過Ｂ型肝炎，百分之十五至二十為Ｂ型肝炎帶原者。每年因肝癌而死亡者達10,000人之多，而其中有80%是因Ｂ型肝炎所引起，定期追蹤Ｂ型肝炎帶原者，是早期發現早期治療最重要的照護方針，為有效追蹤肝炎帶原者回診，需有個案管理師專責此業務以及資訊系統的輔助應用。本研究以某區域醫院為例，自88年開始於醫院內部增設肝炎諮詢中心，並由資訊人員開發了肝炎個案管理資訊系統。個案管理師透過肝膽科門診醫師轉介收案外，並由核醫科檢驗有Ｂ型、C型肝炎個案，由個案管理師以寄發通知單的方式，請病患至諮詢中心回診追蹤，評估收案後收集個案資料登錄於資訊系統，資訊系統有統計分析及資料查詢等多項功能，可協助個案管理師針對每位個案，每半年主動提醒病患回診做檢查及檢驗，若檢查、檢驗有異常現象，即安排個案做進一步醫療處置。自88年到94年12月31日止共收案13,835名Ｂ型、C型肝炎個案，其中Ｂ型肝炎患者佔83%，在分析整體之照護效益上，於(1)早期發現B型、C型肝炎患者肝功能異常率總計達6.17%，而將近有80%之年齡層分佈於青壯年期，意即挽救了700位青壯年免於肝臟進一步損害，並即時獲得最適當的照護 (2)早期發現B型、C型肝炎患者肝硬化、肝癌發生率總計達2.72%(3)個案管理中Ｂ型肝炎帶原者每年因肝癌、肝硬化而死亡者為0.007~0.065%，遠低於文獻資料所提之300萬帶原者中每年即有一萬名死亡(4)每半年至一年定期回診個案達27.67%，與研究前不到2%定期回診率確實有顯著改善(5)肝炎個案管理業務對醫院成本之影響，則每月可產生387,010元的利潤。

關鍵字

醫療資訊系統；個案管理；肝炎

並列摘要

Taiwan is a popular area for hepatitis B. Generally amongst adults over 95% have been infected with hepatitis B and 15~20% is hepatitis B carrier. Every year number of deaths due to liver cancer is as many as 10,000 and 80% is caused by hepatitis B. Periodical follow up of hepatitis B carrier is the most important caring policy on its early discovery and treatment.This research is based on a regional hospital as an example. Since 1999, the Hepatitis Counseling Center was established inside the hospital. In addition,information personnel also developed the Hepatitis Case Management Information System. Besides that the case manager can receive case through introduction by doctors in the outpatient services ,the medical department will also conduct examination on hepatitis B and C cases.The case manager will request patients to go to the counseling center for diagnosis and follow up in the form of issue of letter of notice.The information system has multiple functions including statistical analysis and information inquiry etc. that can assist case manager to conduct automatic reminder the patient to return for.From 1999 to December 31, 2005, all together 13,835 hepatitis B and C cases are collected .In regard to the analysis on overall caring benefit,(1)the rate of early discovery of liver function abnormality in patients with hepatitis B and C is 6.17% and close to 80% of the age group is middle age person..(2) the rate of early discovery of hepatitis B and C patient with cirrhosis and liver cancer is 2.72% (3) in case management, death of hepatitis B due to liver cancer and cirrhosis is 0.007~0.065% that is far lower than the number in the documentary information (4) periodical return for diagnosis case every half year to one year reaches 27.67% and there is significant improvement compared with less than 2% who returned for diagnosis periodical before the research (5) for the effect on the hospital cost by hepatitis case management activity, each month $387,010 profit can be generated.

並列關鍵字

Medical Information system；case management ；hepatitis

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