運用系統模擬探討醫院協同環境之轉院機制

Applying a System Simulation for the Patient Transfer Mechanism under the Hospital Collaboration Environment

楊淳懿(Chun-Yi Yang)

指導教授 ： 陳平舜

中原大學/電機資訊學院/工業與系統工程研究所/碩士(2011年)

https://doi.org/10.6840/cycu201100253

摘要

近年來醫療品質日益受到重視，如何利用有限醫療資源來提升病患的醫療品質形成一個重要的學術與實務議題。由於在醫療資源有限下的情況下病患人數逐年增加，造成病患等待接受醫療服務與獲得醫療資源的時間逐漸增加，除增加病患因無法及時獲得所需的醫療服務而導致病情惡化的狀況外，對醫院之名聲也有負面影響。因此，為解決此議題，本研究的研究目的為透過醫院協同的概念，探討如何透過醫療資源的共享，縮短病患等待接受醫療服務與獲得醫療資源的時間，進而提升醫院的醫療服務品質。因此，本研究以個案醫院放射科現有的轉院機制為例，藉由探討個案醫院兩個院區之醫療資源共享情況，進一步分析其醫院協同之轉院機制是否能有效縮短病患等待接受醫療服務與獲得醫療資源的時間。另外，本研究提出除個案醫院醫院協同之轉院機制現況外的可行方法，除藉由系統模擬模式比較其方法與個案醫院之轉院機制現況的優缺點外，還針對個案醫院之轉院機制進行敏感度測試與分析，並針對各模擬情境提出因應對策與建議。
研究發現醫院之間的確存在因醫療資源負荷不平均，而造成病患所獲得之醫療品質下降的狀況。藉由系統模擬比較個案醫院有醫院協同轉院機制與無醫院協同轉院機制兩種方案後，證明醫院協同的確能藉由平衡醫療資源負荷，達到有效縮短病患等待接受醫療服務的時間之目的，同時也能使病患獲得更快速與更優質的醫療服務品質。此外，本研究針對個案醫院放射科檢查系統與轉院機制現況，除提出每天應從A院區轉至B院區進行檢查的病患人數外，還提供個案醫院在未來就診的病患人數持續成長的狀況下，維持病患快速獲得醫療服務的因應對策與建議。
最後，藉由訪談個案醫院醫院協同之轉院機制實施方式，進一步發現目前對於醫院協同之相關規範尚未具全，因此除政府主導的醫療體系和同醫療體系（醫院聯盟）之醫院協同外，跨醫療體系之醫院協同則會因醫療行為（如：檢查方式）及會計系統（如：收費機制）等因素造成醫院協同實施之阻礙。由於本研究只針對同醫療體系之醫院協同進行研究與探討，因此未來研究可以本研究為基礎，拓展到跨醫療體系之醫院協同，以增進醫院協同實務上的應用價值。

關鍵字

水平協同 ； 系統模擬 ； 轉院機制 ； 醫院協同

並列摘要

Medical-care quality has recently gotten a lot of attention than before. How to use limited medical resources to improve patients’ medical-care quality becomes an important academic and practical topic. Due to the increment of patients and restricted medical resources, patients sometime cannot be cured timely, which leads to the worse physical condition and to damage hospital’s reputation. In order to solve this problem, the objective of this research is therefore to apply the concept of hospital collaboration to study how to share medical resources with other hospitals so as to reduce patients’ average waiting time and to improve the hospital medical-care service quality. This research considers a patient transfer mechanism of a hospital’s radiology department as case study. Through sharing medical resources within two hospital districts, this research investigates whether the collaborative patient transfer mechanism can reduce patients’ average waiting time or not. Further, this research proposes a new collaborative patient transfer mechanism and applies a system simulation to compare pros and cons of these two patient transfer mechanisms. Consequently, this study performs sensitivity analyses for the collaborative patient transfer mechanisms and find out corresponding strategies and suggestions for different simulation scenarios.
The results of this research show that the utilization of medical resources between two hospital districts is not equivalent, which leads to the decrease of patients’ medical-care quality. Comparing the collaborative to non-collaborative patient transfer mechanisms, the findings show that the collaborative patient transfer mechanism can indeed reduce patients’ average waiting time through balancing medical resources. Patients can obtain quicker and better medical-care service quality. In addition, this study explores the current situation of the case hospital radiology department and its patient transfer mechanism and proposes a better alternative, which transfers suitable patients from hospital districts A to B. This study also discusses a scenario of patients’ growth in the coming future and proposes a corresponding strategy and suggestion.
Finally, through interviewing with managers of the case hospital, this research summarizes that the current regulation of hospital collaboration is still room for improvement. Therefore, besides implementing the medical alliance by government and by allied hospitals, implementing cross-alliance hospital collaboration exists many obstacles, such as medical procedures (i.e., examination methods) and accounting systems (i.e., diagnosing fees). Since this research only focuses mainly on the hospital collaboration among allied hospitals, future research can extend the results of this research to cross-alliance hospital collaboration among non-allied hospitals in order to increase the practical value.

並列關鍵字

horizontal collaboration ； system simulation ； patient transfer mechanism ； hospital collaboration

參考文獻

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