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  • 學位論文

癌登資料庫在癌症診療品質監測之應用

Application of Cancer Registry Database to Cancer Diagnosis and Treatment Survillance

指導教授 : 陳金淵
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摘要


目的:提升癌症診療品質是癌症防治政策的重要方針。為了有效降低診療服務的變異性,確保醫療結果的品質,有賴採行具備實證基礎的診療準則。目前以提昇診療品質為導向之相關資訊系統並不普遍,因此,本研究擬利用癌症診療指引及品質測量指標規劃癌症登記資料庫,不但能夠提供符合衛生主管機關登錄申報之要求,更可以協助醫師在診療研究之需求,作為醫師診療指引遵循率之監測工具及標竿學習之參考平台。 方法:本研究自行開發系統,使用南部某醫學中心2002年1月至2006年12月之癌症登記資料庫,篩選膀胱癌新發個案且不拒絕醫師診療建議之患者218位為資料庫建置內容。在Windows XP作業環境下,以Microsoft Access 2003作為品質監測系統的設計工具及後端資料庫管理。 系統建置分三階段:(1)參考癌症診療指引並邀集醫師討論,選定合宜之品質測量指標;(2)結合衛生主管機關及醫師臨床研究之需求,完成癌登資料庫收錄欄位之確認;(3)針對臨床主治醫師及住院醫師(合計19位)進行系統測試,藉由問卷瞭解系統之品質、預期效益及使用者滿意度等表現。 結果:開發完成之系統功能包括:(1)「品質測量指標計算」-以百分比呈現個別醫師及全科平均遵循率十一項,可供醫師自我檢視及標竿學習之用;(2)「建議診療項目判斷」-依不同癌症期別,分成術前檢查、手術治療、化學藥物治療、後續追蹤等四部份,作為醫師提供診療服務之檢核機制;(3)「管理統計分析」-提供單位主管了解診療個案來源及服務量趨勢。 回收問卷18份(回收率94.4%)。系統品質方面,83.4%的測試者認同系統內資料的正確性高、77.7%認同系統操作穩定性、77.8%表示資料存取方便、72.2%認為系統收錄欄位可以符合研究需求。在系統效益方面,「可以反應治療準則的執行率」、「可以當改善治療準則的依據」及「提升癌症診療的結果」獲得99.9%之高度認同。在書面資料滿意度方面,也獲得九成以上測試者之認同。 結論:為協助臨床醫師採行更佳化的癌症診療服務決策,應用資訊科技提供具備實證醫學基礎且符合「適時、適地」要求的品質監測系統,應是未來相關照護的發展趨勢。 本研究利用癌症診療指引之判斷,就癌症登記資料庫應用於品質測量指標、建議診療項目及病患服務量之呈現,獲得大部份測試者之認同及滿意。未來將進一步針對臨床醫師之「診療指引遵循率」進行剖析,並與醫療費用、照護品質等資料做相關性檢測,以驗證其在實務上之成效。

並列摘要


Objective: The improvement of cancer diagnosis and treatment quality is an important strategy for the national cancer prevention policy. To effectively reduce treatment variation and ensure medical outcome, it is necessary for physicians to follow appropriate evidence-based practice guidelines. Nevertheless, so far the development and utilization of clinical information systems with focus on cancer diagnosis and treatment quality is still limited. This study aimed to develop such a quality monitor system based on cancer registry database, while in consideration of both health service authorities’ requirement and clinical physicians’ need, that it may serve as a mechanism for monitoring the compliance of practice guidelines and a platform for benchmarking. Methods: Derived from the 2002-2006 cancer registry database at a medical center in the southern Taiwan, the 218 new cases of bladder cancer patients who were willing to follow practicing physicians’ clinical suggestions were used to develop a cancer diagnosis and treatment quality monitor information system for this study. The Microsoft Access 2003 was adopted as the development tool and database management system under the operating system Windows XP. The development process was comprised of three steps: (1) selecting pertinent quality monitoring indicators with reference to clinical guidelines and through consultation with practicing physicians; (2) verifying the collection of database columns (variables) to fulfill the requirements of health service authorities and practicing physicians; and (3) conducting a system evaluation based on 19 physicians’ testing use and questionnaire feedback. Results: The developed system includes three main functions: (1) Calculation of Quality Indicators—providing 11 compliance rates for each individual physician and the department as a whole to help physicians review their own performance and/or to serve as benchmark; (2) Censor of Incomplete Items—providing information of omitted diagnosis and/or treatment during the pre-surgery examination, surgical treatment, chemotherapy, and follow-up by cancer stage; and (3) Administration Statistic—providing the department head with necessary information to oversee the patients sources and trend of service volume. With respect to the evaluation of system performance, 18 questionnaires were collected with a response rate of 94.4%. In terms of system quality, the dimension of data accuracy was recognized by 83.4% of respondents, the operating stability by 77.7%, the convenience of data retrieval by 77.8%, and the fulfillment of research need for database columns by 72.2%. In regard to system effectiveness, “appropriately reflecting the compliance rate of practicing guidelines,” “helpfully serving as the foundation of treatment improvement,” and “potentially helping improve the medical outcome of cancer diagnosis and treatment” were commonly recognized by 99.9% of respondents. As of document satisfaction, more than 90% of respondents demonstrated positive feedback. Conclusions: It would be the future trend of health care to furnish clinical physicians with optimized healthcare decision tools for cancer diagnosis and treatment. An alternative is to provide quality monitoring system based on clinic evidence “in the right place at the right time” with the aid of information technology. The study successfully develops a prototype of quality monitoring system and was satisfactorily accepted by the end-users. In the future, the compliance rate of clinical guidelines will be analyzed and linked to medical expenses and medical quality to examine the relationship.

並列關鍵字

bladder cancer quality

參考文獻


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