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醫院實施臨床路徑對住院日數、醫療費用及醫療照護品質影響之研究-以人工髋關節置換手術為例

A Study on the Effects of the Practice of Clinical Pathway in Hospitals on Length of Stay, Medical Expenses, and Medical Quality-Total Hip Replacement as an Example

摘要


從管理的角度看,控制是組織用來創造一個能夠激勵組織成員努力,以達成組織所期望或預定之產出標準的環境。當醫療院所在面臨成本效益考量時,為了避免醫療費用的浪費,在確保並且提升病患醫療照護品質的情形下,如何降低住院日數、提高病床利用率、控制醫療成本等,便成了各醫院所努力的目標。因此,醫療院所勢必探取許多管理控制的系統或方法,來達成醫院管理的目標,其中個案管理與臨床路徑是最近發展且最常被醫院管理者用於病患醫療業務品管的方法;分析臨床路徑,找出最有成本效益的治療方式,在維持與過去一樣的治療效果,或甚至更好的醫療品質,並期望降低平均住院天數,是醫院管理者一直努力之目標,然而若實施過當,僅著重督促病患早日出院,則可能因過份重視成本控制而損害醫療品質。為了深入瞭解並評估醫療院所實施臨床路徑的實際效益,本研究採用凖實驗法、及凖特定任務小組設計,以回朔方式收集資料,進行組別差異的描述性研究,並從醫療照護品質(包括留置導尿管、傷口引流管、靜脈黯滴注射天數、併發症發生率、14 天再入院率、及病患手術俊第一次下床時間)、住院日及醫療費用等臨床、時間、及財務構面加以探探醫療院所實施臨床路徑之效能。研究結果發現,實施臨床路徑的醫院在降低醫療費用及住院日方面顯著高於未實施醫院,至於醫療品質指標方面,則大致無明顯差異。

並列摘要


From the managerial perspective, control is a necessary mechanism for an organization to motivate its members in order to reach the organization's expected goals. It is a common dilemma as well as mission for hospitals to attain cost effectiveness and assure medical quality simultaneously. Shortening length of stay and increasing bed turnover are strategies popularly adopted by hospitals to contain costs. Some managerial control systems or methods have been applied to the hospital industry nowadays. Among them, case management and clinical pathway is a newly developed tool. Through the analysis of clinical path, the most efficient procedure can be determined without sacrificing the treatment outcome and medical quality. However, should it be inappropriately utilized, medical quality can be jeopardized. The current study is intended to adopt a quasi-experimental design to explore the implementation of clinical pathway in three dimensions. They are clinical (days of on foley catheter, on Hemo Vac, on IV, and ambulation), time (length of stay), and financial (medical expenses). The results show that hospitals with implementing clinical pathway sy stem are much better in terms of 1 owing medical expenses and length of stay than those without. But there are no significant differences among hospitals in the aspect of indicators of medical quality.

被引用紀錄


劉沛雯(2009)。住院病患護理依賴度、護理層級組合與照護時間之相關性〔碩士論文,長榮大學〕。華藝線上圖書館。https://doi.org/10.6833%2fCJCU.2009.00133
陳鈺薇(2013)。探討醫療預算系統對醫療決策行為之影響〔碩士論文,國立臺中科技大學〕。華藝線上圖書館。https://doi.org/10.6826%2fNUTC.2013.00022
顏淑婷(2014)。重大外傷病人於外傷科成立前後醫療資源耗用及醫療品質差異分析〔碩士論文,義守大學〕。華藝線上圖書館。https://doi.org/10.6343%2fISU.2014.00214
鄭浩任(2009)。老年髖骨骨折之兩種主要型態其術後住院天數及醫療耗用之比較〔碩士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU.2009.00378
邱慶宗(2007)。應用人工智慧於醫療資源利用率分析與探討-以股骨轉子間骨折手術為例〔碩士論文,國立虎尾科技大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0028-1501201314421335

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