臨床路徑在網際網路上之系統實作與評估
中文摘要
臨床路徑是醫療管理者用來控制醫療成本及改善醫療品質的方法之一，也是成果管理 ( outcomes ma nagement ) 的工具之一，可用來追蹤病人由住院到出院每天的治療過程，讓病人順著臨床路徑建議 的治療方式進行，並利用分析、評估及廣佈醫療成果，來改進整個醫療體系的管理方式，可避免醫 療資源的浪費，並提昇醫療品質。臨床路徑的施行，常因各種主觀的環境而造成不同的結果。林口 長庚紀念醫院泌尿外科開始實行臨床路徑已有五年之久，由他們的實驗臨床路徑之經驗得知，實行 臨床路徑可以達到： 1. 降低病人的醫療費用 (Admission Charges) 、 2. 縮短病人的住院天數 (Length of Hospital Stay) 、 3. 改善醫療模式、 4. 改善醫療品質 (Quality of Healthcare) 。
根據林口長庚紀念醫院實行臨床路徑的經驗，若將整個臨床路徑施行之流程電腦化，可避免紙張的 浪費。另外若能配合資料庫，在資料傳輸及資料儲存方面亦也比傳統紙張作業便利。除此之外也由 於 WWW(World Wide Web) 的風行及其便利性，只要使用者能夠連上網際網路就可以使用，打破時 間及空間的限制。另外，使用者不需另外加裝任何軟體，亦沒有電腦作業系統平台之限制，只需要 開啟瀏覽器 (Browser) 即可使用。
本文將建立一 Web-based 之臨床路徑決策支援系統 (Clinical Pathway Support System — CPSS) 。 CP SS 系統乃是利用網際網路的便利性等特點，再結合林口長庚紀念醫院實行臨床路徑數年之經驗而 成之 Web-based 系統，可供多數使用者同時上線使用外，亦提供大家一個共同討論的空間，提高對 臨床路徑及醫療品質的重視。 CPSS 系統之主要目的，為建立、實行、及自動的評估臨床路徑實行 之後的效果。 CPSS 之評估方向，將朝病人住院天數、醫療費用及醫療的變異性 (variation) 等重要 指標著手。另外，為配合衛生署中央健保局 (Bureau of National Health Insurance. D.O.H) 之給付標準 以及作業流程，本系統所建立之資料庫，來源為全民健康保險醫療費用支付標準 ( 中華民國八十七 年二月版 ) 。使用者在建立臨床路徑表單時，可以透過介面直接由資料庫中選取健保給付之項目，
省去輸入資料或是輸入錯誤之麻煩，亦符合健保作業之標準流程。
相信建立這樣一個系統，可以讓建立及實行臨床路徑的醫療人員，能夠客觀的評估施行臨床路徑的 成果，同時亦可透過該系統來評估自己醫院的醫療品質。
Implementation and Evaluation of Web-based Clinical Pathway Support System
英文摘要
Implementation of Clinical Pathway is one way of the cost control and improving the quality of healthcare by healthcare mana ger. It’s also a kind of tool to evaluate the outcomes management. Clinical Pathway can be used for following up the treatmen t processes of patients everyday from admission to discharge, and the patient is treated according to the recommendations on t he clinical pathway special form. It can also improve the ways of whole healthcare manage system by analyzing, evaluating a nd spreading the result of healthcare to prevent from wasting of healthcare resources and promote the healthcare quality. How ever, it often has lots of different results by kinds of subjective factors when implementing Clinical Pathway.
The department of Urology in Chang Gung Memorial Hospital (CGMH) have implemented the clinical pathway for five years . And according to there experiences of implementing the clinical pathway, they can (1.) reduce the admission charges, (2.)
shorten the length of hospital stay, (3.) modify the healthcare mode, and (4.) improve the quality of healthcare.
Besides, we can also prevent from the wasting of paper if we computerize the whole procedures of implementing clinical path way. During implementation, It’s more convenience in transfering data and storage if we work with database. Besides, becaus e of the popularity and facilities of the WWW(World Wide Web), user can use the system after they connecting to the Internet . User need not install any additional software and can use this system by just opening the web browser in their own computer s.
In this thesis, we’ll build a Clinical Pathway Support System on Internet— CPSSI. The CPSSI is built by using the facilities o f Internet and the experiences of clinical pathway implementation in CGMH for several years. It can not only be used by man y users at the same time , but provide a space that everyone can discuss there, and so that raise the respects of clinical pathway and the quality of healthcare. The mainly purposes of CPSSI are creating , implementing and evaluating the clinical pathway a utomatically. The key points of the evaluation of the implementation of clinical pathway in CPSSI are the length of hospital st ay, admission charge, and the quality indicators. The database of CPSSI is built according to the payment system of Bureau of National Health Insurance. D.O.H, so that user can select the items in this database when building the clinical pathway form, a nd it can also reduce the inconvenient of data input.
We believe that the healthcare staffs whose create and implement the clinical pathway through the CPSSI can evaluate objecti vely the results of implementation of clinical pathway, and the healthcare quality at their own hospitals.
