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題名: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--以人工髖關節置換手術為例
書刊名:健康管理學刊
作者:祝道松 引用關係
作者(外文):Zhu, Dauw-song
出版日期:2004
卷期:2:1
頁次:頁21-36
主題關鍵詞:醫院管理臨床路徑醫療品質成本控制論病例計酬Hospital administrationClinical pathwayMedical qualityCost controlCase payment
原始連結:連回原系統網址new window
相關次數:
  • 被引用次數被引用次數:期刊(2) 博士論文(0) 專書(1) 專書論文(0)
  • 排除自我引用排除自我引用:2
  • 共同引用共同引用:15
  • 點閱點閱:38
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。
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.
期刊論文
1.Kahn, K. L.、Keeler, E. B.、Sherwood, M. J.、Rogers, W. H.、Draper, D.、Bentow, S. S.、Brook, R. H.(1990)。Comparing outcomes of care before and after implementation of the DRG-based prospective payment system。Journal of the American Medical Association,264(15),1984-1988。  new window
2.Hornbrook, M. C.(1985)。Techniques for Assessing Hospital Case Mix。Annual Review of Public Health,6,295-322。  new window
3.Kahn, K. L.、Rogers, W. H.、Rubenstein, L. V.、Sherwood, M. J.、Reinisch, E. J.、Keeler, E. B.、Draper, D.、Kosecoff, J.、Brook, R. H.(1990)。Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system。JAMA,264(15),1969-1973。  new window
4.Wammack, L.、Mabrey, J. D.(1998)。Outcomes assessment of total hip and total knee arthroplasty: critical pathways, variance analysis, and continuous quality improvement。Clinical Nurse Specialist,12(3),122-129。  new window
5.江雅芬(19991200)。臨床路徑理論與實務--以實施人工膝關節置換術臨床路徑經驗為例。國防醫學,29(6),572-576。  延伸查詢new window
6.陳瑞瑛、洪維河(19950200)。臺大醫院住院日控制作業。醫院,28(1),31-34。  延伸查詢new window
7.廖熏香、王俐人、林俊龍(19981200)。慈濟醫院臨床路徑之實務經驗。醫院,31(6),61-77。  延伸查詢new window
8.Ethridge, P.、Lamb, G.(1989)。Professional Nursing Case Management Improves Quality, Access and Costs。Nursing Management,3,30-35。  new window
9.Graybeal, K. B.、Gheen, M.、McKenna, B.(1993)。Clinical Pathway Development: The Overlake Model。Nursing Management,24(4),42-45。  new window
10.Hofmann, P. A.(1993)。Critical Path Method: An Important Tool for Coordinating Clinical Care。Journal on Quality Improvement,19(7),235-246。  new window
11.Long, W. T.、Dorr, L.、Healy, B.、Perry, J.(1993)。Functional Recovery of Noncemented Total Hip Arthroplasty。Clinical Orthopaedics and Related Research,288,73-77。  new window
12.Metcalf, E. M.(1991)。The Orthopedic Critical Path。Orthopedic Nursing,10,25-31。  new window
13.Rubenstein, L. V.、Kahn, K. L.、Reinisch, E. J.、Sherwood, M. J.、Rogers, W. H.、Kamberg, C.、Brook, R. H.(1981)。Changes in Quality of Care for Five Diseases Measured by Implicit Review, 1981 to 1986。The Journal of the American Medical Association,264(15),1974-1979。  new window
14.Roush, S. E.(1985)。Patient-perceived Functional Outcomes Associated with Elective Hip and Knee Arthroplasty。Physical Therapy,65(10),1496-1500。  new window
15.Zander, K.(1991)。Case Management in Acute Care: Making the Connections。The Case Manager,2,39-43。  new window
16.林碧珠、莊琴英、陸嘉玲、顏碧秋、王金蓮、陳瓊香(19990400)。臨床路徑在骨科之應用。護理雜誌,46(2),45-54。new window  延伸查詢new window
17.Cohen, E. L.(1991)。Nursing case management--Does it pay?。Journal of Nursing Administration,21(4),20-25。  new window
18.Kahn, K. L.、Rubenstein, L. V.、Draper, D.、Kosecoff, J.、Rogers, W. H.、Keeler, E. B.、Brook, R. H.(1990)。The Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients - An Introduction to the Series。JAMA: The Journal of the American Medical Association,264(15),1953-1955。  new window
19.Kosecoff, J.、Kahn, K. L.、Rogers, W. H.、Reinisch, E. J.、Sherwood, M. J.、Draper, D.、Roth, C. P.、Chew, C.、Brook, R. H.(1990)。Prospective Payment System and Impairment at Discharge - The 'Quicker-and-Sicker' Story Revisited。JAMA: The Journal of the American Medical Association,264(15),1980-1983。  new window
圖書
1.Eitheredge, M. L. S.(1989)。Collaborative Care: Nursing Case Management。Chicago:American Hospital Association。  new window
圖書論文
1.李玉春(1996)。健康保險支付制度。健康保險。臺北:巨流。new window  延伸查詢new window
 
 
 
 
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