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題名 | Does the Use of Clinical Paths Improve the Efficiency and Quality of Care under the Case Payment System for Inguinal Herniorrhaphy or Transurethral Prostatectomy?=在論病例計酬制度下對於接受腹股溝疝氣修補術及經尿道前列腺切除術的病人施行臨床路徑可以改善醫療照顧的效率及品質? |
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作者 | 張慧朗; 黃世聰; 謝明里; 王大民; 崔克宏; 賴榮豪; | 書刊名 | 長庚醫學 |
卷期 | 22:3 1999.09[民88.09] |
頁次 | 頁400-408 |
分類號 | 416.2423 |
關鍵詞 | 論病例計酬制度; 臨床路徑; 成果評估; 腹股溝疝氣修補術; 經尿道前列腺切除術; Case payment system; Clinical path; Outcome assessment; Herniorrhaphy; Transurethral prostatectomy; |
語文 | 英文(English) |
中文摘要 | 背景:此篇論文的目的,旨在評估在論病例計酬制度下,在接受腹股溝疝氣修補 術或經尿道前列腺切除術的病人,施行臨床路徑,對於醫療費用及醫療品質的影響。我們的 臨床路徑,包括論病例計酬制度所規定的全部基本診療項目。 方法:從1997年10月,國家健康保險局對於接受腹股溝疝氣修補術或經尿道前列腺切 除術的病人,施行論病例計酬制度。在同一時間,我們開始對於這種病人施行臨床路徑。我 們將1997年10月至1998年3月治療的病人,與1996年10月至1997年3月施行論病例計 酬制度前治療的病人做一比較,同時我們比較這兩段時期八種品質指標的差異。 結果:施行論病例計酬制度及臨床路俓後,病人住院日數明顯的減少(p<0.001)。在接受 腹股溝疝氣修補術的病人,其總住院費用明顯減少7.5%(p=0.001)。在經尿道前列腺切除術 的病人,其總住院費用減少4.5%(p=0.089),但還未達明顯的差異。施行論病例計酬制度及 臨床路徑後,在接受腹股溝疝氣修補術的病人,有兩種品質指標有明顯的改善。而在經尿道 前列腺切除術的病人,有三種品質指標有明顯的改善。約有60%接受腹股溝疝氣修補術的 病人,及約有70%接受經尿道前列腺切除術的病人,可以完全依照臨床路徑的治療模式進 行。 結論:此篇論文的結果顯示,在接受腹股溝疝氣修補術或經尿道前列腺切除術的病人, 施行包括論病例計酬制度所規定的診療項目之臨床路徑,可以減少病人的住院日數,減少病 人的總住院費用,同時改善醫療品質。 |
英文摘要 | Background: We evaluated the effects of implementing clinical paths for both inguinal herniorrhaphy (IH) and transurethral prostatectomy (TURP) on the efficiency and quality of medical care under the case payment system. Methods: Patients undergoing IH or TURP were treated using the guidelines for clinical paths under the case payment system (CPUCP). The results of treatment after implementation of CPUCP were compared with results for patients treated before implementation of CPUCP. We also compared results using eight quality indicators both before and after implementation of CPUCP. Results: The post-CPUCP length of hospital stay decreased significantly in patients who underwent either IH (p<0.001) or TURP (p=0.008). The post-CPUCP total admission charges decreased (p=0.001) by 7.5% in the IH group alone. Two quality indicators in the IH group and three quality indicators in the TURP group were significantly improved after implementation of CPUCP. The percentage of patients who completed treatment without deviation as recommended by the guidelines for CPUCP was about 60% in the IH group and about 70% in the TURP group. Conclusion: The results of this study indicate that the implementation of clinical paths under the case payment system for patients undergoing inguinal herniorrhaphy or transurethral prostatectomy can improve the efficiency and quality of medical care. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。