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E89099
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007
從管理控制的角度探討臨床路徑的實施效能
An Exploratory Study on the Practice of Clinical Pathway: a Perspective of Managerial Control
1.徐永新
1.Yung-hsin Hsu
1.國立東華大學企業管理學系
1.Department of Business Management, National Dong Hwa University
001,002,003,004
1.國立東華大學企業管理學系
1.Department of Business Management, National Dong Hwa University
002
1.行政院國家科學委員會
1.National Science Council
A.14 計畫執行期間(起):2000-08-01
A.14 計畫執行期間(訖):2001-07-31
2000-07-012001-06-30
A.16 收到日期:2001-12-03
2
台灣地區各級醫院接受TKR手術之病人

1

A類醫院:44 B類醫院:30 C類醫院:31


44
003
01
C.2 聯絡日期:2002-04-16
2
1.國立東華大學企業管理學系
1.Department of Business Management, National Dong Hwa University
1
C.7 資料公開日期:2004-08-01
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008
2
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1
1
1
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3
001
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1.成本控制
2.論病例計酬
3.臨床路徑
4.醫院管理
5.醫療品質
1.Case Payment
2.Clinical Pathway
3.Cost Control
4.Hospital Administration
5.Medical Quality
從 管理的角度來看,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,便成了各醫療院所努力的目標。因此,醫療院所 勢必採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,本研究採用準實驗法以回朔 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、靜脈點滴注射天數、併發症發生率、14天再入院率、及病患手術 後第一次下床時間)、住院日及醫療費用等臨床、時間、及財務構面加以探討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 system are much better in terms of lowing 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.

D.16 完成檢誤日期:2003-08-20
D.17 預定釋出日期:2004-08-01
D.18 初次釋出日期:2004-08-01
D.19_1 最新版釋出日期:2004-08-01
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10.6141/TW-SRDA-E89099-1
http://efenci.srda.sinica.edu.tw/webview/index.jsp?object=http://efenci.srda.sinica.edu.tw:80/obj/fStudy/E89099
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