臺灣博碩士論文加值系統

當科技快速進步，醫療服務也持續推陳出新，各種能減緩病患疼痛的麻醉方式也是其中重要的一項。目前台灣大部分醫院，包括台大醫院已經有病患術後自控式止痛服務的提供，但因為PCA小組尚在起步階段，再加上病患老舊觀念所造成的阻礙，使得術後止痛服務的使用率不如預期；以目前台大醫院每位病患須自費7,300元，每個月平均約有350病患使用，總產質約2,555,000，若能因服務品牌質的提升，使每個月病患使用數量達500名（達每月開刀人數約15%），則每個月總產質可提高至3,650,000元。因此，如何有效推廣該項服務，提升服務的品質與數量，讓病患樂於接受術後麻醉服務，同時也院方自費項目的產值也十分可觀，是值得探討與研究的議題。
本研究計劃主要是針對本院PCA小組在投入人力與相關設備等資源後，下一步如何全面提昇急性疼痛服務的質與量，做完整地分析、探討；並針對問題提出解決方案。首先是經由平衡計分卡的建立來確立問題及假設，之後將嘗試在所有急性疼痛服務流系統程中建構動態調整模式，企圖藉由因果回饋圖和模擬結果找出不同科別、病房找出其主要驅動要素因子 (driver)，針對該驅動要素因子 (driver)的調整改善，最後經由動態平衡計分卡與KPI值（Key Performance Index）的成效評量，找出適合不同科別、病房的策略指導方針，希望完成建構一套持續成長、改進的急性疼痛服務模式。有機會並希望將此系統模式應用到其他醫院，讓台大醫院急性疼痛服務小組成為台灣發展院內急性疼痛服務的領先指標與模範。

With the rapid progression of new technology, medical services have continuous changed and developed day by day. Different kinds of analgesic methods or packages for relieving postoperative pain are one of the items. At present, most of big hospitals, including NTUH (National Taiwan University Hospital) have provided patient controlled analgesia for postoperative pain management. Owing to the initial development stage of APS (Acute Pain Service) team in our hospital and the obstacle from traditional old concept, the applying percentage of APS for the clinical practice was beyond the expectation. At present, patients have to pay NT 7,300 for receiving APS and about 350 patients will apply APS per month. The overall gross income (patients have to pay by themselves and the health insurance does not cover) will be around NT 2,555,000 every month. If the case number could increase by improving the service quality and then around 500 patients (15% of total patients receiving operation) will apply APS per month, the overall gross income will increase to around NT 3,650,000 every month. Thus, how to popularize this service by upgrade the service quality and quantity, and then increase the willing of patient to adopt this service with increasing the self-payment income for hospital simultaneously should be an important issue for further study and investigation.
This study was conducted to completely analyze, evaluate and propose the solution how to upgrade and improve the quality and quantity of APS in our hospital, since we have invested a lot of capital and manpower in setting up APS team. At first, we try to make sure and find out the target issues, problems and assumptions via BSC (Balanced Scorecard) analysis. Then, we will construct a dynamic modifying model from the APS systemic processing and try to dig out the key driver factor in the different wards and surgical departments through the cause & effect feedback diagram and the simulation results. At last, we will focus to make the modification and improvement for those key driver factors and by using the dynamic BSC and KPI value (Key Performance Index) to make the final evaluation and judgment of achievements. The main purpose or goal is tried to construct an evaluation and continuous improvement system model to upgrade the quality and quantity of acute pain service for different wards and surgical departments in our hospital. In the near future, we might popularize this APS system model to the other hospitals to upgrade the NTUH APS team as the leading index and role model in developing APS in Taiwan.

口試委員審定書 iii
誌謝 iii~iv
中文摘要 v~vi
英文摘要 vii~viii
目 錄 ix~x
圖目錄 xi~xii
表目錄 xiii~xiv
第一章 緒論……………………………………………………………………...1~2
第一節 研究背景與研究動機……………………………………………1~2
第二節 研究目的………………………………………………….2
第三節 研究構………………………………………………….3~5
第二章 文獻探討與現況背景分析…………………………………6
第一節 台灣全民健保下自費醫療之簡介與現況分析...6~8
第二節 醫院自費性醫療項目：以手術後急性疼痛處置為例….9~14
第三章 研究設計與方法………………………………………15
第一節 個案研究法……………………………………………15~17
第二節 靜態的平衡計分卡分析...........................18~19
第三節 系統動態學之因果關聯圖……………………………… 20~22
第四章 個案分析…………………………………………… 23
第一節 個案概況與簡介………………………………………23~41
第二節 個案分析與檢討………………………………………42~44
第一段 分析學習成長構面『內部組員』中的『護理人員流動率』
對於『病患使用PCA的質與量』之衝擊與影響……..........45~50
第二段 分析因應JCI對急性疼痛處理的要求改變『內部流程構面』對於『病患使用PCA的質與量』之衝擊與影響..........51~52
第三節 個案未來發展與建議………………………………..53~54
第一段 分析顧客構面中『內部顧客』與『外部顧客』對於
『病患使用PCA的質 與量』之衝擊與影響……………..........53
第二段 其他可能影響APS業務因素-影響或衝擊
『病患使用PCA的質與量』..............54
第五章 結論與建議……………………………………………55
第一節 研究結論………………………………………………55~56
第二節 研究建議………………………………………………57~58
第三節 研究限制………………………………………………58~59

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