臺灣博碩士論文加值系統

為了提昇醫療品質以及抑制醫療資源的耗用，許多醫療院所開始研究提昇品質的方法，而其中又以臨床路徑最受醫療管理者熱愛，但其成效有限。故本研究以目前企業最流行的流程管理分析方法，以顧客為導向，並針對臨床診療流程與提升醫療品質進行研究。
本研究的目的分別為：一、建構「應用流程管理於提昇臨床診療品質」之參考模式。二、評估流程管理運用在臨床診療品質促進模式之初步效益。三、提高醫療資源之運用效率。四、提昇臨床診療品質。五、藉由品質提昇小組運作，將工業工程的觀念與技術，如：流程管理、問題解決方法與步驟、統計分析方法等導入醫療業。
最後，本研究以「痔瘡疾病（Hemorrhoid）」的診療流程為例，採用橫斷式研究法。先應用多變量統計方法，在某特定時段醫護人員的臨床決策分析，並建構單純痔瘡疾病的臨床治療演算法，再以實驗組與對照組的方式，來驗證臨床治療演算法。

In order to promote medical quality and restrain the consumption of health resources, many medical organizations started to research the way to improve the quality. Clinical path has catch lots of attentions but the contribution is limited. In order to explore the medical quality, this research applies the methodologies of the customer-oriented process management to study the clinical therapy process,
The purposes of this research are as follows. First, it is to establish a reference for the similar medical centers to adopt process management to construct the model of clinical practice quality. Second, it is to analyze the initial effect for the application of process management on the model of clinical therapy quality improvement. Third, it is to enhance the efficiency of medical resources. Fourth, it is to improve clinical practice quality. Finally, it is to employ the concept and the skills of industrial engineering to the medical industry by QIT（Quality Improvement Team）such as process management, problem solving procedure, statistics, etc.
Finally, this research investigates the therapy process of the hemorrhoid disease by using the cross section study. First, applying multivariate analysis that examines the clinical decision making of caregiver in special time establishes a clinical therapy algorithm of hemorrhoid. Finally, using the experiment group and contract group validates the assessment of clinical therapy algorithm.

第一章 緒論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究範疇與限制 4
1.4 研究方法與架構 5
1.5 章節摘要 6
第二章 文獻探討 8
2.1 醫療品質 8
2.1.1 醫療品質的起源 8
2.1.2 醫療品質的定義 10
2.1.3 醫療品質的指標 13
2.1.4 醫療品質的評估 16
2.2 流程管理 19
2.2.1 流程管理的定義與步驟 19
2.2.2 臨床路徑 23
2.2.3 診療模式分析 27
2.2.4 醫師診療分析 31
2.3 臨床決策 35
2.3.1 臨床決策的定義與構成 35
2.3.2 臨床決策變異 36
2.3.3 臨床決策的類型 41
2.3.4 臨床決策的步驟 44
2.3.5 臨床決策的評估 46
第三章 臨床診療模式分析之實例研究 47
3.1 痔瘡病患之定義、診斷與治療 47
3.2 痔瘡疾病的門診診療 53
3.3 痔瘡疾病的急診診療 56
3.4 痔瘡疾病的住院診療 57
3.4.1 麻醉部門的診療分析 61
3.4.2 開刀房的診療分析 68
3.4.3 恢復室的診療分析 75
3.4.4 藥劑部門的診療分析 79
3.4.5 護理部門的診療分析 81
3.5 診療模式之研究架構與研究設計 87
3.6 診療模式之研究變項 88
3.7 診療模式之研究材料與研究方法 89
3.8 資料處理分析與應用的統計方法 91
第四章 臨床診療模式之建構分析 94
4.1 痔瘡病患之現況分析 94
4.2 痔瘡病患人數分配分析 95
4.3 診療過程品質分析 96
4.4 診療結果品質分析 97
4.5 主治醫師之醫療資源使用差異分析98
4.6 主治醫師之病患診療結果差異分析99
4.7 手術方式之醫療資源使用差異分析99
4.8 手術方式之病患診療結果差異分析100
4.9 手術醫師之診療方式差異分析 101
4.10麻醉醫師之麻醉方式差異分析 101
4.11臨床診療模式之建構 102
第五章 臨床診療模式之實證分析 117
5.1 資料收集之設計 117
5.2 樣本資料之現況分析 120
5.3 病患人數分配分析 123
5.4 診療結果品質分析 123
5.5 實驗組與對照組之差異分析 124
5.6 麻醉方式之差異分析 126
5.7 臨床診療模式實施前後之差異分析126
5.8 研究結果討論 127
第六章 結論與展望 134
6.1 研究結論 134
6.2 研究貢獻 136
6.3 未來展望 138

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