多指標及區間資料下的臨床路徑表現分析

Abstract

近年來，由於國民生活水準提升、醫療技術日新月異以及全民健康保險制度的實施，使得醫療產業逐漸受到社會大眾的重視，現階段管理目標為維持原有醫療品質、合理範圍內的預算控制及減少醫療資源的浪費，對現今醫療院所來說，著手於臨床路徑上的管理被視為可以帶來最大效益的方法。然而網絡狀圖的臨床路徑，其每個醫療站之間都有直接或間接的交互影響，過去研究著重在單一指標的績效表現評估，忽略了其他指標對臨床路徑績效表現的影響，且在現實生活中，每個醫療站的指標資料值會受到併發症、照護人員狀態等因素影響而使得指標資料值並非固定值，變動性高的指標資料值在評估績效表現時難以執行，造成臨床路徑的參考價值降低。本研究提出多指標模型和區間資料模型對臨床路徑進行分析，設定影響臨床路徑績效表現的多項指標，在此多項指標對績效表現的影響程度是未知的，透過模型找出相對績效表現差的路徑；在指標資料值方面，給予指標資料區間性，設定指標資料值的上限和下限，使資料值在一定範圍內具有變動性，並透過模型找出相對績效表現差的路徑。透過本研究模型所找出相對績效表現差的路徑可以協助醫療團隊更加重視及關注該條路徑，進而提升臨床路徑的參考價值，形成醫療團隊與病患之間的雙贏。

In recent years, advance of medical technology and implementation of national health insurance system make medical industry gradually become an important issue. Hospital administrators not only maintain quality of care but also control budget. The clinical pathway is considered to be an effective approach to achieve those goals and it is a network-like figure. Between each of medical station has a direct or indirect interaction. Researches have focused on a single indicator of performance evaluation, neglecting impact of other indicators on performance evaluation. In reality life, data of indicators are not a fixed point and may behave as intervals. Imprecise data of indicators are difficult to be evaluated. This study proposes multi-indicator model and interval data model to identify the set of critical clinical pathways. In addition, we use interval data to describe imprecise data. We give data upper and lower bound limits, which make the data values range in a certain interval, and use the interval model to identify which path has relatively poor performance. Through this study, identification of paths of relatively poor performance can help the medical team to pay more attention to those paths.