實證醫學與醫療品質改善之應用.ppt.pptVIP

實證醫學與醫療品質改善之應用 Presented by : Dr.陳杰峰clifchen@ http://clifchen.idv.tw 自我介紹 現任 萬芳醫院整形外科主治醫師 萬芳醫院實證醫學中心主任 台北醫學大學公共衛生學系講師 學歷 中國醫藥學院醫學系醫學士 Johns Hopkins University, M.P.H.公共衛生學碩士 台北醫學大學醫學資訊研究所博士班研究生 研究主題：醫療決策輔助系統 圖善不足以為政，還要有方法 Ginkgo for Memory Enhancement ??A Randomized Controlled Trial?? Paul R. Solomon, PhD; Felicity Adams, BA; Amanda Silver, BA; Jill Zimmer, BA; Richard DeVeaux, PhD  銀杏與記憶、集中力、注意力及學習能力 一項有二百三十人的銀杏臨床試驗顯示，銀杏並無法由實驗證明可促進健康老年人的記憶力。 一九九七年銀杏相關的市場，在全美國有二億四千萬美元市場 不能因為無副作用就代表有治療效果 Ginkgo for Memory Enhancement Six-week randomized, double-blind, placebo-controlled, parallel-group trial. ginkgo did not facilitate performance on standard neuropsychological tests of learning, memory, attention, and concentration or naming and verbal fluency in elderly adults without cognitive impairment. over-the-counter treatments Are we doing the right things? (CQI) EBM / EBP is not new, but… Standards of evidence are new Randomized Controlled Trials (RCT) Tools are new Meta-analysis, decision analysis New decision making framework Informed consumers Continuous Quality Improvement CQI is customer driven CQI is organization wide CQI is process focused CQI uses output or inspection measures 2.尋找文獻證據 (Tracking down the best evidence) Best practice What Information we need ? EBM FRAMEWORK Purpose of guidelines To make evidence based standards explicit and accessible To make decision making easier and more objective Assessing professional performance To educate patients and professionals about current best practice To improve the cost effectiveness of health services To serve as a tool for external control 5.對過程進行稽核 (Auditing performance in step 1-4) evidence-based outcome evaluation (EBOE) the evidence-based outcome evaluation (EBOE) should be the engine driving the guideline process. This could be performed by statistical means with meta-analyses. That approach requires RCTs. Unfortunately, there are not many RCTs in most surgical fields, including trauma