品质改善成本效益英文版.pptxVIP

品質改善成本效益—TQIP對外科預防性抗生素使用之影響國泰綜合醫院 黃清水副院長國泰綜合醫院TQIP小組ManagementOrganizationEconomicsupportModel of a National Health SystemResourcesHealth NeedsHealth ResultServices delivery國泰綜合醫院TQIP小組Limited Medical Resourcesvs.Optimal Healthcare Quality國泰綜合醫院TQIP小組Low Cost vs High Effectiveness= Cost-effective(The relationship between achieving certain objectives and consumption of resources， costs vs outcomes)國泰綜合醫院TQIP小組Efficacy vs Effectiveness Efficacy is a measure of the extent to which objectives (result, cure) are achieved in real practice settings. Effectiveness concerns generalizability of results of treatment.國泰綜合醫院TQIP小組Healthcare Cost as % of GNP13.4% - 13.7%(5.4% Taiwan)國泰綜合醫院TQIP小組US Healthcare Cost in $$1.491 TrillionPredicted increase of 10% in 2000 2.2 Trillion by 2008國泰綜合醫院TQIP小組CLIENTSOCIETYPAYERPROVIDERCost--Effectiveness國泰綜合醫院TQIP小組Cost of Surgical OperationsExpendable suppliesInstrumentsEquipmentImplantsFacility CostEmployeesPre-op testing國泰綜合醫院TQIP小組Expendable suppliesLaparotomy packageGown, gloves and towelsPrepEKG and oxygen finger padsAnesthesia gases and masksLocal anesthesia and antibiotics國泰綜合醫院TQIP小組Medical (Year 2000)Hospital 40%Professional 42%Pharmacy 18%(25% Taiwan)國泰綜合醫院TQIP小組Full Time EmployeeReceptionistPreop nurseCirculating nurseSurgical techRecovery room nurseOR supervisorCOO facility- $22/hr for 9-9/5hrs for each case $209/hr. for every case國泰綜合醫院TQIP小組品質成本預防性成本：教育訓練, 資格認定, 指標建立, 治療共識評鑑成本：定期監測, 稽核,滿意度調查內部失敗成本： 執行前或執行中失敗之成本外部失敗成本：錯誤導致醫療糾紛與賠償國泰綜合醫院TQIP小組Effectiveness-Outcome measurement病人方面：Audit of patient outcomes(併發症,死亡率,住院日,病假日,回復工作能力,生活品質,長期結果,再發率,存活率)第三付費者：健保支出國泰綜合醫院TQIP小組TQIP對外科預防性抗生素使用之影響抗生素費用是全院藥品費用支出之大宗合理使用抗生素可避免藥物副作用89年衛生署提出本院清淨手術抗生素之使用量偏高院內缺乏系統性收集外科預防性抗生素使用指標國泰綜合醫院TQIP小組設定目標合理化外科預防性抗生素之使用不影響外科病患感染率為前提下掌握使用時效降低抗生素使用量國泰綜合醫院TQIP小組方 法立意取樣：TQIP II b ：CABG、THR、TKH、ATH、APP. 五種術式收案對象之預防性抗生素使用對象：醫療服務提供者方法：Cost / Effect iveness ratio國泰綜合醫院TQIP小組成本效益指標使用量■ 使用費用使用時間（過程）院內感染率（結果）平均住院天數（結果）Independent t-test國泰綜合