以合乎成本效果之临床指引达民众.pptVIP

可選擇瀏覽方式或直接輸入關鍵字 * 当前58页，共84页，星期日。 THANK YOU FOR YOUR ATTENTION * 当前59页，共84页，星期日。 OUTLINES of my talk Current problems of Healthcare systems: Cost containment and cost shifting Cost-effective clinical guidelines are necessary in every aspects of healthcare Core value of patient-centered and evidence-based make outcome evaluation unavoidable Quality-adjusted survival as a common unit for outcome/risk evaluation Opportunities for Christian Hospitals * 当前60页，共84页，星期日。 Evidence based medicine實證醫學 There is no room for spending money on ineffective diagnosis and treatment for any medical condition.(健保付不起沒有實證醫學基礎的診療) Quality assurance, safety, and efficacy for all medical managements. (所有的診療均需保證其品質、安全性及有效性) Find the real causes and effects for all healthcare practices (所有醫療照護均需找出其真正的因與果) * 当前26页，共84页，星期日。 Sustainable management of National Health Insurance (如何使健保永續) Prevention of diseases – No. of patients reduced (預防疾病，全民少病多快樂) Pursuing true values in health care – Evaluating health outcome per dollar spent, developing cost-effective clinical guidelines, and putting into practice (發展並推廣合成本效果的臨床指引) Raise premium whenever is necessary – Difficult for people and politicians to accept (說服政治人物及人民提高健保的保費) * 当前27页，共84页，星期日。 什麼是合成本效果的臨床指引？ 臨床指引 (Clinical guidelines) 實際臨床醫務診療的標準作法 成本效果 (Cost-effective) 耗用最低單位成本下達成最大健康效果 以具有成本效果的治療為優先考量 測量醫療照護的效果及成本，計量出每一單位成本所增加的健康效果，做為治療行為優先順序的參考。 * 当前28页，共84页，星期日。 Health benefit (健康效益) 以多活ㄧ個健康人年或多活ㄧ人年計算，同時考量死亡及非致命的健康結果(non-fatal health outcomes) healthy life year quality-adjusted life year life year 健康計量 存活時間長短(survival time) 生活品質(quality of life，QOL) 心理計量(psychometrics) &效用計量 (utility measurement) * 当前29页，共84页，星期日。 健康人年(QALY)的計算： ∑ (在狀態i下之存活長度) × (在狀態i下之生活品質) What is QALY(健康人年是什麼)? QALY gained from an intervention * 当前30页，共84页，星期日。 Survival curve × Average HRQL e.g : Hemodialysis(HRQL≒0.7)Area under curve × 0.7 存活函數下之面績為平均餘命，把它乘以平均生活品質即為調整生活品質後之存活壽命(quality-adjusted life expectancy) * 当前31页，共84页，星期日。 Estimated surviva