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實證醫學 與醫療品質

臺北醫學大學 • 市立萬芳醫院. 實證醫學 與醫療品質. Presented by : Dr. 陳杰峰 clifchen@ms1.hinet.net http://www.wanfang.gov.tw/ebm. 大綱. 實證醫學與醫療品質 萬芳醫院推動實證醫學歷程 未來的發展及目前的困難. 醫療生態的變化. 五種健保支付制度 Fee for Service Per Diem Case Payment : DRG Capitation Global budget Capitation 降低成本的需求. knowledge. EBM.

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實證醫學 與醫療品質

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  1. 臺北醫學大學•市立萬芳醫院 實證醫學與醫療品質 Presented by : Dr.陳杰峰clifchen@ms1.hinet.net http://www.wanfang.gov.tw/ebm

  2. 大綱 • 實證醫學與醫療品質 • 萬芳醫院推動實證醫學歷程 • 未來的發展及目前的困難

  3. 醫療生態的變化 • 五種健保支付制度 • Fee for Service • Per Diem • Case Payment : DRG • Capitation • Global budget • Capitation • 降低成本的需求

  4. knowledge EBM physician Guideline CME CRM patient CQI hospital The Road Map

  5. Continuous Quality Improvement • CQI is customer driven • CQI is organization wide • CQI is process focused • CQI uses output or inspection measures

  6. Reducing infections among women undergoing cesarean section in Colombia by means of continuous quality improvement methods Archives of Internal Medicine; Chicago; Oct 22, 2001; Michelle Weinberg, et al

  7. Literature Review • Teams reviewed authoritative texts and published reports to identify risk factors for surgical site infections and effective prevention strategies. • MEDLINE database (MeSH terms: cesarean section, endometritis, surgical wound infection, cross infection, and infection control). • Several team members summarized the literature during the 2-day workshop.

  8. the accompanying Plan-Do-Study-Act (PDSA) cycle • the team must design and test changes in systems of care: a change is planned (Plan), • it is implemented on a small scale (Do), • its effect is evaluated (Study), • depending on the result, the change is accepted, modified and tested again, or abandoned (Act).

  9. the surgical site infection rate decreased • In hospital A, (P<.001). • In hospital B, (P=.04) downward trend .

  10. 慢性病的趨勢

  11. 糖尿病

  12. 網路資源介紹 • Cochrane Collaboration • Wanfang EBM Center • National Guideline Clearing House • Medline • Google

  13. Ginkgo for Memory EnhancementA Randomized Controlled Trial Paul R. Solomon, PhD; Felicity Adams, BA; Amanda Silver, BA; Jill Zimmer, BA; Richard DeVeaux, PhD JAMA, Vol. 288 No. 7,August 21, 2002

  14. 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 EnhancementJAMA, Vol. 288 No. 7,August 21, 2002

  15. 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) -----Ginkgo for Memory EnhancementJAMA, Vol. 288 No. 7,August 21, 2002

  16. ‘’實證醫學顧問“(EBM consult) • 臨床醫療只有不到20%使用到實證醫學中的最佳證據 • 結合實證醫學的最佳結論于目前的醫令系統中，當可讓臨床醫師能在鍵入ICD代碼時，若有相關的疑問，或想進一步了解，即可點選螢幕中的 ‘’實證醫學顧問“(EBM consult)，在診間即獲得更新的第一手實證醫學資料

  17. 醫療行為的ISO化?

  18. 實證醫學中心推動概況 -- CQI is organization wide

  19. 創新策略領導者 EBM團隊陣容 圖書館專業人員 臨床流病及 醫學資訊 跨領域人員 資訊專業人員

  20. 實施成果----網頁流量每月平均4,000人上網搜尋醫學文獻實施成果----網頁流量每月平均4,000人上網搜尋醫學文獻

  21. 90.01-91.06 以義工講師為主的 實證導讀及電子教學獲同仁熱烈迴響 • EBN教學課程 204 堂 • EBP教學課程 101 堂 • 實證醫學 導讀 33堂 • 電子學習 課程共 114 堂 • 文獻搜尋 課程共 25 堂 統計至91/06/31止

  22. 萬芳醫院實證醫學推展歷程 90.02.01 成立實證醫學推動小組及實證醫學中心。 90.02.06 設立各護理站供查詢實證醫學文獻之上網 電腦，提供隨時查詢臨床問題之效益。 90.02.15 設立電子教室(e-learning room)並擬定使 用規則，開放醫療人員及實習生24小時刷 卡進入使用。

  23. 推動困難性 • 實證醫學之理念尚未普及 • 本土文獻缺乏 • 文獻評讀不易 • 電腦應用及跨資料庫平台文獻搜尋機制未成熟 • 人力及硬軟體欠缺

  24. 推動過程中瓶頸的突破 • 下載速度 • 資料庫搜尋層級設計 • 著作權考量 • 符合網頁設置目的之架構 • 使用者介面考量 • 內部及外部網路考量 • 中英文介面考量 • 網頁製作軟體版權問題

  25. EBM • EBM is a supplement to, not a substitute for, professional skills and experience.

  26. 謝謝!! 陳杰峰醫師clifchen@ms1.hinet.net http://www.wanfang.gov.tw/ebm

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