醫病共享決策的數位轉型與執行管理

Digital Transformation and Executive Management in Shared Decision Making

縮減醫病溝通的鴻溝，讓病人與醫師共同參與醫療決策以促進病人安全的觀念，近年來在全世界已被廣為接受。臺大醫院基於促進醫療品質與病人安全的理念，也積極投入醫病共享決策（shared decision making, SDM）的發展與推廣應用。臺大醫院SDM的推廣分為三大重點：建立推展SDM之整體架構；創新導入資訊化界面於SDM數位轉型；以及運用量化目標管理方法鼓勵臨床醫療人員應用SDM。臺大醫院藉由跨科部協調整合、資源挹注，並整合資訊與臨床研究電子數據採集系統，建構全院性推動架構、SDM主題發展模組、創新數位轉型與有效管理機制，順利發展共計52項SDM主題，於2020年1－9月間讓2174位病人藉由SDM實際參與醫療決策，其成效評估之標準化分數達0.862（滿分為1），顯示出相當正向的病人與家屬回饋成果。提供第一線醫療人員良好的SDM推動架構與數位資訊支援，有助於增進醫病溝通成效，提升病人的滿意度。

The concept of reducing the communication gap between doctors and patients, and participating in medical decision-making to enhance patient safety, has been widely accepted in recent years. Based on the core concept of medical quality and patient safety, the National Taiwan University Hospital has been actively involved in developing, promoting, and applying shared decision-making (SDM) for patient care. The implementation of the integrated SDM process in NTUH consisted of three strategies: establishing a systematic framework for promoting SDM, innovating and introducing information interface for the digital transformation of SDM, and applying management by objectives clearly defining the aims as the incentive management model to encourage healthcare workers to use SDM. With the coordination of multiple disciplines and departments, resource allocation, and integration of information system and the integration of the Healthcare Information System and the Research Electronic Data Capture (REDCap)® system, the hospital has constructed an institution-wide promotion structure, SDM developing modules, innovative digital transformation, and effective management mechanism. From January to September 2020, a total of 52 SDM themes and processes have been developed, and 2174 cases participated in the decision-making process through SDM. The standardized score of evaluation reached 0.862 (out of a full score of 1), showing positive results reported from patients or family members. Establishing infrastructure and digital information support for frontline healthcare workers may improve communication effectiveness between the patients and healthcare workers and increase patient satisfaction.