醫院實施臨床路徑對住院日數、醫療費用及醫療照護品質影響之研究——以人工髖關節置換手術為例

A Study on the Effects of the Practice of Clinical Pathway in Hospitals on Length of Stay, Medical Expenses, and Medical Quality—Total Hip Replacement as an Example

從管理的角度來看，控制是組織用來創造一個能夠激勵組織成員努力，以達成組織所期望或預定之產出標準的環境。當醫療院所在面臨成本效益考量時，為了避免醫療費用的浪費，在確保並且提升病患醫療照護品質的情形下，如何降低住院日數、提高病床利用率、控制醫療成本等，便成了各醫療院所努力的目標。因此，醫療院所勢必採取許多管理控制的系統或方法，來達成醫院管理的目標，其中個案管理與臨床路徑是最近發展且最常被醫院管理者用於病患醫療業務品管的方法；分析臨床路徑，找出最有成本效益的治療方式，在維持與過去一樣的治療效果，或甚至更好的醫療品質，並期望降低平均住院天數，是醫院管理者一直努力之目標，然而若實施過當，僅著重督促病患早日出院，則可能因過份重視成本控制而損害醫療品質。為了深入瞭解並評估醫療院所實施臨床路徑的實際效益，本研究採用準實驗法、及準特定任務小組設計，以回朔方式收集資料，進行組別差異的描述性研究，並從醫療照護品質（包括留置導尿管、傷口引流管、靜脈點滴注射天數、併發症發生率、14天再入院率、及病患手術後第一次下床時間）、住院日及醫療費用等臨床、時間、及財務構面加以探討醫療院所實施臨床路徑之效能。研究結果發現，實施臨床路徑的醫院在降低醫療費用及住院日方面顯著高於未實施醫院，至於醫療品質指標方面，則大致無明顯差異

From the managerial perspective, control is a necessary mechanism for an organization tomotivate its members in order to reach the organization’s expected goals. It is a common dilemma as wellas mission for hospitals to attain cost effectiveness and assure medical quality simultaneously. Shorteninglength of stay and increasing bed turnover are strategies popularly adopted by hospitals to contain costs.Some managerial control systems or methods have been applied to the hospital industry nowadays.Among them, case management and clinical pathway is a newly developed tool. Through the analysis ofclinical path, the most efficient procedure can be determined without sacrificing the treatment outcomeand medical quality. However, should it be inappropriately utilized, medical quality can be jeopardized.The current study is intended to adopt a quasi-experimental design to explore the implementation ofclinical pathway in three dimensions. They are clinical (days of on foley catheter, on Hemo Vac, on IV,and ambulation), time (length of stay), and financial (medical expenses). The results show that hospitalswith implementing clinical pathway system are much better in terms of lowing medical expenses andlength of stay than those without. But there are no significant differences among hospitals in the aspect ofindicators of medical quality.