指導教授：賴飛羆臺灣大學：資訊工程學研究所于還莒Yu, Hwan-JeuHwan-JeuYu2014-11-262018-07-052014-11-262018-07-052013http://ntur.lib.ntu.edu.tw//handle/246246/261507臨床路徑是在醫療執行過程中遵循共用診斷及治療程序，是醫護機構用來確保健康照護品質的方法之一，如何有效地獲取不同醫護機構的臨床路徑並建構一套比較的方法進行比較是個問題。 此研究目的是要設計及發展一套臨床路徑比較系統，使醫護人員或醫護機構管理階層可以方便地比對並指出醫院彼此之間臨床路徑的相似及差異之處，以協助其提昇自我機構的健康照護服務品質。 此研究提出兩種比較方式，第一種方式是以醫令類別為比較基礎，適用於比較來自不同健康照護體系不同格式的臨床路徑；第二種方式是以頻繁醫令集為導向進行比較，是從臺灣全民健保研究資料庫已申報的實際醫療紀錄中萃取出各醫院的頻繁醫令集進行比較。 第一種方式已應用於臺灣及蒙古兩家醫院的肝癌外科手術臨床路徑比較，發現兩家醫院的抗生素及止痛策略有差異，並對差異可能原因進行探討；第二種比較方式則發現低復發率與高一致性指標的頻繁醫令集相關，一致性指標數值70%被發掘可作為品質追求的基準。 總結，此研究設計並發展了一套臨床路徑比較系統，使其能同時滿足不同健康照護體系之間比較及實際醫療紀錄導向比較的需求，醫護人員及醫護機構管理階層能運用此系統方便地比較出臨床路徑之間彼此的差異，進而做出必要的調整，以提昇其臨床醫護的品質。Clinical pathway is one of the ways to assure quality of health care by following common diagnostic and therapeutic procedures in clinical practice. How to effectively collect clinical pathways of different care providers and determine methods to compare them can be a problem. The objective of this study was to develop a clinical pathway comparison system for physicians and care provider management to conveniently identify the similarity and difference among hospitals and help improve their health care quality. Two approaches were designed. One was physician order category-based, which was designed to compare different format clinical pathways from different health care systems. Another one was frequent physician order set oriented, which was designed to compare the frequent physician order sets derived from the evidence records of National Health Insurance Research Database (NHIRD) in Taiwan. The first approach has been used to compare the hepatocellular carcinoma (HCC) surgical clinical pathways of Taiwan and Mongolia—resulting in differences of antibiotics and anti-pain being found, for which possible causes were discussed. Another approach showed that low recurrence rate associated with high consistency frequent physician order adherence. A consistency index 70% was found to be seen as a reference benchmark to pursue.誌謝 i 中文摘要 ii Abstract iii Chapter 1 Introduction 1 1.1 Background 1 1.2 Motivation 3 1.3 Overview of the Dissertation 4 1.4 Organization of the Dissertation 7 Chapter 2 Related Work 8 2.1 The Origin of Clinical Pathway 8 2.2 The Meaning of Clinical Pathway 8 2.3 The Development of Clinical Pathway 10 2.4 The Structure of Clinical Pathway 11 2.5 The Effects of Clinical Pathway 12 2.6 The Comparison of Clinical Pathway 13 Chapter 3 Physician Order Category Based Clinical Pathway Comparison 15 3.1 Introduction 15 3.1.1 The Needs for Clinical Pathway Comparison 15 3.1.2 The Problems 16 3.1.3 Objectives 18 3.2 Methods 18 3.2.1 Physician Order Category 18 3.2.2 Document Transformation 19 3.2.3 XML Schema 22 3.2.4 System Architecture 24 3.2.5 Use Cases 24 3.2.6 Activity Diagram 26 3.2.7 Layered Framework 28 3.3 Results 31 3.3.1 Comparison of Taiwan and Mongolia 31 3.3.2 The Differences Found 34 3.4 Discussion 36 3.5 Summary 39 Chapter 4 Frequent Physician Order Set Oriented Clinical Pathway Comparison 40 4.1 Introduction 40 4.1.1 Health Care Quality and Clinical Pathway 40 4.1.2 The Problems 41 4.1.3 Objectives 42 4.2 Methods 43 4.2.1 Data Source 43 4.2.2 Data Preparation and Aggregation 45 4.2.3 Frequent Physician Order Sets 46 4.2.4 Consistency Index 48 4.2.5 Charlson Comorbidity Score 49 4.2.6 Recurrence 50 4.2.7 Comparison Algorithm 50 4.2.8 System Architecture 52 4.3 Results 53 4.3.1 Aggregate by Year and Hospital 53 4.3.2 Frequent Physician Order Sets and Consistency Index 56 4.3.3 Comparison of Three Medical Centers 57 4.3.4 Consistency Index vs. Recurrence Rate 60 4.4 Discussion 60 4.5 Summary 64 Chapter 5 Conclusion and Future Work 65 5.1 Conclusion 65 5.2 Future Work 66 Bibliography 69986789 bytesapplication/pdf論文使用權限：不同意授權臨床路徑醫令集比較thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/261507/1/ntu-102-D95922028-1.pdf