2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649726摘要：緊急醫療系統(EMSS)銜接醫療，衛生與公共安全三大領域，攸關公眾健康與醫療事故緊急應變的樞紐，提升其品質是不容忽視的議題。到院前心跳停止病患(OHCA)的存活率，最能反應一個社會緊急醫療照護的整體水準，目前國際間均以標準Utstein格式來研究到院前心跳停止的流行病學，並用以評估緊急醫療系統成效。Utstein格式包括病患因素，事件因素，現場急救處置因素，以及預後，可比較不同緊急醫療系統急救復甦成效。透過網頁介面與網路的快速便捷，可同時多個後端(橫跨衛生及消防救護系統)資料上傳、查詢、監測、與長期追蹤個案預後，並建立資料收集的整合架構。建立網路化OHCA登錄與追蹤系統，可減少原本包括消防端、責任醫院端、及管理端人員重複抄寫或輸入資料與往返寄送紙本檔案之困擾。本研究團隊自2008年起，已成功建置Utstein格式「網路化心跳停止病患(OHCA)登錄系統」，並於2010年6月正式於台北市EMSS上線使用。國際經驗顯示，政府或健康與公共衛生照護單位應建立緊急醫療系統品質管理與評估架構，規劃藉由指標數據之監控、分析、追蹤，達到品質管理與提昇的終極目標。指標群涵蓋範圍，則應包括結構面、過程面、與結果面。如前述，到院前心跳停止(OHCA)可作為評估緊急醫療系統的重要依據，因此，建置OHCA急救品質管理評估架構，可作為「緊急醫療系統品質管理」的最重要依據與主體。本研究計畫欲建置之OHCA急救復甦執行成效e化評估、監測、警示、與品質管理系統，對公眾健康緊急醫療的發展與提昇，至為樞鑰。本計畫為参年度之連續計畫，以研究團隊已建立的「網路化心跳停止病患登錄系統」為基礎，持續擴充、應用與延伸e 化品質管理；重點在設計OHCA 病人急救復甦執行成效之e 化評量系統，建置急救復甦執行成效圖型化監測與警示系統，與以急救復甦執行成效建置緊急醫療救護隊效率評估系統。除持續前瞻式長期登錄追蹤病案，並擬將上述新發展之品質管理系統，整合於「網路化心跳停止病患登錄系統」，以提昇系統管理端更即時有效的e 化監測與策略管理。另將同時研究本系統登錄資料，應用地理資訊系統空間分析與統計工具，進行公眾早期去顫急救系統規劃。<br> Abstract: Emergency Medical Service System (EMSS) is critical to public health system acrossthree major dimensions including medical care, health, and public safety. The continuousquality assurance of EMSS should not be overlooked. The survival of out-of-hospital cardiacarrest (OHCA) could mostly reflect the level of EMSS in a community. Currently the UtsteinStyle format is internationally and widely used for OHCA researches and EMS systemevaluation. The Utstein format is composed of patient, event, and prehospital emergency carecharacteristics, and outcomes. The format could be utilized for comparison among variousEMSS.Web-based model of registry may facilitate timely recordings and improve data accuracy.It may also save time that individual EMS healthcare providing unit could input optimal datadirectly from end-user domain through web-links, without frequent multilateralcommunications between each unit, and could retrieve or monitor the results easily. Our teamhas successfully established an Utstein Style “Web-based OHCA Registry System” smoothlyand functionally running online since June 2010.The experiences form U.S indicated that government or health authority shouldimplement and maintain a quality evaluation system of EMSS, to achieve continuous healthquality promotion through monitoring, analyzing, and tracing the Key Performance Indicators(KPI). The KPIs should include the dimensions of structure, process, and outcome.Resuscitation of OHCA is crucial to EMSS performance. An excellent system for qualityevaluation and management of OHCA is the key to success for better EMSS performance.Our proposal will able to establish a web e-system for OHCA resuscitation EMS performance.The multi-functions of this web e-system will include performance evaluation, effectivenessmonitoring, early warning for deterioration, and prehospital care efficiency.The proposing 3-year project is to establish and implement a web e-system of EMSquality and performance integrated with Taipei OHCA Registry Web, and to expand its multifunctions.The major tasks are designing an e-scoring system for EMSS resuscitationperformance, establishing an e-SPC (statistical process control) system for EMS performancemonitoring and early warning, evaluating prehospital emergency care efficiency, andintegrating the above into Taipei OHCA Registry Web, to enhance more prompt orinstantaneous management and strategic improvement. Besides, we will apply GIS(Geographic Information System) techniques and statistics to develop a scheme for PublicAccess Defibrillation (PAD) sites implementation.到院前心跳停止網頁登錄系統緊急醫療系統公眾早期去顫地理資訊系統Out-of-hospital Cardiac Arrest (OHCA)Web RegistryEmergency Medical Service (EMS) performanceComposition ScorePublic Access Defibrillation (PAD)Geographic Information System (GIS)