2007年12月18日星期二

The Heart of A Healthcare Quality Forum之筆記

The Heart of A Healthcare Quality Forum之筆記（by Hanching Chung）

陳先生
周五我的handout 請參考醫療保健品質論譠 HANDOUT from hanching chung有問題請連絡 23650127

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鍾漢清
Hanching Chung (or HC/ hc)

........隨便讀一下美國這領域的書，就會感到必須皓首才可能窮點經。對於美國醫療系統的品管等( 不錯的)簡介，可以參考Juran's Quality Handbook第五版之Healthcare Services 章。我看其中約三分之一所根據的是 T. Noland 等應用Deming 的改善應用— 論文兩篇關於等待和延誤之研究—約 1996。文中說到RAND 在70年代對於界定系統 —含顧客— 之貢獻。

另外，偶爾一揮手，可參考紐約時報的社論Editorial

America's Lagging Health Care System Published: November 1, 2007

和美國 W. Edwards Deming 協會：.

"Will the Utilization of Six Sigma, as a Tool in Healthcare Quality Management, Produce a Decrease in Medical and Medication Errors in the U.S. Healthcare System?" by S. Graser, Deming Scholar, Fordham University
(THE 12TH ANNUAL RESEARCH SEMINAR
13-14 February 2006 New York City)。【注二】

【注一】

書名, 從體液論到醫學科學(From humors to medical science)作者, John Duffy. 青岛出版社，2000從體液論到醫學科學:美国医学的演進歷程

美國醫療界危機之(七本)書評

Does Health Care Have a Future?
by Joe Flower and David Knott

【注二】

我的網路資源2007年

今年2007我在"中文品質百科" ；quality world 品質世界http://hcdeming.blogspot.com/ 和" 品質論壇"等blogs都剪貼不少關於英國 -台灣等醫療品質之資料，讀者很容易可以找到。

QualityTaiwan 中文品質百科 Search Result : 醫

（約）十分之一代表：

Taiwan IHA 台灣國際醫衛行動團隊

Changhua Health Care Quality Newsletter {彰化醫療品質通訊}

Quality Standards in Traditional Chinese Medicine 傳統中藥的品質標準

pay-for-performance 論質付費（英美醫療）

日英醫院與療效

NHS 諸醫院的病人死亡率比較：素質差的醫院病人死亡率明顯比素質優良的醫院高。

general practitioner英國醫生的品質評審： Quality and Outcomes Framework(QOF),

· Diagnosis-Related Group (DRG) 診斷關聯群

· double blind experiments 雙盲試驗

· emergencey measures

統計用語にいうsensitivityとspecificity(Oct 5, 2002)

· Claude Bernard著《實驗醫學研究導論》北京：商務（1991）

· clinical trials 臨床試驗

Cancer centers release survival rates ( Japan)

日本走出第一步

有些醫院的病人末期的比率多所以其5年"預後率"看來比較差所以有許多因素讓公布的數據無法反映所謂"醫療品質"

Cancer centers release survival rates

10/05/2007

in health care.with special moral duties

洗手沒？

Better: A Surgeon's Notes on Performance

Economic Scene

No. 1 Book, and It Offers Solutions

The typical book about current affairs is better at describing problems than solutions. But there is a nice surprise at the end of “Overtreated.” (If you find yourself wishing the book had fewer anecdotes, I’d suggest you skip to the end rather than putting it down.) In plain English, Ms. Brownlee lays out an agenda for reform that is usually confined to academic journals.

It includes some steps that should be widely popular, like giving doctors incentives to explain the risks and benefits of procedures more clearly than they do now. Research has shown that patients frequently decide against marginal care when they know the true risks and benefits. Malpractice laws would also need to be changed so doctors were not sued by patients who later changed their minds.

Other solutions would be more difficult — because medical evidence is often murky, because hospitals and insurers would fight to keep their revenues and because most Americans think it’s the other guy who’s getting unnecessary treatment. These are the reasons that presidential candidates don’t focus on wasteful treatment.

But models for reform are out there. Hospitals that don’t use the fee-for-service model, like those run by the Veterans Health Administration, are already getting better results for less money. They closely track their performance — that is, the health of their patients — and motivate employees to improve it.

As I’ve written before, there is nothing wrong with devoting a large chunk of our economy to medical care. Since the 1950s, doctors have made incredible progress against diseases that were once inevitably fatal. That progress is probably the finest human achievement of the last half century.

If we weren’t wasting so much money on overtreatment, it would be a lot easier to repeat the achievement over the next half century.

行也blog 坐也blog 放下blog 何等自在：

管理學新生 http://hcnew.blogspot.com
台灣戴明圈: A Taiwanese Deming Circle
戴明顧問公司http://www.deming.com.tw/
simon university總部 http://mypaper.pchome.com.tw/news/2adigoxl
Books Birdviews 書海
People 人物 http://hcpeople.blogspot.com/
質與量
品質世界 quality world http://hcdeming.blogspot.com/
中文品質百科﹐http://qualitytaiwan