第3回委員会(2月20日)資料NO
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11 E.Codman A.Donabedian Benefit, utility and risk A.Donabedian risk Output Output Output Adequacy Continuity / over time Efficacy (randomized controlled clinical trials) 7
12 Effectiveness (controlled trials) ( / ) / Structure, Process, outcome (structure) (Process) (Outcome) (structure) (Process) (Clinical Indicator) (Outcome) Donabedian ( ) ( ) (Peer Review) 8
13 (QOL) QOLQuality of Life (efficacy) (effectiveness) (availability) (efficiency) TQM(Total Quality Management) QC (National Committee for Quality Assurance: NCQA) HEDIS(Health Employer Data Information Set)JCAHO 2 (Consumer Assessment of Health Plans CAHPS R ) the Agency for Healthcare Research and Quality CAHPS R 9
14 ( ) HEDIS(Health Plan Employer Data and Information Set) HMOsHealth Maintenance Organization HEDIS CAHPS R HEDIS HCUP QIs(Healthcare Cost and Utilization Project Quality Indicators) ( ) 9 2 ( ) cesarean section deliveries 9 3 () 9 AHRQ Quality Indicator AHRQ QIs 1) Qis2)3) AHRQ QIs HCUP 1990 HCUP QIs HCUP QIs AHRQ QIs The Agency for Healthcare Research and Quality(AHRQ) 10
15 AHRQ State-level data organization HCUP HCUP AHRQ ( ) HCUP Quality Indicators 33 HCUP QIs HCUP Quality Indicators AHRQ Quality Indicators QIs QIs QIs ( ) ( ) 1)
16 1) 1) 2) (JCAHO 1991) 1956 (Spirit of consumerism) OTA 1988 (consultation intervention) ( ) - (patient-client marketing) Herzberg 2 ( ) Bond & Thomas(1992)La Monica and associates(1986) Herzberg Juran(1989) Herzberg ( ) (Herzberg 1959) ( ) ( ) Juran 12
17 Patient satisfaction ( ) Patient satisfaction Donabedian(1980) ( ) Pascoe(1983) Guzman (1988) Petersen(1988) Smith(1992) Risser(1975) ( ) Abdellah-Levine Instrument (3 ) (8 ) (6 ) (4 ) (10 ) (8 ) (11 ) Risser Patient Satisfaction Instrument(RSI) La Monica-Oberst Patient Satisfaction Scale(LOPSS) 1986 Risser Leio-Kilpi & Vuorenheimo ( )
18 Vuori(1987) (a) (b) (c) Donabedian(1980) the Office of Technical Assessment of the USA Congress(1988) (Meterko 1990) Vuori(1987) (a) (b) (c) (d) (e) (Petersen 1988) (Bond & Thomas 1992) 14
19 1 2 2) Walter J Schraml 7 ( ) 3) ( ) 3 15
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23 p A.MERKOURIS RN, MSc, PhD, J. IFSNTOPOULOS, V. LANARA RN, PhD and C. LEMONIDOU RN, MSc, PhD: Patient satisfaction: a key concept for evaluating and improving nursing service, Journal of Nursing Management, , p (10)2000 P (4)1999P
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32 ISO9000 (Peer Review) (Clinical Indicator) 28
33 / Clinical IndicatorPeer Review () / QOL (Structure) ISO9000 (Process) ( ) (Outcome) Stephen J. O Connor and Joyce A. Lanning: The new health care quality: value, outcomes, and continuous improvement An overview of the current perspectives, clinical laboratory management review, July/August 1991, ,
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52 ISO9001 (structure) process (outcome) ISO9001 ISO
53 ISO9001 ISO9001 ISO9001 (outcome) process ISO9001 ISO9001 ISO9001 ISO9001 ISO9001 ISO
54 ISO9001 ISO9001 ISO9001 ISO9001 ISO9001 ISO QC ISO ISO9001 JIS Q 9000 JIS Q 9000 JIS Q ISO
55 ISO ISO (products) 4. ( ) End Result 4 EBMEvidence-based Medicine ISO
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91 1 ISO9001 ISO9001QMS 87
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