第３回委員会（２月２０日）資料NO

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2 ISO9001 ISO9001

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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40 2,500 18,000 VIP Good show Bad show S C S E SV ASV MGR SV ASV MGR 36

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55 ISO ISO (products) 4. ( ) End Result 4 EBMEvidence-based Medicine ISO

56 Fee for service ISO ISO 52

57 clinical outcome 53

58 durative power of atony (living will) steak holder ISO9001 ISO ) protocol, guideline 54

59 JIS Q

60 EBM(Evidence Based Medicine ) ISO 9001 ISO

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65 ISO9001 ISO9001 When Where or Who What How 61

66 B C A B A ISO9001 ISO

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商学　６３‐１・２☆／５．冨田

商学　６３‐１・２☆／５．冨田 70 1 Donabedian1980 Parasuraman, Berry, and Zeithaml1988 71 1Donabedian Donabedian1980 2 1 1 2 2 Donabedian1980 Donabedian1980 3 1 3 Donabedian1980Donabedian1982 Donabedian1985 Donabedian1966 72 1 Donabedian1968,