Clinical Tracer of Quality ??? ???????????????? ????????????????????? ?? ??

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Clinical Tracer of Quality ?????????????????????
??????????????????? ?? ??

• ?????????????? ?????
• ??????????????????????
• ???????????????????????

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????????????????????????????????????? ?? ??
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New HA Standard 2006Major Changes

• ???????????????????????????????? Management
  Quality Healthcare Quality
• Healthcare Quality
• ??????????????? ??????????????????
  ????????????????
• ??????????????????????????????????????????????????
  
• Performance excellence MBNQA/TQA/ PMQA
• Less prescriptive, more generic
• More result oriented

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New HA Standard 2006Major Changes

• ?????????????????? (Synthesis, alignment,
  integration)
• ???? Key hospital systems ???????
• ?????????? 3 C ???????????????????????????
• ????? (context)
• Core Value Concept
• Criteria standard
• ???? Learning improvement ?????? creativity
  ?????????????????? (innovation)
• More emphasis on Result

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???????????????????? New Standard Structure
???????????????????????????????????
??????????????????????? ????????????????
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???????? MBNQA/ TQA
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????????????????????????????????PMQA
????????????????????
??????????? ???????????? ?????????????
5. ??????????? ?????????????
2. ????????? ?????????????? ??????????
1. ????? ??????
7. ??????? ????????????
6. ????????? ?????????
3. ??????????????? ?????????????????? ????????????
????????
4. ?????? ???????????? ???????????????????
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???????????????????????????
?????? IV
??????????? ?????????????
????????? ???????
?????????? ???????????????????? ??????????? ??????
??????????????? ???????????????????? ?????????????
???? ????????????????????
?????
???????
?????????????????? ???????????????
????????? ?????????
?????? I
MBNQA/TQA Model
??????????????? ??.
?????? II
?????????? ??????????? ?????? ???????????????????
????????????????????????????? ????????????????????
? ?????????????? ???????????????? ????????????????
? ????????? ???????????????? ????????????????????
???????????????? ???????????????????????? ???????
?????????????? ??? 60 ??
?????? III
????????????????????
?????????????????????????? ????????????????? ?????
???? ?????????????? ???????????????????????? ?????
???????????
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HA Standard 2005 Structure

• Part I Organization Management Overview
• Part II Key Hospital Systems
• Part III Patient Care Processes
• Part IV Organization Performance Results

??? I-IV
Part I-IV
???? 1-7
Categories 1-7
?????? .1 - .3
Item .1 - .3
??????? a - f
Sub-item a - f
Bullet
Bullet
???????????????????????????????????
??????????????????????? ????????????????
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Part I Organization Management Overview

• 1. Leadership
• 2. Strategic Management
• 3. Focus on Patients/Customers
• 4. Information and Knowledge Management
• 5. Staff Focus (HR)

???????????????????????????????????
??????????????????????? ????????????????
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Part IIKey Hospital Systems

• 1. Risk, Safety, and Quality Management
• 2. Professional Governance
• 3. Physical Structure and Environment of Care
• 4. Prevention and Control of Infection
• 5. Medical Record System
• 6. Medication Management System
• 7. Clinical Laboratory System
• 8. Working with Community

???????????????????????????????????
??????????????????????? ????????????????
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Part III Patient Care Processes

• 1. Entry
• 2. Patient Assessment
• 3. Planning of Care
• 4. Patient Care Delivery
• 5. Information and Empowerment
• 6. Discharge Planning Continuity of Care

???????????????????????????????????
??????????????????????? ????????????????
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Part IV Organization Performance Results

• 1. Health Care Results
• 2. Patient and Other Customer-focused Results
• 3. Financial Results
• 4. Staff and Work System Results
• 5. Organizational Effectiveness Results
• 6. Governance and Social Responsibility Results
• 7. Health Promotion Results

???????????????????????????????????
??????????????????????? ????????????????
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??????????????????/??????????????????? Important
of Core Value/Concept Context
???????????????????????????????????
??????????????????????? ????????????????
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????????????????????????????????????????????????
Context
Scoring Guideline
Criteria
Core Value Concept
???????????????????????????????????
??????????????????????? ????????????????
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???????/???????? ?????????/????????? ????????????
?????? ??????????? ??????????? ?????????? ????????
/????????
3C ???????????
Visionary Leadership System Perspective Agility
Patient Focus Focus on Health Community
Responsibility
Value on Staff Individual Commitment Teamwork Ethi
c Professional Standard
???????? ???????? ??????? ???????? ??????????
Creativity Innovation Management by
Fact Continuous Process Improvement Focus on
Results Evidence-based Approach
Learning Empowerment
???????????????????????????????????
??????????????????????? ????????????????
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Core Value Concept ???????????????????????
???????????
Visionary Leadership System Perspective Agility
Patient Focus Focus on Health Community
Responsibility
Value on Staff Individual Commitment Teamwork Ethi
c Professional Standard
???????? ???????? ??????? ???????? ??????????
Creativity Innovation Management by
Fact Continuous Process Improvement Focus on
Results Evidence-based Approach
Learning Empowerment
???????????????????????????????????
??????????????????????? ????????????????
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Standard Implementation Assessment
Context
Critical issue Major risk Specific
condition Target group
Priority
Key Process Requirement
Standard
Purpose
Check
Without context specific, implementation of
standards is meaningless
???????????????????????????????????
??????????????????????? ????????????????
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?????????????????????????????????????????
(3C-PDSA)
???????????
Do
Core Value Concept
Action
Plan
Study
?????????
Units Systems Patient Pop. HPH
Design
Objective/Indicator
Context
Learning
??????????????
Standard/Criteria
Improvement
Act
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3C ??????????????????????????

• C1 Hospital Context
• C2 Criteria/ Standards
• C3 Core value and concepts

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Clinical Tracer of Quality
???????????????????????????????????
??????????????????????? ????????????????
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???????????? (Clinical Population)
??????? (Case)
?????????????? ??????????????? ???????????????????
??? ??????????????????? ??????????????????? ???
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Clinical Tracer of Quality

• Definition
• Clinical tracer of quality A clinical CQI story
• Clinical tracer of quality Opportunities for
  improvement

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Clinical Tracer ???????

• ??? ??????????????????????????????????????????????
  ??????????? ??????
• ???????????????????? (Patient Care Process)
• ???????????????????? (Quality Improvement
  Process)
• ??????????????? ??????????????????????
• ???????????????????????????????????
• ???
• ???????
• ???????????
• ?????????????

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Clinical Tracer

• ???????????????????????????????????????????
  ??????????
• ??????????????????????????????
• ???????????????
• ????????????????????????????????????
• ?????????????????????
• ????????????????????????????????????????????????
  ???
• ?? Core Value Concept ????????????? ???? Focus
  on Results, Management by Fact, Evidence-based
  Practice, Patient Focus

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Clinical tracer of quality A clinical CQI story

• Clinical Tracer ???????????? Clinical CQI Story
  ??????????????????????????????????
  ??????????????????????????????????????????????????
  ???????????????????? ???????? ????????????????????
  ??????????????????????????? ??????????????????????
  ?????????????????????
• Clinical Tracer ??????????????? ????????????
  ?????????????

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Clinical tracer of quality Opportunities for
improvement

• Clinical Tracer ??????????????????????????????????
  ???????????????????????????????????
  ????????????????? ????????????????????????????????
  ????????????????????

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Clinical tracer of quality Opportunities for
improvement

• Clinical Tracer ?????????? Core Value Concept
  ???????? ????
• Patient Health Focus
• Teamwork
• Learning Improvement
• Management by Fact
• Focus on Result
• Evidence-based
• Professional Standard
• Creativity Innovation

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Clinical tracer of quality Opportunities for
improvement

• ?????????? Clinical Tracer ????????????????????
  Core Value Concept ?????????????????????????????
  ???????? ?????????????????????????????? Core
  Value Concept ??????????????????

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Clinical Tracer ?????????????????

• ??????????????????????????????????????????????????
  ?????????????
• ??????????????? Clinical QI Team ???? Patient
  Care Team ???? Clinical Lead Team
  ?????????????????????? trace quality ??????????
• ?? ??.???????? ????????????????? Clinical Lead
  Team/Patient Care Team (?????? ??.???????)

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????????????????????? ???????????

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• ????????????????????????????? ????????????,
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  ????? (??????????????????????????????) ??????????

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?????????? 1 ??????????????? Tracer

• What ?????????????????????????????? tracer
  ??????????????? ??. ??????????????????????? ??.
• Why ???????????????????????????????????????
  tracer ?????????????
• How

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?????????? 1 ??????????????? Tracer How

• ????????? tracer
• ???????????/?????????? tracer ???????
• ????????? tracer ?????????????????????????????/???
  ????
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???????????????????????
????????? S ??????????????????????
??????????????????????????????????? Major ???
Minor Specialist ?????????????????????????????????
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? 5 ???? ?????????????????????????????????????????
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???????????? ?? ?? ???? ????????? S ????????? 90
100 ???????? (???????????????) ???????????????
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??? ???? ?????????????????????? (?????? 8.6)
(?????????????????????????????????????????????????
??????????????), ???????????????? Re-admit
????????????(?????? 6.6), ????????????????????????
????????????(?????????????????????????????????????
?) ???????????????????????????????????????????????
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???
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?????????? 2 ????????????

• ????????????????????????? 3-5 ???????
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• ??????????????????????????????????????????????????
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  ??????????? ?????

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???????????????????????
2. ????????????/??????????????? 2.1)
????????????????????????? 2.2)
???????????????????????????? 2.3) ??????????????
???????? ????????? ???????????????????????? ?
Appropriateness
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?????????? 3 ????????????????????????

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  ?????/?????????????????
• ???????????????? run chart ???? control chart
  ????????

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???????????????????????
3. ?????????????????????????????? 3.1)
????????????????????????????????? (?????????????
1 4) 3.2) ?????????????????????? (Pain Score)
???????????????? VAS 3.3) ????????????????????
??????????????????? ????????? ??????????????????
???????????? chart
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?????????? 4 ????????????

• ?????????????????????????????
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(??????????????????)

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4.1 ???????????? (tracer) ?????????? ?????????????
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4.2 ???????????? (tracer) ?????????? ?????????????
???????

• ???????????????????????????????????????
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4.3 ???????????? (tracer) ???????????????????????
????????????????
- ???????????????????????????????????????????????
?????????????????????????????????????? -
????????????????????????????????????????????????
????????????/??? ????????????????????????
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???????????????????????????
?????? IV
??????????? ???????
????????? ???????
?????????? ???????????????????? ??????????? ??????
??????????????? ???????????????????? ?????????????
???? ????????????????????
?????
???????
?????????????????? ???????????????
????????? ?????????
?????? I
MBNQA/TQA Model
??????????????? ??.
?????? II
?????????? ??????????? ?????? ???????????????????
?????????????????????????? ????????????????????? ?
????????????? ?????? ????????????????????????? ???
??????? ???????????????? ????????????????????
?????? III
???????????????? HA/HPH ????????????????????? 60
??
????????????????????
?????? ??????? ??????????/????????????? ???? ?????
???????????????? ?????????????
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??????????
Benchmarking
Clinical Outcome
Medical Record/Bedside Review
????????????
Root cause Analysis from Incidence
Evidence-based Practice
??????????????????
Assessment
Discharge
Planning
Care Delivery
Empower
Entry
Holistic Care
Target groups
Health conditions
Multidisciplinary Team
Procedures
KPI Monitoring
Diseases
Context
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?????????? 5 ????????????????????

• ?????????????????????????????????????????????????
  ?????????????????????????????????

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???????????????????????

• 5. ????????????????/ ????????????
• ?????????????????????? ???. PCU ??? ??.
  ??????????????????????????????????????????????????
  
• ?????????????????????????????????????????????????
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• ?????????????????????????????????????????????????
  ???????????????????

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?????? Clinical Tracer

• ???/???????/?????????????/???????/?????? ????
• ???????????? ??.?????? ?????????????
• ???????????????????????? 2-5 ???????
• ?????????????????????????????????/??????
  (???????????????)
• ?????????????? (???????????)
• ???????????????????? ?????????????????
  ?????????????? ????????? ???????????????????????
• ???????????????????? ?????????????????????????????
  ??? ???????????????? ??????????????????? ???????
• ??????????????? ???????? ??????
  ??????????????????

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Patient Care Improvement??????????? ????????????
????????????
????????????????????????
KPI Monitoring
???????????????? ???
??????????????????????
Multidisciplinary Team
Benchmarking
?????????????? ????????????????????????? ?????????
??????????
??????????????????????
?????????????????
Medical Record/Bedside Review
Holistic Care
?????????????????
?????????????????????????
Root cause Analysis from Incidence
Evidence-based Practice
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Patient Care Improvement (Part II)
Benchmarking
Clinical Outcome
Medical Record/Bedside Review
Root cause Analysis from Incidence
Evidence-based Practice
Patient Care Process (Part III)
Assessment
Discharge
Planning
Care Delivery
Empower
Entry
Target groups
Holistic Care
Health conditions
Multidisciplinary Team
Procedures
Technology Evidence Context
KPI Monitoring
Diseases
54
Clinical Tracer of Quality 1-2 pages
???????????????????????????????????
??????????????????????? ????????????????
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3. ?????????????????? ?????????????????
Patient Care Improvement (Part II)
Benchmarking
Clinical Outcome
Medical Record/Bedside Review
Root cause Analysis from Incidence
4.??????????????????????????
Evidence-based Practice
Patient Care Process (Part III)
Assessment
Discharge
Planning
Care Delivery
Empower
Entry
Target groups
Holistic Care
Health conditions
Multidisciplinary Team
Procedures
Technology Evidence Context
KPI Monitoring
Diseases

1. ?????
2. ????????????/???????????????