목차
제1장 의료 질 관리의 이해 1
1. 의료 질 관리의 도입배경 2
1) 의료기관 간의 경쟁· ········································ 2
2) 의료기관 운영의 효율성····································· 3
3) 사회적 압력··············································· 3
4) 의료기관의 외부평가 강화···································· 4
5) 지불제도의 변화· ·········································· 4
2. 의료 질 관리 관련 모델 6
1) 전문직 모델··············································· 6
2) 관료 모델················································· 6
3) 산업 모델················································· 7
3. 의료 질 관리의 역사 7
1) 고대····················································· 8
2) 중세와 르네상스 시대· ······································ 8
3) 근대····················································· 9
4) 20세기 이후·············································· 9
5) 산업분야의 영향· ··········································13
6) 현대의 질 관리· ···········································14
4. 우리나라 의료 질 관리 활동 15
제2장 의료 질의 개념과 접근법 21
1. 의료 질에 대한 정의 22
1) Lee & Jones의 정의······································· 22
2) Vuori의 정의············································ 23
3) Myers의 정의· ··········································· 24
4) Donabedian의 정의······································· 25
5) Institute of Medicine의 정의· ······························ 28
6) 의료의 질에 대한 다양한 시각······························· 29
2. 의료 질 관리의 주요 개념 29
1) 질 평가 (Quality Assessment)······························· 29
2) 질 관리 (Quality Control, QC)······························ 29
3) 질 보장 (Quality Assurance, QA)··························· 30
4) 질 향상/개선 (Quality Improvement, QI)····················· 30
5) 총체적 질 관리 (Total Quality Management, TQM)············ 30
6) 지속적 질 향상 (Continuous Quality Improvement, CQI)· ······ 30
7) 성과향상 (Performance Improvement, PI)· ····················31
8) 위험관리 (Risk Management, RM)···························31
9) 의료이용도 감사 (Utilization Review, UR)······················31
3. 구조-과정-결과 모형과 측정 31
1) 모형의 이해· ··············································31
2) 구조, 과정, 결과의 측정과 속성의 이해························· 34
3) 구조, 과정 및 결과의 상호관련성····························· 36
제3장 질 향상 활동 모델 41
1. 질 향상 활동의 기본 모델 42
1) PDCA 모델· ············································ 42
2) FOCUS-PDCA®········································ 43
3) 기타 모델················································ 45
4) 질 향상 모델과 관련된 기본 개념· ·····························47
2. 프로세스 개선 및 성과향상 모델 48
1) 총체적 품질 관리/지속적 질 향상····························· 48
2) 식스시그마·············································· 49
3) 린······················································51
4) 린식스시그마············································· 54
5) 의료 질 향상 방법론의 발전과 특성· ·························· 54
3. 질 향상 활동의 단계 57
1) 질 향상 활동 10단계········································57
2) 한국의료질향상학회 질 향상 활동 초록 제출 구성 사례··········· 60
3) 질 향상 모델의 적용의 중요성································ 60
제4장 질 향상 활동 도구 65
1. 팀 접근을 위한 도구 66
1) 브레인스토밍· ············································ 66
2) 친화도· ················································· 67
3) 인과관계도/어골도········································ 69
4) 흐름도· ··················································71
2. 자료 분석을 위한 도구 73
1) 히스토그램···············································73
2) 파레토 도표···············································74
3) 런차트· ··················································76
4) 관리도·················································· 78
5) 산점도· ················································· 79
3. 질 향상 활동의 기타 유용한 도구 81
1) 체크시트· ················································81
2) 레이더 차트···············································81
3) 의사결정나무············································· 82
4) 간트차트· ··············································· 84
5) 의사결정 매트릭스········································· 84
6) 역장분석· ··············································· 85
제5장 환자안전 89
1. 환자안전의 필요성 90
2. 환자안전 관련 주요 개념 92
3. 환자안전 관련 요인 95
1) 인적 요인················································ 96
2) 시스템 요인· ············································· 97
3) 의료현장의 특성· ········································· 99
4. 환자안전 문제의 확인 100
1) 근본원인분석·····················································100
2) 오류유형과 영향분석··············································104
5. 환자안전 사건보고체계 110
1) 의료기관의 환자안전 사건보고체계····························112
2) The Joint Commission(TJC)· ······························115
3) 투약오류보고 프로그램· ····································118
4) 식약청의 모니터링 시스템· ··································118
5) 오류의 공개··············································119
6. 환자안전 증진 전략 121
1) 세계보건기구의 환자안전목표· ·······························121
2) 미국 TJC의 국가환자안전목표· ······························122
3) 미국의학원의 권고안· ······································125
4) 미국 IHI의 환자안전 권고안·································125
5) 우리나라의 의료기관인증기준과 환자안전 증진전략· ··············127
6) 환자안전문화의 구축·······································129
제6장 근거중심실무와 의료 질 향상 135
1. 근거중심실무의 기본 개념 136
1) 근거중심실무의 필요성· ····································136
2) 근거중심실무의 정의· ······································139
2. 근거중심실무의 단계 140
1) 1단계 : 임상질문 만들기····································140
2) 2단계 : 근거 찾기··········································142
3) 3단계 : 근거 평가··········································143
4) 4단계 : 의사결정· ·········································145
3. 체계적 문헌고찰의 이해 147
1) 체계적 문헌고찰의 개념·····································147
2) 체계적 문헌고찰의 과정····································149
4. 근거중심 의료 질 향상 154
1) 근거중심실무의 관점· ······································156
2) 의료 질 향상의 관점· ······································156
3) 근거중심실무와 의료 질 향상의 융합· ·························157
4) 근거중심실무와 의료 질 향상을 위한 근거· ·····················158
5. 근거중심실무의 적용사례 158
1) 의료기술평가·············································158
2) 진료지침과 진료계획서· ····································161
3) 근거중심실무 적용사례· ····································161
제7장 진료지침과 진료계획표 167
1. 진료지침 168
1) 진료지침의 정의··········································168
2) 근거중심적 진료지침 개발방법· ······························170
3) 외국의 진료지침 개발 현황· ·································178
4) 우리나라의 진료지침 개발 사례······························180
2. 진료계획표 182
1) 도입배경················································182
2) 진료계획표의 개념·········································184
3) 진료계획표의 기본 목적· ···································186
4) 진료계획표의 적용 범위····································187
5) 진료계획표의 구성 요소· ···································187
6) 진료계획표의 구조········································187
7) 진료계획표의 개발과정· ····································189
8) 진료계획표 개발 시 주의사항· ·······························197
9) 진료계획표의 장점과 단점···································199
10) 진료계획표의 기대효과· ···································199
11) 진료지침과 진료계획표의 비교····························· 200
제8장 임상질지표와 결과 연구 205
1. 임상질지표 206
1) 임상질지표의 도입배경···································· 206
2) 임상질지표 개요··········································212
3) 임상질지표의 활용········································ 220
2. 의료의 질과 변이 221
1) 의료 질에서 변이의 중요성· ·································221
2) 변이에 영향을 주는 요인··································· 222
3) 변이의 유형············································· 223
4) 변이를 감소시키기 위한 전략······························· 223
3. 결과 연구 223
1) 결과 연구의 도입배경····································· 224
2) 결과 연구 개요· ········································· 224
3) 결과 연구의 활용········································· 225
제9장 환자만족도 231
1. 환자만족도의 중요성과 관련 이론 232
1) 환자만족도의 중요성· ····································· 232
2) 환자만족도 관련 주요 이론································· 234
3) 환자만족도에 영향을 미치는 요인· ··························· 235
4) 만족도 측정의 3가지 원칙·································· 235
2. 환자만족도 조사 설계 방법 236
1) 목표설정· ·············································· 236
2) 팀 구성 및 조사계획서 작성· ······························· 237
3) 조사방법 선택· ·········································· 237
4) 조사도구 개발· ·········································· 240
5) 자료 수집·············································· 242
6) 자료 분석 및 발표········································ 244
7) 만족도 향상을 위한 QI 실천 및 평가························· 244
3. 환자만족도 조사의 실제 245
1) 국내 환자만족도 조사의 실제· ······························ 245
2) 국외 환자만족도 조사의 실제· ······························ 247
제10장 의료정보와 질 향상 253
1. 의료정보의 이해 254
1) 의료기관의 정보시스템· ··································· 255
2) 기반 기술과 분석 도구···································· 262
2. 의료정보와 의료 질 향상 266
1) 임상의사결정지원시스템 ··································· 266
2) RFID를 이용한 환자안전 관리· ···························· 268
3) 진료접점 시스템·········································· 269
3. 의료정보를 이용한 의료 질 향상의 실제 269
1) 임상 질 지표 산출의 자동화· ······························· 269
2) 전자의무기록을 이용한 약물 부작용 감시·······················271
4. 시스템공학과 의료 질 향상 272
1) 시스템공학과 의료서비스 프로세스··························· 273
2) 시뮬레이션과 시스템 다이내믹스 · ····························274
3) 프로세스 마이닝· ········································ 278
제11장 의료기관 인증제도 285
1. 의료기관 인증과 인증제도 286
1) 의료기관 면허, 자격 및 인증의 정의· ························· 286
2) 의료기관 인증의 역사· ···································· 289
3) 의료기관 인증제도의 목적, 장점 및 위협요소· ···················291
4) 국제인증기구로서 국제의료질향상학회························ 293
5) ISQua의 국제인증프로그램· ······························· 296
2. 외국의 의료기관 인증제도 299
1) 미국··················································· 299
2) 캐나다··················································301
3) 호주··················································· 302
4) 영국··················································· 304
5) 프랑스 Haute Autoritede Sante· ··························· 305
6) 대만 Taiwan Joint Commission on Hospital Accreditation····· 306
3. 국내 의료기관 인증제도 및 향후 발전 방향 307
1) 의료기관평가제도········································ 307
2) 의료기관인증제도· ········································313
제12장 의료 질 관리의 실제 323
1. 질 향상 전담 조직의 운영 324
1) 질 향상 전담 조직체계···································· 324
2) QI 부서의 인력 구성······································ 325
2. 의료기관의 질 향상 활동 사례 330
1) 정맥주사팀 구축을 통한 의료 서비스 질 향상·················· 330
2) 입퇴원 과정 개선활동· ···································· 333
3. 우리나라 의료 질 향상 전망 337
찾아보기 341
