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          의료 관광 산업이 차세대 신성장 동력으로 동남아시아를 중심으로 전 세계적으로확산되고 있는 추세이다. 의술이 세계 최고 수준으로 발달해 있는 미국에 비해 우리나라의 의료기술 수준도 미용성형, 보철, 라식 등에서 최고의 기술과 서비스의 가격경쟁력도 높아 실제로 선?
          의료의질향상지침서(제2판)
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          출판사 고려의학
          저자 박운제
          출판년도 2009년6월25일
          ISBN 9788970437033
          판형 410쪽 | B5 | 2판
          수량
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          상품상세설명상품상세정보 / 관련상품목록 / 상품구매후기 / 상품Q&A

          책소개

           의료 관광 산업이 차세대 신성장 동력으로 동남아시아를 중심으로 전 세계적으로
          확산되고 있는 추세이다. 의술이 세계 최고 수준으로 발달해 있는 미국에 비해 우리
          나라의 의료기술 수준도 미용성형, 보철, 라식 등에서 최고의 기술과 서비스의 가격
          경쟁력도 높아 실제로 선진국 등에서 의료관광 목적으로 찾고 있다.의료법과 각종

          규제로 제한적이지만 일부 의료기관에서 해외환자를 유치하여 진료하고 있고, 국내
          선진 병원들이 의료의 질적 수준검정을 위해 국제인증 프로그램인 JCI 인증을 받기
          위해 경쟁적으로 대비하고 있는 등 의료 환경변화에 적극적으로 대처하고 있다. 지금
          까지 발간된 QA에 대한 번역서, 지침서들은 전담자나 일부 직원들이 관심의 대상이
          었으나 의료계의 급격한 변화와 최고경영자들의 병원경영관리에 대한 높은 관심으로
          이제는 의료정보 및 관리 분야 관계자들도 고유업무 영역의 확대나 전반적인 지식수
          준 향상을 위해 의료 질 관리업무가 필수적으로 요구된다. 초판에서 미흡했던 부분을
          수정과 보완을 했으나 아직도 부족한 점은 더 많은 지식을 축적하여 앞으로의 개정을
          통해서 전문서적으로서 거듭날 것을 약속드리며, 이번 개정판은 부족한 저에게 독자
          여러분들이 보내주신 지도편달이 있었기 때문입니다.


          이 교재가 의료분야 실무자들이나 그 외 병원 모든 관계자들 또는 의료분야를 전
          공하는 학생들에게 의료의 질 향상의 입문서로써 개념과 방법론을 모두 다루고 있으
          므로 병원의 전반적인 질 향상 활동업무에 필요한 기본 자료로 활용될 수 있고, 의료
          의 질 관리 활동에 대한 광범위하고 이해의 폭을 넓힘으로써 병원에서의 질 향상 업
          무의 리더와 병원경영효율화에 중추적인 역할을 할 수 있는 작은 길잡이가 될 수 있
          기를 기대한다. 끝으로 의학 관련 전문서적 출판 분야에서 항상 앞서가는 고려의학 경
          영진의 배려와 교재 작성 및 수정에 많은 도움을 준 담당자에게 깊은 감사를 드린다.


          2009년 6월
          저자



          저자 및 역자 소개

           

          박운제

           

          • 충남대학교 보건대학원 보건학석사 

          • 원자력병원 의무기록과 근무

          • 단국대학교 기획조정실 QA담당

          • 대전보건대학 의무행정과 강사: 적정진료과목

          • 現 대한의무기록협회 이사

          • 現 대전보훈병원 의무기록실 QA담당

          • 자격증: 의무기록사, 병원행정사, 의료보험사



          목차

          1장 질 관리의 역사와 개념 …… 1
          1. 의료의 질의 역사(History of Quality Assurance) ······································· 2
          2. 품질 관리의 역사(History of Quality Control) ··········································· 6
          1) 품질관리(Quality Control)의 발전과정 ···················································· 6
          2) 종합적 품질경영(Total Quality Management) ········································· 7
          3. 의료의 질의 목적 ······················································································· 8
          1) 의료의 질 관리 적용 영역 ····································································· 8
          2) 의료의 질 향상 필요성 ·········································································· 9
          3) 의료의 질 향상에 고려하여야 할 필수 요소들 ····································· 10
          4. 의료의 질 정의 및 구성요소 ····································································· 10
          1) W. Edwards Deming의 정의 ······························································· 11
          2) Joseph M. Juran의 정의 ······································································ 17
          3) Philip B. Crosby의 정의 ······································································ 19
          4) Donabedian의 정의 ·············································································· 22
          5) Myers(1969)의 정의 ·············································································· 22
          6) Feigenbaum ·························································································· 23
          7) D*A*T 모델 ························································································· 24
          5. 전통적인 질 관리(QA)와 질 향상 관리(QI)의 비교 ·································· 25
          1) 전통적인 질 관리(QA)와 질 향상 관리(QI)의 비교 ······························ 25
          2) 전통적인 질 관리(QA)가 질 향상 관리(QI)로 적용될 수 있는 분야 ···· 26
          3) 전통적인 질 관리(QA)와 비교되는 질 향상 관리(QI)의 세 가지 중요한
          요소들 ·································································································· 29

          2장 의료의 질 평가를 위한 접근 및 활동 영역 …… 31
          1. 의료의 질 향상사업 특성 ·········································································· 32
          1) 주체에 따라 ·························································································· 32
          2) 방법에 따라 ·························································································· 32
          3) 의료의 질 특성 ····················································································· 34
          2. 의료의 질 접근방법 ·················································································· 35
          1) 질 평가를 위한 접근 - 구조, 과정, 결과 ············································· 35
          3. 의료의 질 향상 활동을 위한 모형과 성공전략 ········································· 47
          1) JCAHO의 감시와 평가모형 10단계 ······················································· 47
          2) 우리나라에서 제시한 질 관리 활동을 위한 10단계 ······························ 52
          3) 의료의 질 향상을 성공적으로 이루어내기 위한 7가지 필수 조건 ········ 56
          4) 성공적인 의료 질 향상 활동의 기본전략: Vouri(핀란드) ······················ 57
          5) 질 관리 활동을 수행할 때 필요한 원칙 ··············································· 57
          6) 질 관리 참여로 개인적인 개선의 기대 ················································· 58
          7) 주제 선정에 있어서는 다음과 같은 내용을 우선적으로 선정하는 것이
          바람직함(Pawsey, 1990) ······································································ 59
          8) 질 향상 활동의 방해물제거 ·································································· 59
          9) 질 향상 활동이 실패하는 이유 ····························································· 60
          4. 질 관리 전담자의 역할 ············································································· 62
          1) 전담자(Coordinator)의 요건 ·································································· 62
          2) 전담자의 7가지 역할 ············································································ 63
          5. 의료의 질 향상 위원회 ············································································· 65
          1) 목적 ······································································································ 65
          2) 구성 ······································································································ 66
          3) 기능 ······································································································ 66
          4) 회의 준비 ····························································································· 67
          5) 회의록 ·································································································· 67
          6) 회의 진행 ····························································································· 67
          7) 질 관리 활동 ························································································ 68

          8) 기타 ······································································································ 68
          6. 팀의 역할 ································································································· 68
          1) 팀이란 무엇인가? ·················································································· 69
          2) 팀의 발달단계 ······················································································ 71
          3) 팀 구성 및 운영방법 ············································································ 72
          4) 팀의 성공요인 ······················································································ 74
          7. 이용도 조사(Utilization Review) ······························································· 74
          1) 이용도 조사체계의 설계 ······································································· 75
          2) 이용도 조사의 범주 ·············································································· 75
          3) 이용도 조사방법 ··················································································· 75
          4) 이용도 조사의 업무(Actual Utilization Management) ··························· 76
          8. 위험 관리(Risk Management) ··································································· 78
          1) 목적 ······································································································ 79
          2) 위험 발생 관리과정 ············································································ 79
          3) 의료행위 중 위험상황 발생되면 ························································· 79
          4) 위험 관리 업무의 기능 ········································································· 80
          5) 위험 관리 업무 ····················································································· 80
          9. 주 진료경로와 임상진료지침(Critical Pathway & Clinical Practice Guideline)
          ·················································································································· 82
          1) 주 진료경로(critical pathway)의 특성 및 기대효과 ······························ 82
          2) 임상 진료 지침(Clinical Practice Guideline) ········································· 85
          3) 사례 관리와 증례 관리 ········································································· 86
          10. 비용 효과적인 질 관리(Cost Of Poor Quality) ······································· 87
          1) Cost Of Poor Quality의 개념과 중요성 ··············································· 88
          2) COPQ 범위와 종류 ·············································································· 89
          3) COPQ의 전략 ······················································································· 90
          11. 병상이용의 적절성 평가(Appropriateness Evaluation Protocol) ·············· 91
          1) AEP 내용 및 특징 ················································································ 92
          2) 전향적 검토(Prospective Review) ························································· 92
          3) 동시적 검토(Concurrent Review) ························································· 92

          4) 후향적 검토(Retrospective Review) ······················································ 92
          5) 적절성 평가의 종류 ·············································································· 93
          6) 부적절 이용의 원인 ·············································································· 93
          12. 의료감사 ·································································································· 95
          1) 의료감사와 의무기록 ············································································ 96
          2) 의무기록사의 역할 ················································································ 97
          13. 중증도 분류체계 ······················································································ 98
          1) MedisGroups ························································································ 99
          2) Disease Staging ·················································································· 100
          3) APACHE Ⅲ ························································································ 101
          4) CSI(Computerized Severity Index) ····················································· 103
          14. 조사방법 ································································································ 104
          1) 조사방법의 종류 ················································································· 104
          2) 조사대상 ····························································································· 105
          3) 설문지 조사방법 ················································································· 106
          4) 조사양식지 개발 ················································································· 107
          15. 용어의 정의 ··························································································· 108
          1) Indicator(지표) ···················································································· 108
          2) Standard(표준) ···················································································· 111
          3) Threshold(역치) ·················································································· 111
          4) Criteria(기준) ······················································································ 112
          5) Benchmarking(수준점설정) ································································· 112
          16. 부서별 질 관리 기준 및 지침 ······························································· 112
          1) 응급실 ································································································ 113
          2) 내과 ···································································································· 116
          3) 산부인과 ····························································································· 116
          4) 외과 ···································································································· 119
          5) 마취과 ································································································ 120
          6) 소아과 ································································································ 122
          7) 정신과 ································································································ 123

          8) 중환자실 ····························································································· 124
          9) 방사선과 ····························································································· 126
          10) 약제 ·································································································· 129
          11) 간호 ·································································································· 132
          12) 의무기록정보관리 ·············································································· 133
          13) 급식영양 ··························································································· 137
          14) 기타 ·································································································· 139
          3장 의료의 질 향상 방법 …… 143
          1. 의료의 질 향상 활동 원칙 ······································································ 144
          2. 측정의 원칙 ···························································································· 146
          3. 질 향상 도구 및 기법 ············································································· 148
          1) 런차트(Run chart, Trend chart) ························································· 149
          2) 관리도(control chart) ·········································································· 150
          3) 흐름도(Flow Chart) ············································································· 151
          4) 브레인스토밍(아이디어 짜내기) ··························································· 156
          5) 명목집단기법 ······················································································ 157
          6) 원인과 효과 도표(Cause and Effect Diagram) ··································· 160
          7) 파레토차트 ·························································································· 162
          8) 우선순위 메트릭스(Prioritization Matrix) ··········································· 163
          9) 산점도(Scatter Diagram) ····································································· 165
          10) 그래프 ······························································································· 166
          11) 벤치마킹 ··························································································· 167
          12) 식스시그마(6 Sigma) ········································································· 174
          13) 기타 ·································································································· 179

          4장 병원 신임제도 …… 183
          1. 우리나라 신임제도의 발전 ······································································ 185
          1) 병원신임평가의 목적 ··········································································· 185
          2) 병원신임평가의 연도별 주요 발전단계 ··············································· 186
          3) 주요 개정 내용 ··················································································· 187
          4) 신임평가 방법 및 결과의 활용 ··························································· 189
          5) 심사위원 구성 및 대상병원 ································································ 190
          6) 신임평가제도의 문제점 ······································································· 191
          7) 병원신임평가 진료과별 pass/fail 점수 적용 ········································ 192
          8) 수련병원실태조사 ················································································ 192
          2. 병원신임평가의 질 관리 부문 ································································· 194
          1) 질 관리 부문의 구성 및 특징 ···························································· 194
          2) 심사문항 및 평가기준상의 가장 큰 문제 ············································ 195
          3) 병원신임평가에서 요구하는 질 관리 활동 방법 ·································· 195
          4) 질 관리 부문 ······················································································ 196
          3. 의료기관 평가 ························································································· 205
          1) 의료기관평가제도의 도입배경 ····························································· 206
          2) 목적 및 기대효과 ··············································································· 206
          3) 평가 추진 경과 ··················································································· 207
          4) 평가문항의 유형 ················································································· 208
          5) 평가기준 구성 ····················································································· 208
          6) 2주기(2007~2009년) 평가기준 주요 개선사항 ····································· 209
          7) 조사방법 ····························································································· 213
          8) 평가시행절차 ······················································································ 214
          9) 평가결과 ····························································································· 218
          10) 평가결과의 활용 ··············································································· 218
          I. 질 향상 활동 지원체계 ············································································ 220
          II. 질 향상 자료수집 및 모니터링 ······························································· 222
          III. 질 향상 활동 직원 이해도 ····································································· 224

          IV. 질 향상 활동 성과 ················································································ 226
          4. 외국의 신임제도 ······················································································ 228
          1) 미국 ···································································································· 228
          2) 호주 ···································································································· 230
          3) 영국 ···································································································· 231
          4) 스페인 ································································································ 231
          5. 국제 의료기관평가 ·················································································· 234
          5장 고객만족도 …… 239
          1. 환자만족의 개념 ······················································································ 240
          1) 고객의 의사결정 ················································································· 240
          2) 고객의 불만 ························································································ 242
          3) 고객의 경청 ························································································ 242
          4) 고객으로서의 환자 ·············································································· 243
          2. 환자만족 경영 ························································································· 243
          3. 고객만족도 ······························································································ 245
          1) 고객만족도 ·························································································· 245
          2) 고객 만족 측정방법 ············································································ 245
          3) 자료수집 방법 ····················································································· 246
          4. 조사대상 선정을 위한 표본추출 ······························································ 247
          1) 표본추출법(Sampling method) ···························································· 247
          5. 고객만족도 설문지 개발 ·········································································· 250
          1) 설문문항 종류 ····················································································· 250
          2) 문항의 수 ··························································································· 253
          3) 설문지 작성의 기본원칙과 문제점 ······················································ 253
          4) 문항의 순서 ························································································ 254
          5) 설문지 디자인 ····················································································· 254

          6. 고객만족도 설문지 작성 ·········································································· 255
          1) 설문지 작성 ························································································ 255
          2) 평가 및 등급 ······················································································ 256
          3) 설문지의 구성 ····················································································· 256
          4) 예비조사(Pilot-test) ·············································································· 259
          5) 응답의 구조화 ····················································································· 260
          6) 자기기입식 설문 ················································································· 261
          7) 설문지 안내문 ····················································································· 263
          8) 보고서 작성 ························································································ 264
          9) 보고서의 구성 ····················································································· 265
          7. 고객만족도 조사 도구 ············································································· 265
          1) 고객만족도 조사 도구 종류 ································································ 265
          2) 고객만족도 조사 도구 작성시 포함될 내용 ········································ 265
          6장 의료의 질 관리를 위한 통계 …… 267
          1. 통계적 이해 ···························································································· 269
          1) 통계 자료(data)의 유형 ······································································· 269
          2) 모집단과 표본 ····················································································· 270
          3) 자료의 형태(Scales of measurement) ················································· 273
          4) 통계적 분석기법은 다음 3가지에 따라 결정될 수 있다. ···················· 276
          5) 대표값(average) ·················································································· 277
          2. 비 모수 통계 검정 ·················································································· 283
          1) 비 모수 통계 분석 ·············································································· 284
          2) 단일표본분석 ······················································································ 285
          3) Two-Independent-Samples Tests(두 독립표본검정): 한 변수에 대하여 독립된
          2개의 집단 ·························································································· 286
          3. 모수통계 검정 ························································································· 287
          1) T-test(독립: 범주, 종속: 연속) ···························································· 287

          2) 분산분석(독립: 범주, 종속: 연속형) ···················································· 288
          3) 상관분석 ····························································································· 289
          4) 회귀분석 ····························································································· 291
          4. 변이(Variation) ························································································ 293
          부록 …… 295
          부록 1. 의료의 질 향상 사업제안서 ························································ 296
          의료의 질 향상 활동보고서 ························································ 297
          부록 2. 의료의 질 향상 평가서 ······························································ 299
          의료의 질 향상 평가 보고서 ······················································ 301
          부록 3. 의료의 질 향상사업 조사 ··························································· 302
          부록 4. 의무기록정보의 질 평가 (의무기록 완결성 및 진료적정성 평가) 336
          퇴원환자 의무기록 점검표 ························································· 336
          진료 적정성 평가 ······································································· 340
          부록 5. 미 완결 의무기록 평가 ····························································· 342
          부록 6. QI 평가서 ················································································ 344
          부록 7. QI 평가서 ················································································ 347
          부록 8. QI 평가서 ················································································ 352
          부록 9. QI 평가서 ················································································ 358
          부록 10. QI 평가서 ················································································ 362
          부록 11. QI 평가서 ················································································ 370
          부록 12. QI 평가서 ················································································ 376
          부록 13. 수술전 재원기간에 영향을 주는 요인에 대한 조사 ·················· 385
          부록 14. 고객 만족도 설문지(외래환자용) ·············································· 392
          고객 만족도 설문지(퇴원환자용) ·············································· 400
          참고문헌 ······································································································ 408
          찾아보기 ······································································································ 410

           



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