Enterprise Master Patient Index Development

2004 2004 2004 9 18 E-mail: [email protected] (Medical Error)Medical Error) 44,000~98,000 >> ,

US$ 90~150 http://www.nap.edu/ catalog/9728.html ! : 100 11.7 12 10 9 8 6.6

6 4 3.70 2.9 2 0 Harvard Medical Practice Study Utah Colorado Study

Australian Healthcare Study UK Pilot Study Danish Pilot Study (underlying disease)underlying disease) (underlying disease)medical management)) Harvard Medical Practice Study: 10.3% 13.6%

/ 7.0% 7.5% 8.1% 52.3% 52.3% 19.4% 12.9%

10.6% 7.0% 3.6% 47.7% 47.7%

? OR ? ? OR ? 90% , .

(Medical Error)Myth of infallible physician) , , (Leape, 1997)Leape, 1997))

? Makes it easy to do the right thing and Make it difficult to do the wrong thing

> forcing function . ?

(Leape, 1997)standardized flow sheets) (Leape, 1997)Reminders) (Leape, 1997)CPOE; computerized physician order entry) / 50

0mg : Percentage of orders for doses exceeding the recommended maximal dose . You cant manage what you cant measure ?

OR ? (Medical Error)1995) Kill the messenger :

: (Leape, 1997) ) , , : , , E.g.:

: (Medical Error)1990 ) (Leape, 1997)District Health Authority) (Leape, 1997)National Health Trust)

// ?

? / 23 ,

. Debra L. Ness Executive Vice President National Partnership for Women and Families ? /

(Leape, 1997)Patients as a safety check for medication error) (Leape, 1997)encouraging patients to speak up) NHS Trust Performance Report NHS : ( )

Marshall MN et al. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA. 2000 Apr 12;283(Leape, 1997)14):1866-7)4. : CABG CABG CABG 5 CABG , , , CABG

6 : 5 (Leape, 1997)Odds ratio, OR)= 0.7)9 [95% , 0.7)3-0.85] 6 (Leape, 1997)OR, 0.66; 95% CI, 0.57)-0.7)7)) (Leape, 1997)OR, 0.7)9; 95% CI, 0.7)3-0.86) Hannan EL, Sarrazin MS, Doran DR, Rosenthal GE. Provider profiling and quality improvement efforts in cor onary artery bypass graft surgery: the effect on short-term mortality among Medicare beneficiaries. Med Car e. 2003 Oct;41(Leape, 1997)10):1164-7)2.

(Medical Error)1)? . . . . Marshall MN et al. The public release of performance data: what do we expect to gain? JAMA. 2000 Apr

12;283(Leape, 1997)14):1866-7)4. (Medical Error)2)? CABG CABG CABG CABG 47)4 56 . 56 14 . 56/47)4

= 11.8% 14/56 = 25.0% 14/47)4 = 3.0% Marshall MN et al. The public release of performance data: what do we expect to gain? JAMA. 2000 Apr 12;283(Leape, 1997)14):1866-7)4. Marshall MN, Shekelle PG, Davies HT, Smith PC. Public reporting on quality in the United States and the United Kingdom. Health Aff. 2003 May-Jun;22(Leape, 1997)3):134-48.

: ? Marshall MN et al. The public release of performance data: what do we expect to gain? JAMA. 2000 Apr 12;283(Leape, 1997)14):1866-7)4. Marshall MN, Shekelle PG, Davies HT, Smith PC. Public reporting on quality in the United States and the United Kingdom. Health Aff. 2003 May-Jun;22(Leape, 1997)3):134-48.

(Medical Error) ) (Medical Error) ) 1. 2. 3. 4. 5. 6. 7). 8. 9.

10. 11. 12. 13. 14. 15. 16. 17. : :

2002 (CT)CT)) 2003

2004 Massachusetts Medical Society. Principles for profiling physician performance. 1999.

? (Leape, 1997) , , ) car seat, , , 1 (Implication)Implication)

: (Leape, 1997)key audience) Responsiveness : benchmarking, , : , Marshall MN et al. The public release of performance data: what do we expect to gain? JAMA. 2000 Apr 12;283(Leape, 1997)14):1866-7)4. : (Medical Error)Understandability)

: -High? OR Low?) (Medical Error)Accessibility) : (Medical Error)Salience): OR ? , , >> (Medical Error)Relevance) ?

: , Marshall MN, Romano PS, Davies HT. How do we maximize the impact of the public reporting of quality of care? Int J Qual Health Care. 2004 Apr;16 Suppl 1:i57)-63. Whats next... Need

Informed Consumers! MedlinePlus : MedlinePlus CHN :

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