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ㆍ출판사 군자출판사
ㆍ저자 최윤경 외
ㆍ발행일 2014-02-28
ㆍ페이지수 368 Pages
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지난 이십년 간 국내 보건의료계의 질에 대한 관심과 질적 수준의 향상은 실로 비약적이었다. ‘질 관리란 용어조차 생소했던 도입 초기에는 많지 않은 초보전담자들이 새로운 용어정의와 방법론에 초점을 맞추어 크고 작은 모임을 통해 서로의 경험을 공유했었다.

20년이 지난 지금은 대부분의 의료계 종사자들이 질 관리에 관여하고 있으며, 다양한 현장에서 질 관리 적용 경험과 새로운 방법론, 질 향상에 따른 환자 결과의 변화 등을 공개적으로 활발히 논의하고 있다. 이처럼 의료기관들이 의료의 질 향상에 노력을 기울이는 데는, 1990년 대 초부터 정부의 적극적인 관여가 있었기 때문이다. 정부가 주도하는 의료기관평가를 시작으로 의료기관 전문평가기관의 설립과 요양급여 적정성평가의 실시까지 선진국에서 많은 기간에 걸쳐 이루어낸 성과를 우리는 비교할 수 없을 만큼의 짧은 시간 내에 이루어냈다.

의료기관은 다양한 보건의료 인력들이 환자를 중심으로 협력하는 독특한 업무구조를 갖는 조직이며, 이들 인력은 궁극적 목표인 환자의 결과 향상에 관여한다. 이제 보건의료계는 지속적인 질 향상 노력이 업무의 일환이 되었으며, 신입직원이 입사와 동시에 그 역할을 해주기를 기대하고 있다.

저자들은 우리나라 의료기관들이 의료 질에 본격적인 관심을 갖기 시작한 도입 초기부터 의료기관에서 질 관리 업무를 담당했으며, 실무자 교육 및 관련 학회 활동 등을 꾸준히 해오고 있다. 이제 저자들은 모두 대학 강단에서 보건의료계 전공학생들을 교육하고 있다. 그동안 저자들은 대내외의 환경 안에서 의료기관이 신입직원에게 요구하는 질 관리 역량을 파악하고, 선도적으로 교과과정 안에 의료 질 관리교과목을 도입하여 가르쳐 왔다. 그런데 아직까지 이러한 요구를 모두 집대성한 교재가 없어서 학생들이 구체적인 내용을 공부하는데 많은 불편을 겪어왔다. 이러한 모든 필요성을 담아 이 책을 집필하게 되었다.

이 책은 의료 질 관리의 역사와 개념, 질 향상 활동 모델, 질 향상 활동 도구, 환자안전, 근거중심실무와 질 향상, 임상진료지침과 진료계획표, 임상질지표와 결과 평가, 환자만족도, 의료정보와 질 향상, 의료기관 인증제도, 의료 질 관리의 실제까지 총 12장으로 구성되어있다. 전체 장의 구성내용에서 보듯이 전반부의 장들은 질 관리의 역사부터 개념 및 이론으로 구성하여 의료 질 관리의 전반적인 이해를 돕고자 했으며, 중반부는 질 향상 활동방법 및 도구, 환자안전, 임상진료지침, 임상질지표, 결과평가 및 환자만족도 등 의료현장에서 적용하고 있거나 도움이 되는 질 향상 활동 내용을 소개했으며, 후반부는 의료정보화 시대에 걸맞는 질 향상 활동과 대외적 인증평가제도를 설명하고, 마지막 장은 실제 의료현장에서의 질 관리 활동 사례를 수록하여 질 관리 활동 전반을 이해하도록 구성하였다.

저자들이 실무와 교육 경험을 살려 학부학생을 위주로 의료 질 관리의 입문서로 도움을 주고자 이 책을 집필했으나 아직까지 부족한 면이 많음을 인정한다. 이 책을 보시는 많은 분들의 관심과 충고를 환영하며, 지속적인 보완을 약속한다. 그동안 이 책이 출간되기까지 많은 지원을 아끼지 않은 군자출판사 관계자 분들께도 감사의 마음을 전한다.

 

 

20142

저자 일동

목차

1장 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

 

 

2장 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

 

 

3장 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) ······················································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

 

 

4장 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

 

 

5장 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

 

 

6장 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

 

 

7장 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

 

 

8장 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

 

 

9장 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

 

 

10장 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

 

 

11장 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

 

 

12장 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

 

 

이 분야 베스트

  • 성공하는 의사들의 진료비법24, 2/e
    24,000원→22,800원
  • 의학통계 ABC
    38,000원→36,100원
  • 개원의를 위한 2017 병의원 세무 길라..
    30,000원→28,500원
  • 친절한 병원 만들기
    15,000원→14,250원
  • 최신 의료 질 관리론
    25,000원→23,750원

이 분야 원서

  • Harrison's ..
    360,000원→250,000원
  • Harrison's ..
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  • Nelson Textbook..
    200,000원→162,000원

  • The Sanford Gui..
    40,000원→34,000원

  • The Sanford Gui..
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이 분야 신상

  • 의료법해설 [201..
    45,000원→42,750원
  • 개원의를 위한 2..
    30,000원→28,500원
  • 근로자지원프로..
    25,000원→23,750원
  • 쉬운 영어로 과..
    15,000원→14,250원
  • 마의너리그 리포..
    15,000원→14,250원

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