Post on 11-Feb-2022
2005 Vol.6 No.2
Prospective Payment System, PPS
Managed Care, MC
The National
Academy of Sciences IOM
The Institute of Medicine
Clinical guidelines
Eddy 1990
Clinical guidelines
Clinical practice guidelines
Clinical Path
,
critical path-
way, clinical pathway, critical path, clinical
protocol, care map, care track
1980 1990
National guideline clearing house
AHRQ Agency for Healthcare
Research and Quality American Med-
ical Association AMA American As-
sociation of Health Plans AAHP
IDS
977
PDA
European Union
2005 Vol.6 No.2
Appraisal of Guidelines
for Research and Evaluation in Europe
AGREE
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sis-Related Groups DRG
clinical guideline
1.
Davis et.al., 1997; Carrick, 1998; For-
moso G et al, Cates et.al., 2001
2.
IOM; Bouvenot J.et al,
2002
Tunis et al, 1994; Hayward et al, 1997;
Olesen F et al, 1997; Flores et.al.,
2000
3.
clinical flexibility IOM; Flores et.al,
2000
Wolff HM et al, 1998; Flores et.al.,
2000 Flores
et.al., 2000; Cynthia M Farquhar,
2002
4.
Cates et.al.,
2001; Bouvenot J.et al, 2002
5. Tunis et
al, 1994; Grilli R.et. al., 1996; James PA
et al, 1997; Flores et.al., 2000; Stoddard
JJ., Cynthia M Farquhar, 2002
Tunis et al, 1994; Cyn-
thia M Farquhar 2002
2005 Vol.6 No.2
Warner, 1998
Davis et.al., 1997; Carrick, 1998;
Flores et.al., 2000; Cynthia M Farquhar,
2002
1990
91 7
7
17
7
92 10-11
SPSS Excel
3160
562 17.8%
503 89.5%
50 8.9%
Cronbach Alph 0.86
Chi-Square P
0.246 0.392
26~84 46.5 11.5
26~35 91 16.2% 36~45
194 34.6% 46~55 158 28.2%
56~65 66 11.8% 66 52
2005 Vol.6 No.2
9.3%
450 63
80.1% 11.2%
358 63.7%
193 34.3%
154 27.4%
) 45
8.0%
103 18.3%
76 13.5%
102
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14 2.5%
1 2 4
22.1% 4 0.7%
71 12.6%
44 7.8%(%)
503 89.5
50 8.9
553 98.4
9 1.6
562 100.0
(%)
26~35 91 16.2
36~45 194 34.5
46~55 158 28.1
56~65 66 11.7
66 52 9.3
561 99.8
1 .2
562 100.0
(%)
450 80.1
63 11.2
513 91.3
49 8.7
562 100.0
(%)
358 63.7
193 34.3
551 98.0
11 2.0
562 100.0
38 6.8 %
53 9.4 % 204
36.3%
1 3 1
23.3% 118 21.0%
105 18.7%
197 35.1%
1
60 12.7 10.3 1 5
141 25.1% 6 10 207
36.8% 11 15 86 15.3%
16 20 28 5.0% 21
25 4.4%
2005 Vol.6 No.2
(%)
131 23.3
118 21.0
105 18.7
197 35.1
6 1.1
557 99.1
5 .9
562 100.0
(%)
1 5 141 25.1
6 10 207 36.8
11 15 86 15.3
16 20 28 5.0
21 25 4.4
487 86.7
75 13.3
562 100.0
(%)
154 27.4
45 8.0
103 18.3
76 13.5
102 18.1
14 2.5
494 87.9
68 12.1
562 100.0
(%)
124 22.1
4 0.7
71 12.6
44 7.8
38 6.8
53 9.4
204 36.3
538 95.7
24 4.3
562 100.0
2005 Vol.6 No.2
Q301 9.23 1.51
Q302 8.69 1.97
Q303 5.86 2.95
Q304 8.26 2.20
Q305 2.29 2.62
Q306 4.29 3.07
Q307 5.28 2.57
Q308 5.40 3.02
Q309 8.70 1.80
Q310 7.18 2.60
Q311 8.65 2.02
Q312 9.03 1.55
Q313 8.46 2.45
Q314 8.65 2.01
Q315 7.48 2.71
Q316 8.43 1.97
Q317 ( ) 5.97 3.23
Q318 8.97 1.76
Q319 7.43 2.79
Q320 8.48 1.84
Q321 8.00 2.45
Q322 7.60 2.45
Q323 4.07 3.17
Q324 5.89 2.94
Q325 7.70 2.66
Q326 5.07 3.23
2005 Vol.6 No.2
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Q302
Q303
Q304
Q305
Q306
Q307
Q309
Q310
Q316
Q317
Q318
Q320
Q308
Q311
Q312
Q319
Q321
Q322
Q323
Q324
Q325
Q326
26 Q301
Q312
Q318
Q309
Q302
Q311
Q314
Q320
Q313
2005 Vol.6 No.2
Q316
Q304
Q321
Q325
Q322
Q315
Q319
Q310
Q317
Q324
Q303
Q308
Q307
Q326
Q306
Q323
Q305
2
9.23 1.51
8.69 1.97
1 5
Stoddard et al. 2002
;
9.239.038.97
8.488.468.438.26
8.007.707.607.487.43
7.18
5.975.895.86
5.405.285.07
4.294.07
2.29
8.658.658.698.70
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
Q30
1Q
312
Q31
8
Q30
9Q
302
Q31
1
Q31
4Q
320
Q31
3
Q31
6Q
304
Q32
1
Q32
5Q
322
Q31
5
Q31
9Q
310
Q31
7
Q32
4Q
303
Q30
8
Q30
7Q
326
Q30
6
Q32
3Q
305
2005 Vol.6 No.2
Cates et al. 2001
Davis
et.al. 1997
Carrick et al. 1998
Warner et.al. 1998
8.26 2.20
5.86
2.95 5.28
2.57 2.29 2.62
Tunis et al. 1994
82%
American College of Physicians
Blue Cross and Blue
shield 6%
Hayward et al. 1997
51-77%
Stoddard et al. 2002
2002
90%
9.23
8.69
8.40
8.50
8.60
8.70
8.80
8.90
9.00
9.10
9.20
9.30
2005 Vol.6 No.2
5.40 3.02
9.01 1.55
cook-medicine
Q311
8.42 2.02
:
Flores et al.
2000
the National Academy of Sci-
ences IOM, the Institute of
Medicine
clinical flexibility
Hayward 1997
Flores 2000
Hayward et al. 1997
5.28
4.29
2.29
8.26
5.86
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
2005 Vol.6 No.2
7.48 2.70
8.46 2.45
8.65 2.01
8.65
5.40
7.43
9.03
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
8.65
8.46
7.48
6.807.007.207.407.607.808.008.208.408.608.80
8.70 1.80 4
Tunis et al.
1994
70% Flores et.al. 2000
Stoddard JJ. 2002
Rao et al. 2002
MRI Zwar N. 2002
Warner et al. 1998
Weingarten
et.al. 1998
7.18 2.6%
Tunis et al.
1994 68%
8.43 1.97%
Stoddard et al.
2002
8.48 1.84
5.97 3.23
8.97
1.76
Carrick et al. 1998 150
41%
Flores et al. 2000
2005 Vol.6 No.2
2005 Vol.6 No.2
Mitchell et al. 2000
Bertakis et al. 1999
Mckay
et al. 1999
7.43 2.79 16
8.00
2.45 7.60 2.45
5.89 29.4
4.07 3.17%
8.70
7.18
8.43 8.97 8.48
5.97
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
2005 Vol.6 No.2
7 .70 2 .66 5 .07
3.23%
Q301
Q304
Q318
Q321
Q312
Q314
8.00 7.60
4.07
5.89
0.001.002.003.004.005.006.007.008.009.00
T-test P
Q301 0.000
Q302 0.006
Q303 0.000
Q304 0.000
Q305 0.001
Q306 0.746
Q307 0.000
Q308 0.020
Q309 0.060
Q310 0.005
Q311 0.636
Q312 0.469
Q313 0.676
Q314 0.675
Q315 0.035
Q316 0.000
Q317 ( ) 0.003
Q318 0.043
Q319 0.000
Q320 0.000
Q321 0.000
Q322 0.001
T-test P
2005 Vol.6 No.2
7.70
5.07
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
2005 Vol.6 No.2
Q325
National Guideline
Clearing House
Cochrane Library
1.
15~20% 17.8%
2.
3.
T-test P
Q322 0.001
Q323 0.000
Q324 0.023
Q325 0.097
Q326 0.002
2005 Vol.6 No.2
1. Practice guidelines in Taiwan
2001-2002 129-36
2. 2002
3. 2002 --
39 29-33
4. Bouvenot J, Gentile S, Ousset S,
Tardieu S, Jouve E, Mendizabal H,
Sambuc R. Factors influencing the ap-
propriation of clinical guidelines by
physicians [Article in French][Ab-
stract]Presse Med. 2002 Nov 23;31 (39
Pt 1):1831-5.
5. Carrick SE; Bonevski B; Redman S;
Simpson J; Sanson-Fisher RW; Webster
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6. Cates JR; Young DN; Guerriero DJ;
Jahn WT; Armine JP; Korbett AB;
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clinical practice guidelines. J Manipula-
tive Physiol Ther 2001 Mar-Apr; 24(3):
170-6.
7. Cynthia M Farquhar, Emma W Kofa
and Jean R Slutsky clinicians' attitudes
to clinical practice guidelines: a system-
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8. Davis DA, Taylor-Vaisey A. Trans-lating
guidelines into practice. A systematic
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experience and research evidence in the
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9. Farquhar CM, Kofa EW, Slutsky JR.
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10. Flores G, Lee M, Bauchner H, Kastner
B. Pediatricians attitudes, beliefs, and
practices regarding clinical practice
guidelines: a national survey. Pediatrics.
2000 Mar; 105 (3 Pt 1): 496-501.
11. Formoso G, Liberati A, Magrini N.
Practice guidelines: useful and "partic-
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physicians by professional setting. Arch
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12. Grilli R; Trisolini R; Labianca R; Zola P
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13. Hayward RS, Guyatt GH, Moore KA,
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jeroni BA. Family physicians' attitudes
about and use of clinical practice guide-
lines. J Fam Pract. 1997 Oct;45(4):341-
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quiry. 37(2):134-45, 2000 Summer.
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titioners want guidelines? Attitudes
toward a county-based and a national
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18. Stoddard JJ. Grossmen JM. Rudell LS.
Physicians more likely to face quality
incentives than incentives that may re-
strain care. [Abstract] Issue Brief/
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19. Tunis, S.R.; Hayward, R.S.; Wil-son,
M.C.; et al. Internists' attitudes about
clinical practice guidelines. Ann. Intern.
Med., 1994,120, 956-63.
20. Ward MM, Vaughn TE, Uden-Holman
T, Doebbeling BN, Clarke WR, Wool-
son RF. Physician knowledge, attitudes
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2002 Feb.
2005 Vol.6 No.2
A study on factors that influence physicians’ willingness for implementa-
tion of clinical practice guidelins was performed through a structured question-
naire. The clinical practice guidelines that have the characteristics such as
match the evidence-based medicine made by association of specialist
flexible in use proctective role in legal events national level
available on journals and monitoring by an independent organization will
be favored by physicians in Taiwan.
2005 Vol.6 No.2