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    題名: 導入以” W.E.C.A.R.E.” 為價值核心的泌尿科全方位即時服務 ～以Z醫院的泌尿科為分析個案～
    Apply “W.E.C.A.R.E.” Value-Based Health Care to the Comprehensive and Extended Service of Urology ~ The Case of Urology Department in Z Hospital~
    作者: 邱逸淳
    Chiu, Yi-Chun
    貢獻者: 李易諭
    Lee, Yih-Yuh
    邱逸淳
    Chiu, Yi-Chun
    關鍵詞: 價值醫療
    泌尿科
    W.E.C.A.R.E.全方位即時服務
    Value-base health care
    Urological center
    W.E.C.A.R.E.Comprehensive and Extended Service
    日期: 2017
    上傳時間: 2018-03-02 14:04:24 (UTC+8)
    摘要: 醫療照護的產品不只是照護，而是健康；醫療照護最終的目的是要讓病人得到更好的健康，更多的醫療照護並不一定等於更好的健康。如何讓病人在醫療過程中得到最高的『價值』，是目前醫療照護的主流。個案研究中，T聯醫Z院區導入『泌尿科W.E.C.A.R.E.全方位即時服務』，結合暖實力的十全價值核心『W.E.C.A.R.E.』，提供來院就診民眾門診、檢查、治療、手術、諮詢之全方位醫療服務的完美結合，以病人為中心，免除門診後需四處排檢、多次看診、等候檢查結果及手術之舟車勞頓，當日門診即時服務，對於必要之檢查當日即可完成，一日手術之服務觀念亦然，擁有最優質專業醫護人員提供諮詢及醫療服務，避免低價值醫療，明顯提升醫療溫度，在質性訪談及個案醫院資料分析中，發現造訪Z院區泌尿科接受醫療的民眾增加，也獲得國家品質標章的肯定，而W.E.C.A.R.E.的暖實力植入也讓全方位即時服務發揮更大的效益；另一方面也結合翻轉醫療，以藍鵲計畫讓醫師走入居家，持續社區領航的高價值模式醫療服務，擴散泌尿科全方位即時服務於行動不便的弱勢居民，T聯醫Z院區成功地以『泌尿科W.E.C.A.R.E.全方位即時服務』作為體系內其他院區的典範。
    High value health care is the core part of the urological practice in the Z branch of T City Hospital. There are outstanding professionals to provide exceptional comprehensive medical and surgical services for diagnostic examinations, treatments, minimal invasive surgeries, laparoscopic surgeries,  and consultations for the populations. The compassionate experienced surgeons and nurses utilize the state-of-the-art urological techniques with the best evidence to treat patients with various urological conditions, including urinary stones, voiding problems, male reproductive problems, sexual dysfunction, female and pediatric urological problems, and urologic oncology.  They provide one-stop multidisciplinary services in order to deliver the most efficient care with high quality.  They have built the core value, “W.E.C.A.R.E.”, into the services spanning from outpatient, hospital, and community in Taipei City to everyone, especially the ones with special needs. More and more patients benefit from their “W.E.C.A.R.E.” centered running model in urological daily practice. Urology Department in the Z branch of T City Hospital successfully established the role-model and influenced the other hospital.
    參考文獻: 一、中文文獻（按筆畫順序排列）

    1. 李振昌、羅耀宗（譯）（2014）。醫療革命：善用競爭策略，創造醫病雙贏的
    療護體制（原Porter, M.E. & Teisberg, E.T.著，）。台北市：天下文化出版社。
    2. 邱逸淳(2017)。藍鵲到我家，醫師歡迎光臨。全民健康保險季刊，122 (1)， 26-
    29。
    3. 林皇甫、邱逸淳（2014）。淺談男性結紮。台北市醫師公會會刊，58(12)，38-
    41。
    4. 許恬寧（譯）（2016）。跟TED 學說故事，感動全世界：賈伯斯會蓋的醫院
    （胡桃山醫院）。台北市：原神出版社。226-37
    5. 程威銘、邱逸淳、林登龍（2016）。慢性攝護腺發炎慢性骨盆腔疼痛症候群的
    診斷與治療。臨床醫學月刊，77(1)，42-49。
    6. 黃柏仁、邱逸淳（2017）。淺談膀胱過動症。台北市社區泌尿學會雜誌，2(1)，
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    7. 黃柏仁、邱逸淳（2015）。攝護腺癌早期診斷指引：摘譯2014年美國泌尿科醫
    學會評論。北市醫誌，12(3)，1-7。
    8. 衛生福利部統計處（2017）。 國民醫療保健支出(NHE)。台北市：衛生福利
    部。

    二、英文文獻（按字母順序排列）

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    4. Chang, C.C., & Chiu, Y.C. (2016). Applying quantitative micro-Raman spectroscopy to analyze stone compositions extracted from ureteroscopic lithotripsy urine. Urological Science, 28(1), 19-22.
    5. Chiu, Y.C., Chen, P.A., Chang, P.Y., Hsu, C.Y., Tao C.W., & Huang, C.C. et al. (2015). Enhanced Raman sensitivity and magnetic separation for urolithiasis detection using phosphoric acid-terminated Fe3O4 nanoclusters. Journal of Materials Chemistry, 3, 4282-4290.
    6. Chiu, Y.C., & Chiu, A.W (2012). Renal Preservation Therapy for Renal Cell Carcinoma. International Journal of Surgical Oncology. Volume 2012(2012), Article ID 123596, doi: 10.1155/2012/123596. 
    7. Chiu, Y.C., Huang, Y.Y., Chen, P.A., Lu, S.H., Chiu, A.W., & Chiang, H.K. (2012). Quantitative and multicomponent analysis of prevalent urinary calculi using Raman spectroscopy. Journal of Raman Spectroscopy, 43(8), 992-997.
    8. Chiu, Y.C., Yang, H.Y., Lu, S.H., & Chiang, H.K. (2010). Micro-Raman spectroscopy identification of urinary stone composition from ureteroscopic lithotripsy urine powder. Journal of Raman Spectroscopy, 41(2),136-41.
    9. Chiu, Y.C., Yang, H.Y., & Chiang, H.K. (2009). Detecting Composition of Urolithiasis by Raman Spectroscopy after Minimal Invasive Urological Management. Proceedings. SPIE 7161, Photonic Therapeutics and Diagnostics V, 71611B (23 February 2009), doi: 10.1117/12.808479.
    10. Chiu, Y.C., Lu, S.H., & Chiu, A.W. (2008). Urolithiasis Management Update. Taipei City Med J, 5(4), 414 –419.
    11. Chiu, Y.C., Chang, S.C., Chen, K.K., & Chang, L.S. (2008). Successful Use of Modified Suprapubic Catheter to Rescue Prostato-Rectal Fistula. Journal of the Chinese Medical Association. 71(6), 321–324.
    12. Chiu, L.P., Tung, H.H., Lin, K.C., Lai, Y.W., Chiu, Y.C. & Chen S.S. et al. (2016). Effectiveness of stress management in patients undergoing transrectal ultrasound-guided biopsy of the prostate. Patient Prefer Adherence, 11(10), 147-152.
    13. Carter, H.B., Albertsen, C.P., Barry, J.M, Etzioni, R., Freedland, J.S., Greene, L.K., & et al. (2013). Early Detection of Prostate Cancer: American Urological Association Guideline 2013. The Journal of Urology, 190, 419-426.
    14. Davis, R., Jones, J.S., Barocas, D.A., Castle, E.P., Lang, K.E., Leveillee, J.R., & et al. (2012). Diagnosis, Evaluation and Follow-Up of Asymptomatic Microhematuria (AMH) in Adults: American Urological Association Guideline 2012. The Journal of Urology, 188(6 Suppl), 2473-2481.
    15. Feliciano, J., Chiu, Y.C., & Stifelman, D. M. (2011). Video Fluorescence Angiography and Its Application in Selective Arterial Clamping during Robotic Partial Nephrectomy: Technique and Initial Experience. J of Endourology Part B, Videourology. 25. .10.1089/vid.2011.0048.
    16. Gray, J.A., Muir (2011). How to get better value　healthcare. Offox press 2011.
    17. Gupta, R., & Moriates, C. (2017). Swimming upstream:　Creating a culture of high-value care. Academic　Medicine, 92(5), 598-601.
    18. Heldwein, F.L., Teloken, P.E., Hartmann, A.A., Rhoden E.L., & Teloken C. (2011). Antibiotics and observation have a similar impact on asymptomatic patients with a raised PSA. BJU Internattional, 170（10）, 1576-1581.
    19. Huang, S.G. (2014). 2014-2015 National Health　Insurance Annual Report. Taiwan National　Health Insurance Administration, Ministry of　Health and Welfare. Taipei.
    20. Huang, Y.Y., Chiu, Y.C., Chiang, H.K., Chou, Y.H., Lu, S.H., & Chiu A.W. (2010). Quantitative analysis of urinary stone composition with micro-Raman spectroscopy. Proceedings. SPIE, 7548, Photonic Therapeutics and Diagnostics VI, 75480X(2010). Doi:10.1117/12.841723.
    21. Hillyer. S.P., Bhayani. S.B., Allaf. M.E., Rogers C.G., Stifelman M.D., & Tanagho Y. et.al. (2013) Robotic partial nephrectomy for solitary kidney: a multi-institutional analysis. Urology, 81(1), 93-97.
    22. Huang, P.J., Matsuda, T., Hsueh Y.T., Chiu Y.C., Huang Y.H., & Chiu A.W et al. (2016). Laparoscopic Partial Adrenalectomy for the Management of Pheochromocytoma: a Case Report and Review of Literatures. Jornal of Endourology Part B; Videourology/Endourological Society: 30(5).
    23. Hooton, T.M., Bradley S.F., Cardenas D.D., Colgan R., Geerlings S.E., & Ric J.C. et al. (2009). Diagnosis, prevention, and treatment of Catheter-Associated Urinary Tract Infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Disease, 50(5), 625-663
    24. Krumholz, H. M., Currie, P.M., Riegel B., Phillips, C.O., Peterson, E.D., & Smith, R. (2006). "A taxonomy for disease management. A scientific Statement From the American Heart Association Disease Management Taxonomy Weiting Group." Circulation, 137(6): 1432-1445. 1-13
    25. Kramer, M.R., & Porter, M.E. (2011). Creating shared value.　Harvard business review, 89, 62-77.
    26. Liao, W.L., & Tsai, F.J. (2013). Personalized medicine: a　paradigm shift in healthcare. BioMedicine, 3(2), 66-72.
    27. Lai, Y.W., Hsueh, T.Y., Hu, H.Y., Chiu, Y.C., Chen S.S., & Chiu A.W. (2015). Varicocele is associated with varicose veins: A population-based case-control study. International Journal of Urology, 22(10), 972-975.
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    29. Mack, N., Woodsong, C., Macqueen, K., Guest, G., Namey, E. (2005), Model 1: Qualitative Research Methods Overview, Qualitative Research Methods: A Data Collector`s Field Guide, USAID / Family Health International. 1-12.
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    32. Meddings, J.,  Rogers, A.M.M., Krein, L.S., Fakih, G.M., Olmsted, N.R., Saint, S. (2014). Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf. Apr, 23(4): 277–289.
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    37. Porter, M.E. (2009). A strategy for health care reform　toward　a value-based system. New England Journal of Medicine, 361(2),109-112.
    38. Porter, M.E.(2008). Defining and introducing value in　health care. Evidence-based medicine and the　changing nature of health care: 2007, IOM　annual meeting summary. National Academies　Press. IOM, 161-192
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    40. Porter, M.E., Pabo, E.A., & Lee, T.H. Redesigning primary care: a strategic vision to improve　value by organizing around patients` needs.　Health Aff (Millwood), 32(3):516-525.
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    三、網路資訊：
    1. 衛生福利部國民健康署。老化海嘯襲臺灣，23鄉鎮超高齡，89%老人有慢性病！健康局成立10週年，公佈台灣老化地圖。[ 下載日期：2017年7月18日] 。
    網站: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1131&pid=2276
    2. 周弘恬。Michael Porter 對美國醫療制度的診斷與處方，2008 年8 月, [下載日期：2017 年12 月3 日]。
    網站:　 http://thchou.blogspot.tw/2008/08/michael-porter.html
    3. Armstrong Institute for Patient Safety and　Quality, High-Value Health Care, [下載日期：2017/12/2]。網站: https://www.hopkinsmedicine.org/armstrong_institute/improvement_projects/high-value-health-care/choosing-wisely-initiatives.html
    4. AUA 2017 Choosing Wisely, [下載日期：2017/12/3]。網站: https://www.auanet.org/practice-resources/patient-safety-and-quality-of-care/choosing-wisely
    5. Better Value Healthcare Ltd (BVHC), [下載日期：2017/12/3] 。網站: https://www.bettervaluehealthcare.net/
    6. Cheng, T.M.. Taiwan’s health care system: The　next 20 years - Brookings Institution., [下載日期：2017年12月2日]。 網站: https://www.brookings.edu/opinions/taiwans-health-care-system-the-next-20-years/
    7. Hunter, S. Medicine is for the people., [下載日期：2017年12月3日]。 網站: http://shawnhunter.com/medicine-is-for-the-people-only-after-will-profits-follow/
    描述: 碩士
    國立政治大學
    經營管理碩士學程(EMBA)
    104932180
    資料來源: http://thesis.lib.nccu.edu.tw/record/#G0104932180
    資料類型: thesis
    顯示於類別:[經營管理碩士學程EMBA] 學位論文

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