| 병원단위의 임상진료지침 개발과정 |
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| 신영수1, 김창엽1, 오병희2, 한규섭3, 윤병우4, 한준구5, 강영호1 |
1서울대학교 의과대학 의료관리학교실
2서울대학교 의과대학 내과학교실
3서울대학교 의과대학 임상병리학교실
4서울대학교 의과대학 신경과학교실
5서울대학교 의과대학 진단방사선과학교실 |
| Development of Clinical Practice Guidelines in a Hospital |
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| Youngsoo Shin1, Chang-Yup Kim1, Byung-Hee Oh2, Kyou-Sup Han3, Byung-Woo Yoon4, Joon-Koo Han5, Young-Ho Khang1 |
1Dept. of Health Policy and Management College of Medicine, Seoul National Univ.
2Dept. of Internal Medicine College of Medicine, Seoul National Univ.
3Dept. of Clinical Pathology College of Medicine, Seoul National Univ.
4Dept. of Neurology College of Medicine, Seoul National Univ.
5Dept. of Diagnostic Radiology College of Medicine, Seoul National Univ. |
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| Abstract |
Background
With increased concerns about variation among physician's practice pattern and their impact on the quality of care, clinical practice guidelines have been developed by many different organizations, with differing aims and incentives. From the same point of view, there is growing interest in the development of clinical practice guidelines in Korea, but with only a few examples. As a result, there is not much exploration on the incentive and barrier to develop guidelines as well as description on the development process. The purposes of this study are to describe the process of the four different clinical practice guidelines in a hospital setting, and to identify incentives and barriers in the development of guidelines.
Methods
For this research, a clinical practice guideline development committee and four clinical practice guideline development teams were organized in a university hospital which has more than 1,200 bead. Twenty eight doctors, three nurses, and one technician participated as members of development teams for eight months. Four to six meetings were held, and three to seven departments in the hospital were involved.
Results
The topics which developed into clinical practice guidelines were cardiopulmonary resuscitation(CPR), blood transfusion, anticoagulation, and angiography. The main goals set by teams were education(CPR, angiography), risk management(blood transfusion), and to enhance quality of care(anticoagulation). Among four teams, only in the team for anticoagulation guideline medical record review and pilot-testing were performed. Also literature review was not carried out systematically. However, all the guidelines were developed by multidisciplinary be used as standard protocols in the practice.
Conclusion
Experience and skill in developing process has to be improved to have a more valid and useful practice guideline. In particular, literature review and problem identification by examining medical record should be emphasized. Also further studies on the clinical outcomes of the guidelines application and changes in physicians' behaviors would be required. |
| Key words
Clinical Practice Guideline;Cardio-Pulmonary Resuscitation;Blood Transfusion;Anticoagulation;Angiography; |
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