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A study on analysis and improvement methods of clinical processes in lung cancer diagnosis and treatment with network planning methods.

网络规划方法对肺癌诊疗临床流程的分析与改进方法研究

基本信息

批准号：
07672436
负责人：
TAKADA Akira
金额：
$ 1.41万
依托单位：
University of Tsukuba
依托单位国家：
日本
项目类别：
Grant-in-Aid for Scientific Research (C)
财政年份：
1995
资助国家：
日本
起止时间：
1995 至 1996
项目状态：
已结题

项目摘要

Based on the medical records of patients who were admitted between April 1991 and March 1992 to treat and examine lung cancer, events, including examinations and medical interventions are identified. Regarding the logical relations of them, time intervals and distribution between them are calculated. With that result, the events that actually affected clinical process of the lung cancer diagnosis and treatment was identified. Then the PERT model was build by these events and is assessed the utility for alternative planing.First, we evaluated application of PERT on diagnosis process. With this evaluation we revealed that the network planning method can be applied into the diagnostic process using the logical and chronological relations between each events in the clinical process.To evaluate the effect of the unexpected event in the application of the PERT (Program Evaluation and Review Technique) for evaluations of clinical process, we examined the therapeutic process of the lung cancer treatment. In therapeutic process, following difficulties are revealed to compromise the application of PERT to such process.1) Therapeutic process are not standardized.2) The time records of medical intervention are subject to be omitted in the medical record.3) The time when the unexpected (or harmful) events are resolved was not explicitly assessed.With these difficulties, logical and chronological relations could hardly be reconstructed from medical history currently used in Japan.In conclusion, this study established the effectiveness of the PERT in the clinical process where standardized to plan and evaluate allocation of medical resources. This study also revealed that its limitation in the process not standardized. To evaluated and enhance the effectiveness of the clinical practice, standardization of the clinical process and appropriated medical records that describes medical interventions and its reasons and assessments are considered essential.

根据1991年4月至1992年3月期间入院治疗和检查肺癌的患者的医疗记录，确定了包括检查和医疗干预在内的事件。根据它们之间的逻辑关系，计算了它们之间的时间间隔和分布。根据该结果，确定了实际影响肺癌诊断和治疗临床过程的事件。然后利用这些事件建立PERT模型，并对模型的效用进行评估。首先，我们评估了PERT在诊断过程中的应用。通过该评价，我们揭示了网络计划方法可以应用于诊断过程中，使用临床过程中每个事件之间的逻辑和时间关系。为了评价PERT（计划评价和审查技术）应用于临床过程评价中的意外事件的影响，我们检查了肺癌治疗的治疗过程。在医疗过程中，PERT方法的应用存在以下困难：1）医疗过程不透明; 2）医疗干预的时间记录在病历中容易被遗漏; 3）意外事件发生的时间（或有害）事件的解决没有明确评估。由于这些困难，结论：本研究建立了PERT在临床过程中的有效性，标准化计划和评估医疗资源的分配。本研究还揭示了其在过程不规范方面的局限性。为了评估和提高临床实践的有效性，临床过程的标准化和描述医疗干预及其原因和评估的适当病历被认为是必不可少的。