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

根据1991年4月至1992年3月期间入院治疗和检查肺癌的病人的医疗记录，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，计算它们之间的时间间隔和分布。在此基础上，确定了影响肺癌临床诊断和治疗过程的因素。然后根据这些事件建立了PERT模型，并对备选规划的效用进行了评估。首先，我们评估了PERT在诊断过程中的应用。通过这个评估，我们发现网络规划方法可以应用到诊断过程中，利用临床过程中每个事件之间的逻辑和时间关系。为了评估意外事件在应用PERT （Program Evaluation and Review Technique）评价临床过程中的影响，我们对肺癌治疗的治疗过程进行了检查。在治疗过程中，发现了以下困难，影响了PERT在治疗过程中的应用。1)治疗过程不规范。2)医疗干预的时间记录可以在病案中省略。3)未明确评估意外（或有害）事件解决的时间。由于这些困难，很难从日本目前使用的医学史中重建逻辑和时间关系。总之，本研究确立了PERT在临床过程中的有效性，规范了医疗资源的规划和评估分配。本研究也揭示了其局限性在于过程不规范。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医疗记录被认为是必不可少的。

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.