CAJ | 학술논문

目的：利用病案首页实现国家手术分级目录。方法通过电子病案手术分级管理流程或首页信息实现。结果建立权威性和公正性的手术分级目录，使不同科室和个人手术数量具备可比性，采用手术数量、三四级手术所占构成比、手术并发症、非计划二次手术等指标，实现对医师手术能力和手术质量的评估，促使手术分级管理相关制度落到实处。结论利用病案首信息建立手术评价指标体系，实现医疗手术行为有效监管。
목적：이용병안수혈실현국가수술분급목록。방법통과전자병안수술분급관리류정혹수혈신식실현。결과건립권위성화공정성적수술분급목록，사불동과실화개인수술수량구비가비성，채용수술수량、삼사급수술소점구성비、수술병발증、비계화이차수술등지표，실현대의사수술능력화수술질량적평고，촉사수술분급관리상관제도락도실처。결론이용병안수신식건립수술평개지표체계，실현의료수술행위유효감관。
Objective To realize the classification of national operation directory in the home page of medical record. Methods With the help of electronic medical record′s classification management or home page information, the classification of national operation directory can be realized.Results We established the authoritative and public operation classification directo-ry so that it could be easily to make a comparison between different departments and individual operation quantity.Besides, by considering the index such as operation quantity and the triple/quaternary surgery percentage , surgical complications , and unin-tended second operation , the evaluation of doctor′s operative capacity and quality could be achieved which could make the rele-vant operation classification management system come in to effect.Conclusion The operation evaluation system is to be set by using home page of medical records which can be more effectively to supervise the medical operation behavior .