72. 大 骨頚部骨折地域連携クリニカルパスの有用性と問題点の検討

 ᄢ⣽㛽㗖ㇱ㛽᛬࿾ၞㅪ៤ࠢ࡝࠾ࠞ࡞ࡄࠬߩ᦭↪ᕈߣ໧㗴ὐߩᬌ⸛
ഭ௛⠪ஜᐽ⑔␩ᯏ᭴ጊญഭἴ∛㒮࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦ⑼
߿
߉
߭ࠈ޽߈
ߣ ߇ ߺ
ߣߺߥ߇
ߌ޿ߎ߁
ߣߒ߆ߟ
߹ߟߒ߹
ߣߒ߭ࠈ
٤౎ᧁ ብ᣿ 㧔37㧕㧘⎎਄ ᕺᐘ 㧔37㧕㧘 ን᳗ ବస 㧔0'㧕㧘᧻ፉ ᐕብ 㧔0'㧕
‫ޤߦ߼ߓߪޣ‬
ㄭᐕߩක≮ࠍขࠅᏎߊ␠ળᖱ൓ߥߤߩᄌൻ
ߦࠃࠅ㧘ක≮ߩᯏ⢻ಽൻߩᵹࠇ߇ㅴ߻ߥ߆ߢ㧘
ᚻⴚ߆ࠄ࿷ቛᓳᏫ߹ߢߩㆊ⒟ࠍห৻ߩක≮ᯏ
㑐ߢቢ⚿ߔࠆߎߣߪ࿎㔍ߣߥߞߡ߈ߡ޿ࠆ‫ޕ‬
ߎߩࠃ߁ߥਛ㧘ᒰ㒮ߢߪ㧘ᐔᚑ ᐕ㧠᦬ࠃࠅ㧘
ᄢ⣽㛽㗖ㇱ㛽᛬࿾ၞㅪ៤ࠢ࡝࠾ࠞ࡞ࡄࠬ
એ
ਅ㧘࿾ၞㅪ៤ࡄࠬࠍ૞ᚑߒ㧘ㄭ㓞ߩක≮ᯏ㑐
ߣߩㅪ៤ߩ߽ߣߦ㧘⸻≮߅ࠃ߮࡝ࡂࡆ࡝࠹࡯
࡚ࠪࡦࠍㅴ߼ߡ߈ߚ‫ޕ‬
੹࿁㧘ࠕࡦࠤ࡯࠻⺞ᩏࠍታᣉߒ㧘ᖚ⠪࡮ኅ
ᣖḩ⿷ᐲߩᛠីߣ㧘࿾ၞㅪ៤ࡄࠬߩ᦭↪ᕈߣ
໧㗴ὐߦߟ޿ߡᬌ⸛ߒߚߩߢႎ๔ߔࠆ‫ޕ‬
‫ޣ‬ኻ⽎߅ࠃ߮ᣇᴺ‫ޤ‬ᐔᚑ ᐕ㧠᦬߆ࠄᐔᚑ
ᐕ㧟᦬߹ߢߦ㧘ᒰ㒮ߦߡ࿾ၞㅪ៤ࡄࠬ߇ㆡ
↪ߐࠇߚ ฬ㧔ᐔဋᐕ㦂 ᱦ㧘↵ᕈ㧠ฬ㧘
ᅚᕈ ฬ㧕ࠍኻ⽎ߦ㧘ㇷㅍߦࠃࠆࠕࡦࠤ࡯࠻
⺞ᩏࠍታᣉߒߚ‫⺞ޕ‬ᩏ㗄⋡ߪ㧘
㧝㧚࿾ၞㅪ៤ࡄࠬߩ⋡⊛ߦߟ޿ߡߩℂ⸃ᐲ
㧞㧚ォ 㒮ᓟߩ⋴⼔㕙߿࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦ
ߩ⛮⛯㧔ࠪ࡯ࡓ࡟ࠬߥක≮㧕
㧟㧚࿾ ၞㅪ៤ࡄࠬߢߩක≮ߦߟ޿ߡߩḩ⿷
ᐲ
㧠㧚࿾ၞㅪ៤ࡄࠬߢߩ໧㗴ὐߩ᦭ή
ߣߒߚ‫ޕ‬࿁╵ᣇᴺߪ㧘ㆬᛯᑼߣߒ㧘㧝㧚ߦߟ
޿ߡߪ㧘ℂ⸃ᐲߩౝኈࠍ㧘㧠㧚ߦߟ޿ߡߪ㧘
໧㗴ὐߩౝኈࠍ⥄↱⸥タߦߡ࿁╵ࠍ᳞߼ߚ‫ޕ‬
࿁╵⠪ߪ㧘ᖚ⠪߇㜞㦂ߢ޽ࠆߎߣࠍ⠨ᘦߒ㧘
ᖚ⠪߹ߚߪኅᣖߣߒߚ‫ߚ߹ޕ‬㧘ォዬవਇ᣿╬
ߩℂ↱ߢㅍઃ࿎㔍ߥ႐วߪ㧘ࠕࡦࠤ࡯࠻⺞ᩏ
ߣห᭽ߩౝኈࠍ㔚⹤ߦࠃࠆ⡞߈ขࠅ⺞ᩏߦߡ
࿁╵ࠍ᳞߼ߚ‫ޕ‬
‫⚿ޣ‬ᨐ‫ޤ‬
ࠕࡦࠤ࡯࠻⺞ᩏ ฬ㧘㔚⹤ߦࠃࠆ⺞ᩏ ฬߩ⸘ ฬࠃࠅ࿁╵ࠍᓧࠄࠇߚ㧔࿁╵₸
㧑㧕‫ޕ‬࿁╵⠪ߪ㧘ᖚ⠪ᧄੱ߇㧢ฬ㧘ኅᣖ߇
ฬߢ޽ߞߚ‫ޕ‬એਅ㧘⺞ᩏ㗄⋡ߦᴪߞߡ࿁╵
ࠍ␜ߔ‫ޕ‬
㧝㧚࿾ၞㅪ៤ࡄࠬߩ⋡⊛ߦߟ޿ߡℂ⸃ߢ߈߹
ߒߚ߆‫ޕ‬
‫ޠߚ߈ߢޟ‬㧠ฬ㧔㧑㧕㧘
‫ޠߚ߈ߢ޿ߚ޿ߛޟ‬
㧤ฬ㧔㧑㧕㧘‫ޠߚߞ߆ߥ߈ߢࠅ߹޽ޟ‬㧤ฬ
㧔㧑㧕㧘‫ޠߚߞ߆ߥ߈ߢޟ‬㧜ฬ㧘ή࿁╵㧠
ฬ㧔㧑㧕ߢ޽ߞߚ‫ޕ‬
ℂ⸃ౝኈߣߒߡߪ㧘
‫ޟ‬ᕆᕈᦼ∛㒮ߢߩ㐳ᦼ㑆
ߩ౉㒮ߪ࿎㔍ߥߩߢ㧘ㅪ៤వߩ∛㒮ߦߡ࡝ࡂ
ࡆ࡝ࠍ⛮⛯ߔࠆ‫ޠ‬㧘‫ޟ‬ᕆᕈᦼ∛㒮ߪᢇᕆᖚ⠪ࠍ
ฃߌ౉ࠇࠆߚ߼ߦࡌ࠶࠼ⓨߌߥߊߡߪߥࠄߥ
޿‫ޠ‬㧘‫ᤨ߁޿߁ߘޟ‬ઍߥߩߢ઀ᣇ߇ߥ޿‫޿ߣޠ‬
߁࿁╵߇ᄙ߆ߞߚ‫ޕ‬
㧞㧚
㧔㧝㧕ォ㒮ᓟߩ౉㒮↢ᵴ㧔⋴⼔㕙㧕ߪࠬࡓ
࡯࠭ߦ㐿ᆎߢ߈߹ߒߚ߆‫ޕ‬
‫ޠߚ߈ߢޟ‬㧠ฬ㧔㧑㧕㧘
‫ޠߚ߈ߢ޿ߚ޿ߛޟ‬
ฬ㧔㧑㧕㧘
‫ޠߚߞ߆ߥ߈ߢࠅ߹޽ޟ‬㧝ฬ
㧔㧑㧕㧘
‫ޠߚߞ߆ߥ߈ߢޟ‬㧜ฬ㧘ή࿁╵㧡ฬ
ߢ޽ߞߚ‫ޕ‬
㧔㧞㧕ォ㒮ᓟߩᱠⴕ✵⠌╬࡝ࡂࡆ࡝࠹࡯࡚ࠪ
ࡦߪࠬࡓ࡯࠭ߦ㐿ᆎߢ߈߹ߒߚ߆‫ޕ‬
‫ޠߚ߈ߢޟ‬㧟ฬ㧔㧑㧕㧘
‫ޠߚ߈ߢ޿ߚ޿ߛޟ‬
ฬ㧔㧑㧕㧘
‫ޠߚߞ߆ߥ߈ߢࠅ߹޽ޟ‬㧟ฬ
㧔㧑㧕㧘‫ޠߚߞ߆ߥ߈ߢޟ‬㧝ฬ㧔㧑㧕㧘
ή࿁╵㧡ฬߢ޽ߞߚ‫ޕ‬
㧟㧚࿾ၞㅪ៤ࡄࠬߢߩක≮ߦߟ޿ߡḩ⿷ߐࠇ
ߡ޿߹ߔ߆㧔࿑㧝㧕‫ޕ‬
㧙㧙
- 161 -
‫ޟ‬ḩ⿷‫ޠ‬㧟ฬ㧔㧑㧕㧘‫߿߿ޟ‬ḩ⿷‫ ޠ‬ฬ
㧔㧑㧕㧘
‫߿߿ޟ‬ਇḩ⿷‫ޠ‬㧣ฬ㧔㧑㧕㧘
‫ޟ‬ਇ
ḩ⿷‫ޠ‬㧟ฬ㧔㧑㧕㧘ή࿁╵㧝ฬ㧔㧑㧕
ߢ޽ߞߚ‫ޕ‬
満
12.5%
やや満足
41.7%
やや不満足
29.2%
不満足
無回答
12.5%
4.1%
10
0
図1
20
30
患者・家族満足度
40
50
㧠㧚࿾ၞㅪ៤ࡄࠬߢߩක≮ߩ໧㗴ὐߪ޽ࠅ߹
ߔ߆‫ޕ‬
‫ ޠࠆ޽ޟ‬ฬ㧔㧑㧕㧘
‫ ޠ޿ߥ ޟ‬ฬ㧔㧑㧕㧘
ή࿁╵㧝ฬ㧔㧑㧕ߢ޽ߞߚ‫ޕ‬໧㗴ὐߩౝኈ
ࠍ㓸⚂ߒߚ߽ߩࠍ⴫㧝ߦ␜ߔ‫ޕ‬
⴫㧝 ໧㗴ὐߩ㓸⚂
࡮ ࿾ၞㅪ៤ߦߟ޿ߡߩ⹦ߒ޿⺑᣿߇ߥ
޿
࡮ ᕆᕈᦼ࡮࿁ᓳᦼ∛㒮ߣ߽ߦ౉㒮ᦼ㑆߇
⍴޿
࡮ ォ㒮߹ߢߩᦼ㑆߇⍴޿
࡮ ㅪ៤వ∛㒮߇㆙ߊ㧘ኅᣖ߇ㅢ㒮ߒߠࠄ
޿
࡮ ㅪ៤వߦ⛮⛯ߒߚ࡝ࡂࡆ࡝ߩᗧ⼂߇
ૐ޿
࡮ 㜞㦂⠪ߦߣߞߡォ㒮ߪ⽶ᜂ
‫ޣ‬⠨ኤ‫ޤ‬
੹࿁ߩ⺞ᩏ⚿ᨐࠃࠅ㧘࿾ၞㅪ៤ࡄࠬߪ㧘ࠪ
࡯ࡓ࡟ࠬߥක≮ߩⷰὐ߆ࠄߪ㧘ᕆᕈᦼ߆ࠄ࿁
ᓳᦼක≮߳ߣ❬ߍࠆ᦭↪ߥ࠷࡯࡞ߦߥࠅᓧࠆ
ߣᕁࠊࠇࠆ‫ߒ߆ߒޕ‬㧘৻ᣇߢߪ㧘㧟ഀએ਄ߩ
ᖚ⠪࡮ኅᣖ߇࿾ၞㅪ៤ࡄࠬߩ⋡⊛ࠍℂ⸃ߢ߈
ߡ޿ࠆߣߪ⸒޿㔍ߊ㧘ℂ⸃ౝኈߣߒߡ߽㧘߿
߿ุቯ⊛ߥශ⽎߇ᢔ⷗ߐࠇߚ‫ޕ‬቟⮮ࠄߪ㧘࿾
ၞㅪ៤ࡄࠬߦ߅ߌࠆォ㒮ᤨߦߪ 㧑߇ਇ቟
ࠍᛴ޿ߡ޿ߚ 㧝㧕ߣႎ๔ߒߡ޿ࠆ‫ޕ‬࿾ၞㅪ៤ࡄ
ࠬߦߟ޿ߡߩ⺑᣿ߣหᗧߪ㧘⸻≮ႎ㈽▚ቯ਄㧘
౉㒮ᓟᣧᦼߦਇนᰳߢ޽ࠆ‫ޕ‬ฃ்⋥ᓟߩᔃᖱ
ࠍ⠨ᘦߒߚ਄ߢ㧘࿾ၞㅪ៤ࡄࠬߩ⋡⊛߿⚻ㆊ
ࠍචಽߦ⺑᣿ߔࠆߎߣ߇㊀ⷐߢ޽ࠆ‫ߦࠄߐޕ‬㧘
ౕ૕଀ࠍឭ␜ߔࠆߎߣߢ㧘ᖚ⠪࡮ኅᣖ߇ࠗࡔ
࡯ࠫߒ߿ߔߊߥࠆߩߢߪߥ޿ߛࠈ߁߆‫ޕ‬
቟⮮ࠄߦࠃࠆߣ㧘ᄢ⣽㛽㗖ㇱ㛽᛬࿾ၞㅪ៤
ࡄࠬࠍ૶↪ߒߡߩ⸻≮ߪ㧘ᖚ⠪஥ߩਇḩߪ
㧑ߢ޽ߞߚ㧔ฬฎደ࿾ၞ㧕㧝㧕ߣߐࠇߡ޿ࠆ‫ޕ‬
੹࿁ߩḩ⿷ᐲ⺞ᩏߢߪ㧘⚂㧠ഀ߇߿߿ਇḩ
⿷࡮ਇḩ⿷ߣߒ㧘߹ߚ㧘ḩ⿷ߣߒߥ߇ࠄ߽໧
㗴߇޽ࠆߣߩᗧ⷗ࠍᓧߚ‫ޕ‬໧㗴ὐߩౕ૕⊛࿁
╵߆ࠄߺࠆߣ㧘ㄭ㓞ߣߐࠇࠆක≮ᣉ⸳߇㆙ᣇ
ߦߥߞߡߒ߹߁ߎߣ㧘ォ㒮వᣉ⸳ߩㆬᛯߦ㒢
ࠅ߇޽ࠅ㧘∛㒮߿࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦᯏ⢻╬
ࠍ⠨ᘦߒߡߩォ㒮߇࿎㔍ߥߎߣ߇ℂ↱ߣߒߡ
⠨߃ࠄࠇࠆ‫ߪࠄࠇߎޕ‬㧘ዊㇺᏒ࿤․᦭ߩ໧㗴
߆߽ߒࠇߥ޿ߣផኤߐࠇࠆ‫ޕ‬࿾ၞㅪ៤ࡄࠬߦ
߅ߌࠆᕆᕈᦼ∛㒮ߩ㊀ⷐߥᓎഀߣߒߡߪ㧘࿾
ၞߩක≮⾗Ḯ㧔ක≮ᣉ⸳ߩ․⦡㧕ࠍℂ⸃ߒߚ
਄ߢߩ㧘ᖚ⠪ߦㆡߒߚක≮ᣉ⸳߳ߩ‫ޟ‬ᯅᷰߒ‫ޠ‬
߇᜼ߍࠄࠇࠆ‫ߪߦ߼ߚߩߘޕ‬㧘ㅪ៤వක≮ᣉ
⸳ߣ޿߆ߦࠦࡒࡘ࠾ࠤ࡯࡚ࠪࡦ߇࿑ࠇࠆ߆߇
㎛ߦߥࠅ㧘ዊㇺᏒ࿤ߢ޽ࠆ߆ࠄߎߘ‫ޟ‬㗻ߩ⷗
߃ࠆㅪ៤‫߇ޠ‬น⢻ߣߥࠆߩߢߪߥ޿߆ߣ⠨߃
ࠆ‫ޕ‬
‫ޤ߼ߣ߹ޣ‬
࿾ၞㅪ៤ࡄࠬㆡ↪ᖚ⠪࡮ኅᣖߦኻߒߡ㧘ḩ
⿷ᐲ⺞ᩏࠍታᣉߒ㧘᦭↪ᕈ߿໧㗴ὐߦߟ޿ߡ
ᬌ⸛ߒߚ‫ޕ‬ඨᢙએ਄߇ḩ⿷ߣߒߡ޿ߚ߇㧘⋡
⊛ߩਇචಽߥℂ⸃߿ዊㇺᏒ࿤․᦭ߣᕁࠊࠇࠆ
⺖㗴߽᛽಴ߐࠇߚ‫ޕ‬ᕆᕈᦼ∛㒮ߣߒߡ㧘⺑᣿
ᤨߦౕ૕଀ࠍឭ␜ߔࠆߎߣ߿㧘ㅪ៤వක≮ᣉ
⸳ߣߩ✎ኒߥ㑐ଥࠍ᭴▽ߔࠆߎߣ߇ኻᔕ╷ߣ
ߒߡ⠨߃ࠄࠇߚ‫ޕ‬
‫ޣ‬ᒁ↪ᢥ₂‫ޤ‬
቟⮮ᥓᵗ㧘૒⮮౏ᴦ㧦࿾ၞක≮ㅪ៤ߦ߅ߌ
ࠆᖚ⠪ḩ⿷ᐲߦߟ޿ߡ㧚࡝ࡂࡆ࡝࠹࡯࡚ࠪ
ࡦකቇ 㧧㧔6XSS㧕㧦 6
㧙㧙
- 162 -