การพัฒนาระบบบริการสุขภาพ Service Plan จังหวัดเชียงใหม่

Service Plan . 12 2560 Provincial Public Health Committee Regulator Provide Supporte r r Regulator CFO 1 Regulator 2 Regulator 3 Regulator 4 SP 23 CHRO 1

2 3 4 CI0

Health Settings . ./ . . . . . (M1)M1) . 150 . 229,601 (M1)A) ) (M1)M2) 2

. 12 . 321,257 . . 387,908 30,595 . ., . . ., ., . .

., . .(M1)M2) , ., . 12 (M1)M2) . ., . . 28 . ., . . . 16 . ., 431,672 (M1)M1) ., ., . . 60 ., . ., ., ., ., 6

. . . 280,455 .., . ,. . 69,151 . 1. STEMI 2. (M1)SK+ PPCI) 3.PPCI 90 4.Door to Balloon Time/ PCI Time (M1)Median) 5.. A) - F2 warfarin clinic 6. (M1)./. ) ..59- . 60 <10% 8.94% (M1)11/123) >80% 88.07% (M1)133/151) >80% 62.16% (M1)23/37)

<90 95 100% < 1 100 % (M1)23/23) 2 1 ..59. 60 1. < 1% 0.22 % (M1)19 ) (M1)8/3,640) PS 0.75 (M1)) 2. < 18 21.41 (M1)370/1,728,2 (M1)) 42) 3. .F2 > 25 % 60.8 ER (M1)14/23) 4.. F2

> 60 % 95.65% 2 ECS (M1)22/23) 5. Fast track EMS (M1)Stroke) (M1)) 6. Fast track EMS (M1)STEMI) (M1)) 7. Fast track EMS (M1)Head Injury) (M1)) 8. > 19 % (M1) 10 %) > 11 % (M1) 10 %) > 87 % (M1) 10 %) > 44 % ..59. 60 14.63 (M1)18/123) 26.09 (M1)18/69)

75 (M1)81/108) 76.19 2 ..59. 60 9. 24 N-Trauma () 10. 24 Trauma () 11. <1% 0.6 (181/30091) < 1% 0.43 (33/7669) 6.99

2 1. 28 < 4 1,000 1 : 500 (30 ) 2. NICU 3. . F1 4. Intrauterine transfer system ..59-. 60 3.93 (32/8,134) 0.96 : 500 (28)

> 60% 100 (7/7) 3 ..59 - .. 60 Breast Cervix 1. > 90 100 % 100 93.94 84.62 83.72 100 67.50 < 2 wks. 2. < 4 wks.

3. > 80 62.07 % Colon Liver 100 Lung 100 74.44 77.78 92.31 > 83.33 No Chem 4 80 % ..59-. 60 1. 65 % 62.06 eGFR < (7,648/12,323)

4 ml/min/1.73 m2/ 2. 50 % 100% CKD clinic . F3 (1/1) 3. . F2 50% CKD clinic 5 1. (Blinding Cataract) 30 2. 90 MVL (SVL) 3. ..59-. 60 > 80 % 85 % (1,054 / 1,242) >80 %

92 % (646 / 704) (SVL 309 ) >75 % 77 % 6 1. ../. 2. 60 % 35 % ..59-. 60 45.7 % (122/267) 19.6 % (255,731/ 1,307,943) 7

1 > 50 % (M1) = 30,464 ) = 2.3 * 2558 15 /100 2558 15 = 1,324,540 2. > 65 %(M1) = 10,596 ) = 0.8 * 2558 15 /100 2558 15 = 1,324,540 3. > 10 % (M1) = 144,375 ) = 10.9 * ..59-. 60 51.61 % (M1)15,724 ) -

77 % (M1)8,107 ) 14.10 % (M1)20,364 ) 8 9 ..59. 60 < 14.5 (260/1837) 20 < 2.3 (30/1324) 4 1. 2. 5 3. < 12.0 10

..59. 60 1. < 30% 19.21 % Sepsis/Septic shock (M1)147/765) 2. 100% 95.92 % Hemoculture (M1)1,319/1,3 antibiotic 75) 3. A) ntibiotic 100% 97.23 % 1 (M1)1,337/1,3 75) 4. Sepsis/Septic 100% 66.03 % shock IV 1000 cc 1 (M1)908/1,375 ) 11 1. 1 5

2.TDT-Pretransfusion Hb9 gm/dl Hct 27 % 3.TDT Feritin < , ng/ml ..59- . 60 0.1 % (2/1,767) 10% >20% 52.7 % (1,003/1,904) >20% 15.1 % (22/144) 12 1. . M2 2.Fast track for open long bone fracture 6 3.Fast track fracture around the hip 60 72 . A) /S/M1

..59- . 60 > 70% 69.49 % (M1)1843/2652) > 25% 46.49 % (M1)53/114) > 25% 25.0 % (M1)58/232) 13 1. Ischemic Stroke 2. Hemorrhagic Stroke 3. Stroke 4. ischemic stroke thrombolytic agent 60 5.

<7% <7% <7% > 65 % > 80 % ..59- . 60 3.31 % (M1)57/1,720) 9.9 % (M1)99/998) 5.74 % (M1)159/2,771) 70.11 % (M1)61/87) 100 % (M1)1,720/1,720) 14 2554 2555 2556 2557 2558 2559 .-.

/ 1 1 1 3 2 4 / . / 1 1 3 2 4 33 54 56 76 67 91 54

/ / .100 (>=5) . 100 (>=1) 3.03 1.78 4.47 2.19 7.40 3.03 1.78 4.47 2.19 7.40 15

. A) ,S,M1 (M1)3) 1. 100 % (3) 2. 100 % (3) PC 3. 100 % (3) 4. 33.33 % (1) (A,S,M1) 5. PC PC (M2,F1-3) 6. 100 % (3) . M2,F1-3 (M1)21) 100 % (21) 95.24 % (20) 100 % (21) - 95.24 % (20) 100 % (21) 16 2 3 17

> 18.5 % ..59. 60 11.60 % 18 1. 35 2. 35 3. pre-diabetes 4. > 80 % > 80 %

< 2.4 % ..59. 60 80.75 % (M1)529,227/ 655,416) 82.42 % (M1)438,574 / 532,090) 2.61 % (M1)1,513/57, 880) 7,605 ..59. 60 6. ( 1 14.72) 14.51 % (M1)10,393/71, 490)

5% 40% 7. ( 1 5% 18.30 % (M1)36,246/19 8,059) 2 7 / - .. (.. 5 ) 267 0

( 0) - (.. 5 ) 267 41 ( 15.3 5) - (.. 5 ) 267 15 ( 2 5.61) 8 2560 - 2564 P L E A) S E A) M

R . RDU 1 3 process : . . RDU 2 . RDU 3 output : . output : . 1. . 1. RDU 1 1. RDU 2 2. 2.Infection: RI, A) D, FTW, NL ATB 20, 20, 40, 10 % 2.Hypertension RAS blockage = 0% 3.CKD NSAID 10% 4.A) sthma inhaled corticosteroid 80% 4.DM

Glibenclamide 5% 5.NSA) ID 5% 3. A) MR 5 output : . 4.PTC 3 5.(M1)ED) 7590% 6. 1 7.Label 3 5.Pregnancy warfarin,statin, Ergots = 0 8.Ethics 3 6.A) MR 1 output : .. 9. 40 .. RI & A) D output : .. 7. 60 .. RI & A) D 3.DM Metformin 80% 6.Pediatrics

nonsedating antihistamine 20% 7.Geriatrics long acting benzodiazepine 5% output : .. 8. 100 .. RI & A) D . RDU 1 > 80 % ..59- . 60 20.83 % ( 5 ) 1.. 2.. 3.. 4.. 5.. 18 Service plan

Engine : Inclusive Growth /Intermediate care D/C >>>>>Re admit/complications >>>>>>LOS^^^ A 138 M1 91 M1. 99 M2-F 44192 Service plan Engine : Inclusive Growth /Intermediate care Intermediate Care M/F Intermediate care . . A 1.Stroke 1.Stroke 2.Head 2.Head injury injury 3.Chronic

3.Chronic wound wound 4.Post 4.Post operative operative physical physical therapy therapy 1 Critical illness + Respirator 2 Critical illness 100% . M,F 3 4 Semicritical illness ..

5 Moderate Convalescen illness ce -Home Ward . Intermediate Care Re admit,complications / CMI / Sum Adj RW Service plan Engine : Inclusive Growth /Intermediate care A) ction plan 1. Intermediate care 2. intermediate care 6BB 3. 4. 4 5. (/) 6. intermediate care

7.

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