背　景健保局自2010年起，住院案件將逐年導入台灣版診斷關聯群（Taiwan diagnosis relatedgroups, Tw-DRGs），當支付制度改變時，醫院為了生存必需採取管理控制的系統或方
法，以維持合理的成本及醫療照護的品質。目　的探討護理管理者介入參與心導管檢查臨床路徑作業流程修正之成效。方　法擷取符合健保局公告Tw-DRGs 125支付原則之案件為對象，進行心導管檢查之臨床路徑修正，並比較修正前後其醫療服務價量、照護品質、平均住院天數及財務風險等差異變化。結　果臨床路徑修正後，心導管檢查前護理照護完整率、平均住院天數、診斷數、手術處置數及合併症／併發症數達到顯著差異，且醫療資源耗用均較臨床路徑修正前為低，並呈現顯著差異（p < .05）。結　論臨床路徑修正從組織、流程到成效管理，醫院方面不僅得到經濟效益的改善，同時對醫療品質的提昇也具有實質的助益。

Background: Taiwan’s Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.
Purpose: This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.Methods: BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac
catheterization clinical pathway. Researchers compared preand postrevision values in terms of mean medical care fees,patient volumes, healthcare quality, and length of hospital stay,as well as financial risk.
Results: Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of
hospital stay, diagnosis numbers, surgical treatment numbers,and numbers of complications or comorbidities. Medical utilization was also significantly lower (p G .05) after revision implementation.Conclusions: Clinical pathway revision involves organization,procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.