R2R

ISBN

978-974-11-1509-9

2554
2,000

. .
.
.

. .
.
.

National Library of Thailand Cataloging in Publication Data

.
R2R .-- : , 2554. 196 .
1. . 2. . I. .
610.72

2 10700
0-2419-9425-6 0-2418-3296
www.si.mahidol.ac.th/r2r

(.)
4 88/39
. . . . 11000
: 0-2832-9200 : 0-2832-9201-2
http://r2r.hsri.or.th.

240/37 10700
. 0-2866-3002-3 0-2848-9704-5
e-mail: union.creation@gmail.com

275


R2R
R2R
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 R2R (Routine to Research: )

(Knowledge Worker)





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(Learning
Organization)

 R2R R2R


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Happy Workplace
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Warfarin

R2R (Journey)

CQI (Continuous Quality Improvement)
R2R Lean R2R

16 2554


4 (.)
(Routine to Research: R2R)


(.)


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R2R Node Network
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(community of R2R practice)
2 3
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2554


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(Node) (INN)
7
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4 1) R2R

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4) R2R
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2554

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11

Area-Based Research R2R

21

R2R

32

45

Mapping R2R

59

R2R

R2R

70

R2R

79

R2R -

89

()

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101

123

137

151

Warfarin

169


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workshop
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KM (Knowledge Management)
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... R2R
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.

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biomedical

Empowerment

 R2R

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(Learning Organization)

R2R

 R2R



(Communication)
(ICT: Information
and Communication Technology)




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10

. ..
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11


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(.)
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12

 R2R

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(Tacit Knowledge) (Explicit Knowledge)






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13

 Node ( )
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Node




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Node
Node
Node Node

Node
Node
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14






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Node
Node



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15

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Node
Node

.

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16

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17


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18

 .









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19


R2R
...
R2R
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20

Area-Based Research

R2R

(Area-Based Research)


(.)

R2R

R2R

R2R
R2R

21

Area-Based Research R2R

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Area-Based Research
...
R2R Area-Based Research





. Area-Based Research














22





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(.)

.

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.
.

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23

 . R2R 3
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CUP
(Contracting Unit for Primary Care) CUP

CUP



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24


R2R
R2R



INN .

Node
Node Node Individual

Node


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Node





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25



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26

Area-Based Research R2R

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27

 R2R
.
.
Area-Based Research
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Node


Node





Node


Node

Node

28

 .

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.
Node Node

Node
Node

Node

Node Node



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29


R2R R2R

R2R











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30


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31

R2R




R2R





32

 R2R
2551
(.) (.)

MOU (Memorandum of Understanding) 4



MOU
R2R
R2R





INN model
I-Individual () N-Node () N-Network
( )

R2R
Node

Node

R2R

33


R2R
Node
Node Node

R2R
R2R
R2R

(
)

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34

 4




R2R



R2R

R2R

35




(Facilitator)


R2R R2R

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36


3


3
18

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37












Node
(.)
.
.
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( )

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38






R2R
(.)

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R2R

R2R INN



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39



individual

R2R

individual
Node Node

individual individual
individual



R2R

40


R2R








R2R
booster follow up





4

R2R

41




4 5
6
R2R


R2R

ISO ISO
ISO

R2R

42

Node...
R2R


Node



Node

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43







R2R R2R


R2R




vision action

44

R2R






(.)
R2R

45

 R2R

INN model: R2R

R2R R2R

R2R

R2R R2R

R2R


(.) (.)

46

 R2R



R2R
R2R
R2R
R2R


INN model
I Individual (Individual Person) R2R
Individual
organization
N Node ( ) Individual organization
Node
N Network () Individual
Node Network
INN share resource

R2R
Individual

INN Network

R2R

47


R2R .





R2R
R2R

R2R
R2R

R2R
...
R2R

Official network

R2R
R2R

48

 Workshop R2R

3-5

R2R Workshop R2R
R2R
Success story telling



Workshop

2 R2R




R2R


R2R

R2R

49





R2R



R2R




()
R2R Workshop

R2R

50


R2R 6-7


R2R

R2R

2-3

R2R

51


HA
2-3 R2R
National forum
R2R

1-2

52


R2R





Key success factor

R2R R2R

R2R

R2R

R2R

R2R
R2R
(Practice) Practice

Impact
Impact factor
R2R

R2R

53


R2R

()





5 (2 )



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2

54










R2R

R2R

55


()
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56





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R2R


Impact

.





R2R

R2R

57









R2R

58

Mapping

R2R

R2R

Mapping
R2R
mapping


R2R

59

 mapping R2R
mapping R2R

Mapping R2R
R2R

R2R
Mapping

Mapping
Mapping .





Mapping

60

 Google map


R2R . 2553

...
Mapping


Mapping


R2R

R2R

61

Approach
Mapping


Mapping Node 2-3
6 Node

Node





Workshop

62



cluster facilitator

mapping

R2R

63



Node

Node
Node

10-20

64

 mapping

Mapping
Mapping

Mapping R2R
Node
Node

R2R

65


. .


. mapping
.

.




.


approach

66

 Node
. (
)
3
3



.
.

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67

 Mapping R2R

R2R

68


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69

R2R

R2R ...



R2R

(R2R
Forum) 1 2551 .

70



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2528

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71

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(Routine to Research) 1 2551


R2R R2R

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72

 R2R

.
R2R Road show
INN




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.



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()

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INN
I-Individual () N-Node ()
N-Network () R2R

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73








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9

9





( )

...
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74



3

3
30


4 1
2 3
4

4

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75





5-10


20


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76


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(
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2-3 R2R

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R2R 1 . 2551
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()
R2R

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81

 R2R

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R2R R2R

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R2R 1
1 ()
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82



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( )

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...

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83

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84


()

(.)




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85

 ()




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R2R


theme R2R
R2R .


16-18 2553

R2R



86



R2R
theme
R2R

.



1-2

R2R

87

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2553


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...

88

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-

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89

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.
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R2R 2
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91

3-4
13
()
R2R

4



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92




30

R2R




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93






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94

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95

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96







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97

 .


R2R



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98


R2R

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99

Warfarin

100

...

1 5


1 10

!

R2R

101

102



(Guideline)

R2R

103

...

104















28

R2R

105



.. 2546


.. 2546
20 50 .. 2547
2050
CVA care map

106
















PCU


Stroke Cornor
4 4 Stroke Cornor

R2R

107

...

108















PCU
1
Tertiary Care
Primary Care

R2R

109





28


726

1 2545 30 2546
320

.. 2548
1 .. 2547 30
.. 2548 406

110



(Echocardiogram)
2

2

R2R

111






.. 2548
Echocardiogram
(Primary Outcome)
(Overall Mortality)
8.7 .. 2546
3.4 .. 2548
(Secondary Outcome)
28

2546-2548
()
()
()
()
()
()
()

112

2546

2548

40.3
20.3
29.4
10.6
6
8.13
5

33.3
9.1
15
3.4
1.2
6.4
1.5

28










15,231
11,224

R2R

113


Stroke
Cornor

...





Routine to Research Research
to Routine

114

(.)
Stroke Unit

R2R

115

 .. 2550 Stroke Fast Tract CVA

Onset () 2
true onset 2
CT scan brain
3 r-TPA 100 .

.. 2550 23
Onset 2 CT brain
Neurologist ER r-TPA

R2R

116







Order CT 2

Code ICD 10
Code ICD 10

. 501 Stroke CVA RW. = 0.68
Cerebral Infarct RW. = 1.14
. 501

R2R

117



(.) (.)

() 40

ICU

118

R2R

119






4

1. Oral Presentation
6 23 2551

2. 4
28 2551
3. 1 The 2nd Novartis Neuroscience Award

7 2552
4.
. 15 2552

120







Code ICD 10

R2R

121










Knowledge-Based Management

...

122

...

R2R

123

124


5

(
9 )

...

R2R

125

126

R2R

127

(Analytic Cross Sectional
Study)

(PCU Based)
136


(.)


128











21 255219 2552 ( .. 1430)

R2R

129











61.76
2 69.85 4
43.86
2 50.85 4

2.95



13



130

...

R2R

131

132

R2R

133


Routine to
Research (R2R)
(.) 2553

(.)

134


30

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135








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...

136

...

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137

138

 ...






200 34,793
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139

80
31



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3.2
6-12

140





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(.. 25382552)
14




Excellent center

Node

R2R

141

.. 2550
.. 2551 3
( )



1

(IT)

142




(UC) (Movable
Unit) 3
(Slit Lamp, Pneumotonometer, Indirect Ophthalmoscope,
Autokeratometer and Autorefraction) (
)

Node
4-6
1 Node

Node

.. 2551
.. 2552

...

4,551
Research and Development
3 60
90 120
R2R

143

 Node
1- 95 4,551
2,176 1,026 809 368
172


87
310
2,010
3


240

PCU Node
32.5

6 8
87

144


. () . ()

. Node
. Node
. Node
Node

98
82
82

72
70
80

Node

.. 2550-2552
.. 2552 42,686 34,261

Node

R2R
Node
...




Node

R2R

145



70
()
OT

200

Node

146

 GP
(General Practice or General Practitioner: GP)


Case study

Node



Node

35
Node


Excellent centre

R2R

147

17
Node

148



Node

Node


















R2R

149

 Node

Node



...
Node

...



Node

Node



...
150

...

R2R

151

152


...



...

(Infection
Control: IC)




IC

(Sterile)


(Re-Sterile)

R2R

153

 ...
(Sterile)
(Re-Sterile)


2,000

. ..

IC

Re-sterile

Re-sterile 30

154




Re-sterile
66.67


720,000

R2R

155

CQI

156

R2R

R2R

R2R 3-4

R2R






...

R2R

157

158








Resterile (Action
Research)


1
50 2 3
1
225 1, 2, 3, 4, 5, 6, 7, 8 9
325

5
2549 2551

R2R

159

1-1.5
3

160







1 1
1 3
1
9
Sterile

R2R

161

1
1 1 7
21


Re-sterile 30
0.3

2,000
Re-sterile 1-1.5

162



(Sterile)
(Re-Sterile)







Re-sterile

R2R

163

164

R2R
R2R
R2R
R2R
R2R

R2R

165

 R2R
R2R


R2R
R2R







29,500
...

166







...

21

R2R

167





...

R2R
( )

168

Warfarin

3 R2R

(.)
R2R

R2R

169

170





/
Warfarin ( Warfarin 13)






/
Warfarin


13

R2R

171

172

R2R

173

2










Warfarin

3
1 15



174


Warfarin
Protromvin Time International Normalized Ratio
(PTINR) 5 5
Warfarin 12
(Warfarin Manager)

2
Warfarin
()
15

Warfarin

/ Warfarin

Warfarin Clinic Warfarin

(Target INR)
24
on warfarin
OPD Card/
Warfarin VCD Fast Track
ER

R2R

175

 Wafarin
Warfarin

VCD
Warfarin

3



34
/
Warfarin
15 /

/

Warfarin


Warfarin Protromvin Time International
Normalized Ratio (PTINR)

176

 Warfarin
Warfarin 1

Warfarin

R2R

177






Wafarin













24

178



.. 2553
Warfarin 23.04 ( 2552) 8.11
(..-..53) 0.48
Warfarin (1,881 )

admit Warfarin

Medical Error
Valve dysfunction

() .... 2553
() 2552
50
44
1
1
4
1

9
5
0
0
4
0

15
13
4 ( 11)
9

/ Warfarin

R2R

179



/
Warfarin

Warfarin Warfarin
Warfarin

Top down f low
chart: Warfarin management

Warfarin
Target INR


Warfarin
Warfarin
Stroke
STEMI

180

Warfarin


/ Warfarin (
Warfarin 13)

20
.. 2553
.. 2554
17
Warfarin

Case conference


2554

R2R

181

R2R


10

R2R
...




3





(STEMI & Warfarin)

R2R
R2R

7

182

 R2R
R2R


R2R

R2R
R2R

R2R








R2R

R2R

183


(
) (
10)
( )
( )
( )
( )
( 2)

R2R
R2R

CQI
QA R2R

R2R

184

 (Steering Committee)
1.

2.

3.

4.

5.

6.

7. ()
8.

9.

10.

11.

12. /

13.

14.

15.

16.

17. R2R

18. R2R

19. R2R

20. R2R

21.

22.

23.

24.

25.

26.

27.

28.

R2R

185


1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14. .
15.
16.

186