居家訪視回饋系統的建置與應用-以承辦論人計酬試辦計劃之醫院為例

The Establishment and Application of Onsite Visits Feedback System– to Practice in the Case of Capitation Demonstration Community Hospital as an Example

張朝閔(Chao-Min Chang)

指導教授 ： 邱泓文

臺北醫學大學/醫學科技學院/醫學資訊研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00030

摘要

臺灣的健保制度目前仍依服務量的多寡給予醫院健保給付(論量計酬)，但近期有許多專家建議應改採論人計酬制度，以避免論量計酬的弊端。

在因應論人計酬支付制的對策上，參與衛福部論人計酬試辦計畫的北部某社區醫院提出責任區照護民眾居家訪視制度，並由全院同仁分組投入訪視作業，初期執行時的資料統計採用Excel方式管理，在數據收集分析與後續追蹤上較為耗費心力，有鑒於此，研究者開發結合Google Maps API技術的「居家訪視回饋系統」，希望藉由本系統建立責任照護區民眾關懷網絡，設置訪視個案回饋、專業人員訪視、高健保耗用個案管理、各項疾病分析統計等功能，同時挑選某一組小隊結合本系統試行居家訪視工作。

居家訪視計劃執行2年後(2012.3~2014.4)後該小隊共訪視257人(含複訪為335人次)，其中由專業人員完成了31筆社區回饋個案的衛教工作，從訪視資料庫來看受訪個案以高血壓(38.13%)與骨關節疾病(18.68%)為大宗，在2014年6月比對受訪個案就診紀錄後發現自述於院外就診的個案其受訪後回流就診率為36.5%，自述有疾病無就診習慣者回流就診率為52.1%，可見居家訪視的制度對於民眾在就醫選擇上產生一定程度的影響。

系統導入後醫事人員與行政人員較先前之年訪視次數各提升1.5倍與2.09倍，而進行問卷調查後平均數獲得4分以上共10題(77%)，代表受訪的101名醫院同仁認同本系統在居家訪視業務上有實質性的幫助，本研究所得之經驗與成果可提供給社區醫院作為健康促進策略應用上的參考。

關鍵字：論人計酬、居家訪視、個案管理、Google Maps API

關鍵字

論人計酬 ； 居家訪視 ； 個案管理 ； Google Maps API

並列摘要

The payment system of Taiwan's health insurance system still remain the current account of services case for hospitals (fee for service), but there are many experts recommend to pay by patient in order to avoid any malpractice by payment for service.

In order to meet the payment by patient, we joining “Care of residence onsite visit” project of mentioned by the community hospital in north Taiwan and sponsored by Ministry of Health and Welfare All hospital members were grouped for conducted onsite visit. In the initiation stage, data were collected and managed by Software Excel, but it spent lot of effort for data analysis and follow-up. Therefore, we use Google Maps API technical for build up the "onsite visits feedback system.”. We hope we could establish the network of residence, set up the feedback by visit patient, case management of highly consumed by health insurance, analysis of diseases. We also select one team to pilot this system with their onsite visit job.

After the plan have been executed 2 years (2012.2~2014.4), the team finished collecting 257 cases (included 335 duplicate visiting cases), there are 31 cases (from 257 cases), data and task have been evaluated by professional staff. From the onsite visiting database, we could find there are many cases diagnosed as hypertension(38.13%) and osteoarthritis disease (18.68%). We analysis the data from Jun-2014 till now, the return rate of outpatient service (36.5%) and 52.1 % for have disease but no regular habit in return to outside service.

After system implement, the medical personnel and administrative staff annual the number of visits were increased to by 1.5 times and 2.09 times in onsite visit , And the survey of system still remain four points above the in average of 10 questions after the survey (77%), On behalf of 101 members to agree that the system is useful and help in onsite visit service in service on onsite visits have substantial help, In this study research, we conclude that experience and achievements of this project could provide to community hospital for their consideration and implement by Health Promotion strategy for any available to community hospitals as health promotion policy is applied on the reference.

Keyword: capitation payment、onsite visit、case management、Google Maps API

並列關鍵字

capitation payment ； onsite visit ； case management ； Google Maps API

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