以多元方式提升安寧會診人次及涵蓋率之成果初探

The Exploratory Outcomes of Using Multiple-facet Approach to Enhance Hospice Palliative Care Coverage Rate in Cancer Patients

謝宜軒(Yi-Hsuan Hsieh) ； 蔡佩渝(Pei-Yu Tsai) ； 謝雅琪(Ya-Chi Hsieh) ； 鍾明成(Min-Cheng Chung) ； 林慶雄(Ching-Hsiung Lin) ； 黃馨葆(Sin-Bao Huang)

《安寧療護雜誌》 23卷2期 (2019/06) Pp. 129-140

https://doi.org/10.6537/TJHPC.201906_23(2).02

摘要

背景：不論是國內外的趨勢，要提升癌症照顧的品質，很重要的一步是將安寧緩和醫療整合到癌症治療。而整合成功與否的品質指標之一，為病人於過世前半年，接受到安寧緩和醫療之比率（亦即安寧涵蓋率）。而要讓病人接受到安寧緩和醫療，從而增加安寧涵蓋率，安寧會診人次是重要的指標。本研究探討中部某醫學中心，以多元方式提升安寧會診人次及涵蓋率之成果。方法：本研究從該醫學中心之癌症登錄系統提取資料，將每年於該院死亡之癌症病人數目定義為安寧涵蓋率之分母，並從院內資訊系統連結，定義在過世前半年曾接受任何一種安寧照顧方式（包含安寧共同照護、安寧居家，或安寧病房）的癌症病人為安寧涵蓋率之分子，相除之後得到個別年度之癌症安寧涵蓋率。此外，本研究紀錄每季和每年度之安寧會診人次和安寧涵蓋率做對照比較。結果：該院之癌症安寧涵蓋率從2011年的49.2%，到2015年增加為70%。本研究顯示，提供安寧轉介獎勵金、舉辦全院專題演講宣導安寧轉介時機與流程、以專職與專責醫師提供安寧會診、增加安寧共照及居家護理師員額、以及提供以團隊為基礎之安寧共同照顧服務，能有效提升安寧涵蓋率。結論：要將安寧緩和醫療有效整合到癌症照顧，需要醫院的大力支持，也需要匯集不同專業人員，持續提供癌症病人高品質的照顧，才能看到具體的成效。

關鍵字

安寧緩和醫療 ； 安寧涵蓋率 ； 癌症 ； 整合

並列摘要

Background: To improve the quality of cancer care, a critical step is to integrate palliative care into cancer care. One of the quality index of successful integration is hospice palliative care coverage rate (HPCCR), which means the proportion of cancer patients who receive palliative care in the last 6 months before death. The purpose of this study is to understand the differences in HPCCR following multiple-facet approach intended to enhance HPCCR in a medical center in central Taiwan. Method: This study collected data from cancer register system of the hospital. The number of dead cancer patients in one-year period was defined as numerator of HPCCR. The number of dead cancer patients in the one-year timeframe who receive any palliative care (including shared care/ home care/ palliative care unit) was defined as denominator of HPCCR. HPCCR was documented every year while the numerator divided by denominator. Result: HPCCR was 49.2% in 2011, and progressed to 70% in 2015. The result showed that multiple-facet approach, including provide incentives to consult palliative care specialist, arrange whole hospital meeting lecture to announce the timing and process of the palliative care referral, increase the numbers of palliative shared care and hospice home care nurses and establish team-based palliative shared care, could effectively increase HPCCR. Conclusions: It needs strong leadership and commitment by the hospital to effectively integrate palliative care into cancer care. In order to see a good outcome, good cooperation of different health care workers to provide high quality cancer care consistently is also needed.

並列關鍵字

Hospice and Palliative Care ； Hospice Palliative Care Coverage Rate ； Cancer ； Integration

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