- 期刊
提升腦中風急性後期照護轉銜率
Utilizing Informatics System to Improve the Transfer Rate of Post-Acute Care Among Patients with Cerebrovascular Diseases
摘要
腦血管疾病造成失能需儘早規劃急性後期醫療照護模式（Post Acute Care, PAC）介入，上游醫院將有復健潛能病人，轉銜至承作醫院接受高強度積極復健，使其快速恢復且降低失能程度。本院2016至2018年腦中風PAC轉銜率平均4.7%，低於2018年健保署建議閾值13%，分析原因：主治醫師對PAC轉銜定義認知不足、現有PAC轉銜流程不完整、主治醫師主動評估PAC轉銜意願低、缺乏評估紀錄及輔助說明單且無明確溝通機制，導致轉銜率偏低，故解決策略，除修訂PAC轉銜流程（含定義）並加強主動評估宣導活動、建構資訊化評估表及記錄歷程，連結團隊照護紀錄及發展醫病共享決策輔助工具等整合策略。專案推行後，透過資訊提示系統，使得醫師可配合主動全面評估PAC轉銜的執行率100%，故PAC轉銜率由4.7%提升至28.6%，已達目的。
並列摘要
Early intervention of post-acute care (PAC) program is highly suggested among cerebral vascular accidents patients who suffer from post-stroke disability. One of the process improvement indicators for the purpose to facilitate recovery and decline overall dysfunction is to increase the patient referral rate from the tertiary medical center to the inpatient rehabilitation hospital. From 2016 to 2018, the average referral rate of stroke PAC program in the target hospital was only 4.7%, much lower than the expected value of 13% as recommended by the National Health Insurance Administration, Ministry of Health and Welfare. The detailed cause analysis revealed that this low referral rate was attributed to a lack of physicians' PAC knowledge, incomplete existing PAC transition process, , an inactive PAC evaluation, the absence of evaluation records, and a lack of PAC instruction for patient education. In order to improve the referral rate, we revised the referral workflow by establishing a standard operating procedure, strengthening proactive evaluation and advocacy activities, implementing a computer-aided integration program between evaluation and medical records for more PAC-eligible candidates, and developing a shared-decision making framework to help medical personnel, patients and caregivers to better understand the stroke PAC program. After these implementation efforts, through the informatics system, physicians could comprehensively evaluate the implementation rate of PAC transition and actively cooperate with the team, the PAC transition rate has further increased from 4.7% to 28.6%.