養護機構個案整合醫療服務模式之成效

Effectiveness of a New Integrated Service Model for Long-term Care Institutions

吳孟嬪(Meng-Ping Wu) ； 陳亮恭(Liang-Kung Chen) ； 黃信彰(Shinn-Jang Hwang) ； 高木榮(Mu-Jung Kao)

《北市醫學雜誌》 5卷5期 (2008/10) Pp. 524-534

https://doi.org/10.6200/TCMJ.2008.5.5.06

摘要

目的：策略聯盟整合中醫療機構與社區養護機構的合作應有助於整體照護品質的提昇。本計畫的目的在於整合健康照護服務，成立「跨專業的居家照護團隊」，並探討此團隊模式對於策略聯盟整合中醫院與養護機構的影響。方法：經由文獻查證與透過長期照護委員會的規劃，成立「跨專業的居家照護團隊」，擬定品質改善計畫及獎勵措施、病歷網路連結及醫師出診服務、協助養護機構建立照顧品質指標監測、設計居家照護專用「安心卡」及單一窗口服務等方案，以提供便捷快速的全方位醫療服務。結果：在服務面已成功建立專責服務團隊提供全方位醫療服務；個案與醫院簽約的養護機構增加為10家。品質面已建立定期監測指標且相關照護品質逐漸提昇，實施半年後鼻胃管自拔/滑脫/阻塞發生率由0.91%降為0.60%，導尿管自拔/滑脫/阻塞發生率由0.48%降至0.17%，泌尿道感染率由4.91%降至3.55%，壓瘡發生率由2.54%降至2.34%，住院率由6.37%降至4.46%，急診使用率2.41%降至1.04%。因照護品質提昇同時也刺激服務量的增加，而服務滿意度高達98%。結論：綜上，此策略聯盟服務方案不僅提供了更好的長期照護服務，也提昇了醫院的服務量。

關鍵字

長期照護 ； 養護機構 ； 居家護理

並列摘要

Objectives: Helping hospitals to promote services within long-term care institutions (LTCI) should be beneficial and improve the quality of care. The purpose of this study was to examine the effect of providing an integrated health care service team from the hospital to the LTCIs. Methods: Before this program's implementation, there was only one LTCI contracted with our hospital. This fact may be related to the lack of an integrated medical service team, inadequate hospital administration coordination, the lack of National Health Insurance coverage, and the roadblock between long-term care and acute care services. Through a literature review and the work of the long-term care committee, a quality improvement project was launched including internet connection of medical records, physicians' visits, facilitating LTCIs to set up quality indicator monitoring, developing an originally designed ”Service Care”, and a single access window to provide rapid, convenient, and multi-dimensional medical services. Results: During the study period, the contracted LTCIs markedly increased reaching 10 and the rate of service satisfaction reached 98%. This improvement in the quality of services simultaneously promoted the service volume of the hospital. Conclusions: The Strategic Alliance Integrated Project provided improved LTCI services and helped the service volume of the providing hospital.

並列關鍵字

long-term care ； long-term care institution ； home care