居家醫療個案來源與結案原因探討－以台北市某區域醫院為例

Source of Cases and Reasons of Case Closure for Patients Receiving Home Medical Care in a Regional Hospital in Taipei

陳美如(Mei-Ju Chen) ； 詹詩嘉(Shu-Jar Jan) ； 黃肇明(Chao-Ming Huang) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 14卷1期 (2017/03) Pp. 13-22

https://doi.org/10.6200/TCMJ.2017.14.1.02

摘要

目的：本研究欲了解某台北市某區域醫院執行「全民健康保險居家醫療照護整合計畫」之「居家醫療階段」其收案來源與結案原因，研究結果將有助於未來政策與醫療資源投入之參考。方法：本研究分析2016 年03 月01 日至2016 年11 月30 日接受台北市某區域醫院「全民健康保險居家醫療照護整合計畫」之「居家醫療階段」資料庫。結果：「居家醫療階段」收案來源主要以自行申請為主(n=1,086，佔70.6%)，已結案比例為15.4%(n=237)。結案者以「自行申請」為多數(n=152，64.1%)。本研究發現不同收案來源與結案原因是否合理有其相關性。收案來源為「住院」者其「合理結案」與「開立處方」比例皆較「自行申請」者為高且達統計上差異(p＜0.001)。結論：接受「居家醫療階段」服務之個案如果因為不合理原因而結案，對於個案而言無法有持續性的照顧，且團隊出訪之效益評估有待思考。因此建議由原照護醫師出訪是可以提升個案持續接受居家醫療階段服務願意之可行因素。此外，建立單一窗口落實說明計畫執行內容與實際出訪初次篩檢個案病況，亦可減低不合理結案之比例，進而提升居家醫療之全人照護品質。

關鍵字

居家醫療 ； 結案 ； 到宅訪視

並列摘要

Objective: This study investigated the source of cases and reasons of case closure during home health care under the coverage of integrated home healthcare program of National Health Insurance in a regional hospital in Taipei. The results are helpful in policy decision-making and medical resource investment in the future. Methods: Data of the cases who received home health care under the coverage of the integrated home healthcare program of National Health Insurance were collected from March 1, 2016 to November 30, 2016. Results: 70.6% of the cases were self-applicants (n=1,086) and 15.4% of the cases (n=237) were closed. Most of the closed cases were self-applicants (n=152, 64.1%). A correlation was found between case sources and the reasons of case closure. Inpatients and those with prescription had higher proportion of reasonable reasons for closure than those who were self-applicants (p values ＜0.001). Conclusion: Cases dropped out for unreasonable reasons might end up with care discontinuity and the effectiveness of team visits should be reviewed. We recommend home visits by patient's former physicians to enhance patient willingness to continue receiving the home health care services. In addition, a single window for explaining the contents of the program and the initial health conditions of the screened patients can reduce the proportion of unreasonable closure and elevate the hoslistic quality of home health care.

並列關鍵字

Home health care ； closed cases ； home visit