建構以價值為導向的居家醫療照護模式

Establishing a Value-Based Home Health Care Model

施至遠(Chih-Yuan Shih) ； 孫文榮(Wen-Jung, Sun) ； 徐愫萱(Su-Hsuan Hsu) ； 李易翰(Yi-Han Lee) ； 黃喬煜(Chiao-Yu Huang) ； 黃肇明(Chao-Ming Huang) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 14卷附冊 (2017/11) Pp. 59-68

https://doi.org/10.6200/TCMJ.2017.14.SP.06

摘要

以價值為導向的醫療照護已成為世界趨勢，在老年化的社會中，越來越多的老年病人患有衰弱與多重慢性疾病，而且不易走出家門就醫。面對這樣的狀況，居家醫療是高價值的的照護模式。根據美國推展「居家基層醫療」(Home-Based Primary Care)的經驗，理想的居家醫療必須是持續性、周全性的照護。因此，我國以往的居家照護模式必須調整，才能因應居家病人的需求。根據臺北市立聯合醫院經驗，高價值居家醫療奠基於團隊與病人家屬之間的「信任」，從生到死陪伴病人的「承諾」，提供由失能依賴到生命末期照護支持的「承擔」。此外，透過家庭會議溝通以建立照護共識、未雨綢繆減少緊急事件發生、無縫接軌的轉銜照護、跨職類跨單位的協同照護，皆為高價值居家醫療照護模式之關鍵因素。

關鍵字

居家醫療照護 ； 居家基層醫療照護 ； 居家緩和醫療照護 ； 價值照護

並列摘要

Value-Based health care has become a global trend in medical services. In an aging society, more and more elderly patients suffer from frailty and multiple chronic diseases and uneasy to leave home for seeking medical helps. In the face of such a situation, home health care appears to be a High- Value care model. According to the United States experience in the promotion of Home-Based Primary Care, an ideal home health care should provide continuous and comprehensive care. Current home-based health care model in Taiwan should be adjusted to meet the needs of homebound patients. According to the experience of Taipei City Hospital, High-Value Home-Based health care relies on the trust between patient, family and medical teams, the commitment of being accompany to the end of life, and the accountability of providing care and support from the moment of loss of ability to end-of-life stage. Moreover, recognizing terminally-ill patients earlier, conducting family meeting to establish care agreement, preventing emergent conditions, and providing seamless transitional care and cross-silo care, are all the key factors in the establishment of High-Value home health care model.

並列關鍵字

Home-Based health care ； Home-Based primary care ； Home-Based palliative care ； Value-Based health care