出院準備服務轉銜長照2.0成效之探討-前瞻性世代研究

Cost and Effectiveness of Long-term Care Following Discharge Planning：A Prospective Cohort Study

李文瑛(Wen-Ying Lee)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2019年)

摘要

研究目的
為響應政府長照2.0政策，目前各醫院積極推動出院準備無縫接軌銜接長照服務，評估此創新出院準備服務模式之成效，期待能夠提供政府於推動長照政策之參考。因此，本研究首先探討無縫接軌組與傳統模式組在出院準備銜接長照2.0的病患人口學特性及臨床特性之差異，接著比較兩組病患其醫療資源耗用及重要相關影響因子，最後探討兩組病患在醫療療效及其重要相關影響因子。

研究方法
本研究採用前瞻性世代研究設計，針對台灣南部某醫學中心2015年11月至2018年2月，住院3天以上，符合長照2.0條件，轉介至長照管理中心之病患，計有49位以傳統模式及119位無縫接軌模式之出院準備服務。利用結構性問卷收集病患人口學特性與臨床特性，另外利用多重共病衰弱指數、日常生活功能、營養篩檢三項工具評估病人臨床特性。統計方法利用線性複迴歸、羅吉斯複迴歸及Cox迴歸分析，評估兩組病患在醫療資源耗用及醫療療效及其重要相關影響因子。

研究結果
無縫接軌組和傳統模式組在病患的人口學特性及臨床特性並無達到統計上顯著性差異。研究結果發現，無縫接軌組的病患，於醫療療效包括非計畫性再入院及死亡率，並無顯著性差異；但在六個月內的平均門診費用、住院費用、急診費用及醫療總費用，相對於傳統模式組具有顯著性較低（p<0.05）。出院準備服務銜接長照2.0的病患人口學特性與臨床特性，對於六個月內的醫療資療耗用以及醫療療效亦具有顯著性相關。

結論與建議
出院準備銜接長照2.0，採用無縫接軌模式相較傳統模式，可顯著性降低醫療資源耗用，在六個月內的平均門診費用、住院費用、急診及醫療總費用都有顯著性降低。整體而言，依失能人口推估經濟負擔，出院準備無縫接軌長照2.0服務每年可節省900至1000億的經濟支出，建議可將此模式擴及全國，不僅能提升長照2.0持續性照護品質，且能降低政府財政負擔。

關鍵詞：出院準備服務、長照2.0

關鍵字

出院準備服務 ； 長照2.0

並列摘要

Purposes
In response to the Government's Long-term Care 2.0 (LTC 2.0) Policy, hospitals are now promoting discharges to prepare a seamless discharge plan to evaluate the effectiveness of this innovative discharge readiness service model. Therefore, this study first explores the difference in demographic characteristics and clinical characteristics between the seamlessly-coupled group and the traditional model group in the hospitalization preparation for LTC 2.0, and then compares the medical resource utilization and medical outcomes of the two groups of patients and their important related factors.

Method
This prospective cohort study collected data from a medical center in southern Taiwan between November 2015 and February 2018, hospitalized for more than 3 days, in accordance with the conditions of LTC 2.0, referred to long-term care center, there are 49 outpatient preparation services in the traditional mode and 119 in the seamless integration modes. This study used a structured questionnaire to collect demographic characteristics and clinical characteristics, as well as the Multimorbidity Frailty Index, Activities of Daily Living Scale (ADL), and Malnutrition Universal Screening Tool ( MUST). Three questionnaires were used to assess the clinical characteristics of patients. Then the multiple regression analysis, logistic regression analysis and Cox regression analysis were employed to evaluate the medical utilization and medical outcomes of the two groups of patients and their important related impact factors.

Result
There was no statistically significant difference in the demographic characteristics and clinical characteristics of the patients in the seamless and traditional mode groups. But, this study found that patients in the seamlessly connected group had significantly lower outpatient costs, hospitalization expenses, and total medical expenses within six months than the traditional model group (p<0.05). At the same time, the demographic characteristics and clinical characteristics of the hospitalization preparation service connecting LTC 2.0 were also significantly correlated with medical treatment consumption and medical efficacy (p<0.05).

Conclusion and Implication
Discharge preparation for the connection of LTC 2.0, using the seamless integration model compared with the traditional model, the consumption of medical resources, outpatient expenses, hospitalization costs, emergency and total medical expenses are significant reduced within six months. There was no significant difference in medical outcomes, including unplanned readmissions and mortality. Overall, the seamless integration group can save an economic burden of NT$90 to 10 billion annually. For the implementation of the government's LTC 2.0, it is nothing more than cost savings. The proposal can be extended to the whole country, which not only improves the quality of the LTC 2.0 continuously, but also reduces the government's financial burden.

Keywords: Discharge Preparation service, Long-Term Care 2.0, Medical Resource Utilization, Medical Outcomes

並列關鍵字

Discharge Preparation service ； Long-Term Care 2.0 ； Medical Resource Utilization ； Medical Outcomes

參考文獻

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英文文獻

American Hospital Association. (1983). Introduction to discharge planning for hospitals. American Hospital Publishing.

Anderson, M. A., & Helms, L. B. (1994). Quality improvement in discharge planning: an evaluation of factors in communication between health care providers. J Nurs Care Qual, 8(2), 62-72.