家庭醫學科主導慢性病房照顧品質醫療費用效益之研究

A Study of the Quality and Medical Resources Effect of the Chronic Ward Cared By Family Physicians

吳中興(wu chung shing)

指導教授 ： 藍守仁

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

研究目的:慢性病房為急性醫療之中置性,延伸照顧,病人病情由急性期轉為慢性期,但仍然需醫療復健照顧,為提高急性病房周轉使用率降低醫療費用則轉至慢性病房,然基於醫療照顧成本及全人照顧品質之維護,若嘗試由全科訓練之家庭醫學科來主導此慢性病房中置性延伸照顧, 其照顧品質之優缺點變化,醫療費用效益分析,組織變革因應機制值得研究以作為後續照顧品質管理之參考及建議,研究方法:以量性分析以某區域醫院家庭醫學科慢性病房入院病人為研究對象,疾病分群來探討(1)入院前及入院中出院後病人之身體心理智能功能變化(2) 慢性病房照顧指標包括:體重變化,褥瘡,感染,再入院,束縛,死亡率(3)醫療費用耗用分析同一病人在入慢性病房前後一週及一月之醫療費用種類及數量之比較 結果: 指標統計顯示慢性病房月住院感染率為5%優於傳統慢性病房(10.8%)慢性病房之醫療成份較少,診察費、病房費、藥費、總費用會較少,慢性病房後一月及二月在彼此身體生活分數,心理社會分數統計上有意義改善.討論及建議:防範院內感染加強感控降低感染率將可有效減少長照病患轉至急性病房之次數，提升醫護人員對身體約束的照護認知及重視，並加強預防褥瘡之發生，進而維護病人安全及提升照護品質實時為慢性病房最需要注意的課題。關鍵字：身體生活分數,心理社會分數, 慢性病房, 中置性延伸照顧 ,慢性病房照顧指標, 醫療費用耗用

關鍵字

醫療費用耗用 ； 慢性病房照顧指標 ； 中置性延伸照顧

並列摘要

Objective: Chronic ward is the intermediate extended care from the acute care. When the patient still need some medical or rehabilitation care . So he is transfer to chronic ward for lower cost and faster bed rotation , family doctor care the acute bed or terminal ward at some medical center or regional hospital now. If the chronic ward could be cared by the family doctor from concerning medical cost and holistic quality. The quality control and medical resources effect, organization modification of the chronic ward cared by family physicians needs our study for further opinion.
Method: From 2007/10/01 to 2008/01/31, part 1: Qualitative method is used to study the process and structure of the chronic ward by depth-talking skill with the ward staff. Part2: Quantitative method is used to study the outcome of the chronic ward by study of the basic and quality index of the chronic ward and the patient. Such as physical and psychological state of the patient and medical resources used before and after the ward. Results: qualitative analysis shows: 1.total care in long term care is the advantage of family practice 2.organization modification is necessary for family practice in chronic ward 3.patient safety medical adverse events show low prevalence and good prevention in chronic ward 4. good cooperation mechanism between physicians and nurse is necessary 5.good satisfaction among patient and medical staff is also needed. From the study , cerebral vascular accident(CVA) and neurological traumas are the main admission reason(73.9%) ,monthly ward infection rate is 5%, it is better than traditional chronic ward(10.8%). Chronic ward has less medical management. So diagnosis fee, ward fee, drug fee,total charge is lower than acute ward. Physical and psychological state after first month and second month in the chronic ward improved significantly.
Discussion: Monthly bed sore rate and constraint rate is noted as 2.5 % and 4.3%. So good infection control prevent more transfer to acute ward, strengthening the recognition of proper constraint and prevention of bed sore make higher quality and lower adverse events.

KEY WORD:physical life score, psychosocial score, chronic ward, intermediate extended care, medical resources effect, quality index of the chronic ward

並列關鍵字

intermediate extended care, ； medical resources effect ； quality index of the chronic ward

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