醫療主任在美國長期照護機構的功能

The Role of the Medical Director of Long Term Care Facility in USA

陳一仁(I-Jen Chen)

《長期照護雜誌》 14卷1期 (2010/04) Pp. 19-26

https://doi.org/10.6317/LTC.201004_14(1).0003

摘要

美國的醫療體系不斷地在改變，由傳統的制度到管理式照護(managed care)，及最近的包裹式照護(bundling care)。而長期照護院所的功能及責任，也由傳統的慢性病照護轉型到亞急性照護，安寧照護的需求也不斷地增加，未來的趨勢將轉變成以較專科的亞急性照護為導向的照護模式。亞急性照護模式除了醫療診療及護理照護外，非常注重復健的服務，如此方能配合整體規劃，縮短住院日數及減低成本，讓病人早日恢復功能及健康而出院；但是在聯邦法規上，尚未有對長期照護之院所執行亞急性照護有所規範，因此現階段只能在現有法規範圍內，不斷地調整及提昇各部門的照護品質，以綜合性地對每一個病人的病情靈活地相互配合，提供更有效率的服務，期符合社會之所需。醫療主任(medical director)的責任不只是監控醫療診療的品質，同時負有以病人最大利益的照護規劃為宗旨的全盤思考，並配合院長執行符合政府法規的行政措施，協助其他部門的品質管控，也要為員工之安全及保健來共同努力，因此責任相當重大。

關鍵字

醫療主任 ； 亞急性照護 ； 長期照護

並列摘要

Most administrators of LTC facilities in the US are not medical doctors. In order to help the governing team to run a facility smoothly and successfully, the medical director not only needs to maintain and update his/her medical skills and stay up-to-date on local, state, and federal regulations relating to LTC, he/she also needs to help the administrator and other departments and committees to provide medical knowledge and appropriate treatment plans for patients, supervise attending physicians, and help with management of the facility. Over the next 20-30 years, the trend will be for nursing facilities to turn away from LTC and more towards subacute care patients. To meet the demands of the changing patient population, LTC facilities will need better skilled nursing and rehabilitation capabilities. The medical director also needs to be well prepared to work with multidisciplinary and transdisciplinary teams in LTC facilities in order to help the governing team to manage care needs and be cost effective. Good quality and good outcomes allow a facility to gain and sustain good market share in its community. This article is written based on the personal knowledge and experience as a contract medical director of LTC over the past 20 years in the US. It is recommended to visit http://www.AMDA.com and attend AMDA conferences and annual meetings for more information.

並列關鍵字

medical director ； subacute care ； long term care