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精神專科RBRVS之精神衛生護理健保給付-前置研究

A Preliminary Study on the Evaluation of Resource-Based Relative Value Scale in Mental Health Nursing

Abstracts


中華民國健保局參考美國Medicare發展醫療資源相對值表(Resource-Based Relative Value Scale,以下簡稱RBRVS)的方法,來訂定特定診療與技術的支付標準。這樣的支付標準產生對精神衛生護理之未來臨床實務與教育皆有很大之影響,因此本研究主要目的為:(1)探討國內精神專科RBRVS中精神衛生護理人員之診療項目;與(2)精神衛生護理於國內精神專科RBRVS之支付標準。研究方法與結果:(1)專家討論:本計畫邀請了十二位專家在座談中討論護理人員在心理治療、團體治療、生理回饋治療、行為治療和家族治療的角色外,以及設定精神衛生護理的診療項目,並分派專家討論各項精神衛生護理的診療項目之分類與項目之適當性,統整精神衛生護理的各項護理技術企望能分別規列在此三大護理層面中:精神科一般護理指導、精神科特殊護理處置與訓練、精神科深度護理治療;(2)實證座談:舉辦了11場「精神衛生護理的診療項目臨床實務護理師之實證座談」,是藉由臨床實務護理師之實證座談將精神衛生護理的診療項目作觀念溝通;(3)德懷法(Delphi)問卷調查:依據Hsiao等學者之等級估測法並用Delphi方式收集臨床精神衛生護理人員對此三層級中各項技術之時間、精神努力與判斷力、技術程度與體力、心理壓力等構面之投入。第一回共回收184份資料,第二回計有161份資料回收,結果(1)總工作量之平均值分別為「精神科一般護理指導」:120,「精神科特殊護理處置與訓練」:150,「精神科深度護理治療」:180;(2)工作強度(精神努力及判斷力+技術程度及體力+心理壓力)之平均值分別為「精神科一般護理指導」:382,「精神科特殊護理處置及訓練」:448,「精神科深度護理治療」:478。專家之間的一致性評估Equal-length Spearman-Brown為0.94,而Average Measure Intra-class Correlation為0.97。進一步以迴歸分析瞭解到真正影響工作量的主要原因為「精神努力及判斷力」和「技術程度及體力」。

Parallel abstracts


This study was a preliminary exploration on the evaluation of Resource-Based Relative Value Scale (RBRVS) in mental health nursing as a reference for mental health payment. An expert consultation group was organized to select the services/procedures to be investigated by survey in mental health nursing. Eleven communication workshops were further established to improve the consensus in senior mental health nurses. A Delphi method was used to survey the procedure time, psychological efforts and relative value scale of the 21 major mental health nursing services/procedures among senior mental health nurses. The results of the study showed that three levels of mental health nursing services/procedures were categorized: (1) general mental health nursing guidance; (2) specialized mental health nursing intervention and training; and (3) advanced mental health nursing treatment. The range of the workload for the three-level of mental health interventions were 99.0~157.9, 132.3~195.4, and 160.7~164.2, respectively. The consistency among raters was ranged from 0.94-0.97 analyzed by equal-length Spearman-Brown and average measure Intra-class correlation. The result showed that major factors in predicting workload were mental efforts and clinical judgment and technical skill and physical effort.

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