- 期刊
提高某居家護理所居家照護個案醫師訪視完成率
Enhancing Physician Participation in Home Health Care Visits
摘要
居家照護團隊中醫師佔相當重要角色，然本機構醫師訪視無法依護理機構設置標準每2個月診察1次，因而影響居家照護個案之服務品質。統計2005年10月1日至2006年3月31日本機構醫師訪視完成率為23.2%。探討醫師訪視完成率低原因有：一、醫師時間配合困難。二、醫師人力不足：因訓練及支援。三、無醫師獎勵制度。四、居家護理師因其他業務繁忙無法完成訪視。五、居家護理師忘記安排醫師訪視。經原因探討擬定改善方法：一、設立代理人制度：醫師及居家護理師。二、設立電腦管理系統網頁預約排班方式。三、居家護理師彈性上班以配合醫師時間。四、擴大可執行居家照護醫師訪視科別。五、建立居家照護醫師訪視獎勵金制度。六、電腦管理系統增列醫師訪視日提示功能。七、制定醫師訪視審核辦法。經近9個月改善後，居家照護個案醫師訪視完成率由23.2%提高至72.1%，成效良好。經此專案的進行，提升居家照護個案醫師訪視完成率，增進居家照護之服務品質。
並列摘要
Physicians play an important role in home health care teams. Most doctors on our team, however, could not meet the nursing agency standard of making regular home visits every two months, adversely affecting the quality of care the team could provide. From October 1, 2005 to March 31, 2006, doctors' visits were completed according to the standard only 23.2% of the time. Reasons for this poor compliance included a number of factors. 1) Doctors were sometimes unable to coordinate their schedule with the rest of the team, there were too few properly trained doctors, and they had no incentive to perform this service. 2) Home health care nurses also sometimes had scheduling conflicts and occasionally forgot to schedule the time with the doctors.A system was developed to improve the process by 1) establishing a pool of substitute doctors and nurses, 2) doing all scheduling online, 3) making the nurses' schedules more flexible in order to accommodate the doctors' schedules, 4) increasing physician manpower by recruiting qualified doctors from a number of specialties, 5) developing incentives for the doctors, 6) setting up automatic computerized reminders of scheduled visits, and 7) developing a standardized protocol for the doctor's visit. In the 9 months after this system was instituted, the percentage of completed visits by doctors had markedly increased from 23.2% to 72.1%. By thus increasing physician participation, we believe the quality of care provided by our home health care teams will beenhanced.