運用資訊化系統提升轉診至基層診所案件數

Utilize an Information System to Enhance the Referral of Outpatients to Primary Clinics

嚴玉華(Yu-Hua Yan) ； 蘇雅慧(Ya-Hui Su) ； 董龍生(Lung-Sheng Tung) ； 林聖凱(Sheng-Kai Lin) ； 陳永富(Yung-Fu Chen) ； 陳俐伶(Li-Ling Chen) ； 黃威達(Wei-Ta Huang) ； 牟聯瑞(Lein-Ray Mo) ； 蔡良敏(Liang-Miin Tsai)

《醫療資訊雜誌》 29卷3期 (2020/09) Pp. 13-24

摘要

背景：台灣政府為落實分級醫療與轉診制度，推動區域級（含）以上醫院門診減量措施，以及健保南區業務組健保管理指標執行結果將會影響醫院健保核付點數，醫院管理者需要積極處理相關健保策略以作為因應。目的：為提升轉診至基層診診所案件數，運用資訊化系統改善及行政能量輔助等方法，針對醫師操作轉診資訊平台及轉診至基層診所案件數進行檢討與改善。方法：本專案自2018年10月至2019年10月，透過決策矩陣分析並進行對策措施，包括1、改善電子轉診系統；2、主治醫師會議宣導及3、行政能量輔助。並將每季轉診件數目標值設定2019年上半年為900件，下半年為1,200件。結果：透過各項策略實施後，每季轉診成功件數結果為2019年各季為Q1達成件數1,075件、Q2達成件數1,280件、Q3達成件數1,499件及Q4達成件數1,289件，全年共達成5,143件，達成率為153.16%，進步率為112%。結論：本專案透過資訊的連結，良好的溝通及團隊合作，讓醫師可以更友善操作轉診平台，除達到原先預期目標之外，也彰顯院方積極配合政府政策，善盡公辦民營醫院的角色。醫師也能適時將病人轉回原就醫診所照護，讓病人獲得連續性照護，並持續與基層診所建立信賴合作關係，達到共創多贏之局面。

關鍵字

轉診 ； 電子轉診平台 ； 門診減量 ； 健保管理指標

並列摘要

Background: For substantiating the tiered medical and outpatient referral system the Taiwan government, has promoted ＂outpatient reduction＂ at regional and general hospitals. Also, the implementation of health insurance management indicators regulated by the sales sector of the health insurance southern division will affect hospital health insurance payment; therefore, hospital administrators need to actively conduct relevant health insurance strategies as a response. Aim: We utilize the improvement of the information system and administrative energy to review and improve the referral information platforms operated by physicians and increase the number of outpatients referred to primary clinics. Methods: This project is planned for a period from October 2018 to October 2019 through decision-making matrix and countermeasures, including: 1. improving the electronic referral system; 2. advocating at the attending physician meetings; and 3. utilizing the administrative energy. The referral number per quarter is defaulted at 900 outpatients in the first half of 2019 and 1,200 outpatients in the second half of the year. Results: After the implementation of various strategies, the number of successful referrals per quarter was 1,075 outpatients in Q1, 1,280 outpatients in Q2, 1,499 outpatients in Q3, and 1,289 outpatients in Q4 for a total of 5,143 outpatients in the year, representing an achievement rate of 153% and an improvement rate of 112%. Conclusion: By improving the with information links and good communication and teamwork, this project allows physicians to operate the referral platform in a more friendly manner. In addition to active referrals, physicians can also transfer the referral patients bake to the primary clinics in a friendly manner, to insecure the proper continuously primary medical care, it also highlights the importance of active cooperation of the hospitals with government policies; Thus, a trustful and cooperative relationship can be established with the primary clinics for a win-win situation.

並列關鍵字

outpatient referral ； electronic referral platform ； outpatient reduction ； health insurance management indicators