推動住院整合式照護團隊之初期成效探討 - 以中部某區域醫院為例

The Initial Effects of the Implementation of Integrated Inpatient Care Team - An Analysis of a Regional Hospital

陳孟涵(Meng-Han Chen)

指導教授 ： 謝淑惠

中國醫藥大學/管理學院/醫務管理學系碩士班/碩士(2014年)

摘要

目的：本研究目的為探討有無啟動住院整合式照護模式之病患其3日內再急診、14日內非計劃性再入院、住院天數、加護病房住院天數和住院費用是否有所差異，將病患分為有啟動住院整合式照護組與沒有啟動住院整合式照護組來進行研究。 方法：本研究以個案醫院之次級資料庫進行研究分析，研究對象為2012年4月到2013年3月有啟動與沒有啟動住院整合式照護模式之病患，樣本數為324人，先以描述性統計與常態性檢定做初步分析，再以獨立樣本ｔ檢定與複迴歸分析有無啟動住院整合式照護模式之病患其住院天數、加護病房住院天數和住院費用是否有所差異，以及用卡方檢定與邏輯斯迴歸分析有無啟動住院整合式照護模式之病患其3日內再急診和14日內非計劃性再入院是否有所差異。 結果：內科一般病房中有啟動住院整合式照護之病患其發生14日內非計劃性再入院的勝算比為沒有啟動的0.184倍（95%CI = 0.037-0.919，p<0.05），其住院費用亦有顯著差異（p<0.10），而外科一般病房、內科加護病房與外科加護病房有啟動與沒有啟動住院整合式照護之住院天數（p<0.05；p<0.01；p<0.01）與住院費用（p<0.10；p<0.01；p<0.01）皆有顯著差異。內科一般病房中有啟動與沒有啟動住院整合式照護之病患其發生3日內再急診與住院天數沒有顯著差異，而外科一般病房與加護病房中有啟動住院整合式照護之品質績效皆沒有顯著差異。 結論：本研究有啟動住院整合式照護之病人可降低3日內再急診、14日內非計劃性再入院、住院天數和住院費用，研究結果顯示住院整合式照護能有效控制病患之品質績效與效率績效。

關鍵字

住院整合式照護 ； 3日內再急診 ； 14日內非計劃性再入院 ； 住院天數 ； 加護病房住院天數 ； 住院費用

並列摘要

Objectives: Our study purpose is to compare the difference of emergency revisit within 3 days, unplanned readmission within 14 days, length of stay, length of stay in ICU, and hospital medical expenditure between inpatients who set up hospital integrated care model or not. Methods: Our study utilizes the secondary database from April, 2012 to March, 2013 in case hospital to collect 324 study subjects that set up hospital integrated care model or not. First, we will use descriptive statistics and normality test to have initial analysis, then compare the difference of length of stay, length of stay in ICU, and hospital medical expenditure by using two-sample t test and regression analysis, and analyze the difference of emergency revisit within 3 days and unplanned readmission within 14 days by using chi-square test and logistic regression analysis between inpatients who set up hospital integrated care model or not. Results: The odds ratio of Inpatients who set up hospital integrated care model and have unplanned readmission within 14 days is 0.184 times less than Inpatients who don’t set up hospital integrated care model in general medical ward (95%CI = 0.037-0.919，p<0.05), which is also statistical significant for hospital medical expenditure(p<0.10). There is statistical significant for length of stay (p<0.05；p<0.01；p<0.01) and hospital medical expenditure (p<0.10；p<0.01；p<0.01) of Inpatients who set up hospital integrated care model or not in general surgical ward, ICU medical ward, and ICU surgical ward. For emergency revisit within 3 days and length of stay in general medical ward and quality performance in general surgical ward and ICU ward, there is no significant difference between inpatients who set up hospital integrated care or not. Conclusion: Inpatients who set up hospital integrated care can decrease emergency revisit within 3 days, unplanned readmission within 14 days, length of stay, and hospital medical expenditure in our study. Our result shows the hospital integrated care can effectively control the quality performance and efficiency performance for inpatients.

並列關鍵字

Hospital Integrated Care ； Emergency Revisit within 3 days ； Unplanned Readmission within 14 days ； Length of Stay ； ICU Length of Stay ； Hospital Medical Expenditure

參考文獻

黃素霞、邱淑貞、盧豐華（民100）。跨團隊的品質改善專案－降低非計畫性15天內再住院率。醫療品質雜誌，5（3），p.85-89。

石崇良（民97）。醫療團隊合作與病人安全。澄清醫護管理雜誌，4（1），p.4-9。

馬瑞菊、古雅如（民99）。醫護合作關係與病患照護結果。護理導航，11（1），p.1-8。

吳錦棉（民91）。國內醫療服務缺失及服務補救現況之探討─以桃園縣區域醫院為例（碩士論文）。取自臺灣博碩士論文系統。（系統編號090YZU00457079）

陳秀娥、劉千華、吳旭鎮、吳淑儀（民101）。推動「住院全人整合照護服務」提升醫療照護品質。彰化基督教醫院二林分院。取自http://www.areahp.org.tw/upload/result_issue_paper/101B0141.pdf