IDS架構下實地訪查與分級支付對呼吸照護病房照護品質的影響－以某地區醫院為例

Under the structure of IDS, the influence of care quality for RCW by site visiting and classified paymentpString

劉杜鎮(liu tu chên)

指導教授 ： 鄭文輝 ； 施純明

亞洲大學/健康學院/長期照護研究所/碩士(2007年)

摘要

研究背景及目的 呼吸器依賴患者整合性照護系統，是藉由這個管理式的照護計畫，提供呼吸器依賴患者完整的醫療照護，進而提高照護品質及節省醫療成本雙重效應。本研究目的乃想瞭解以實地訪查分級支付為導向的控制下，對長期呼吸器依賴患者的整體照護品質提升是否有明顯之效果。從醫院經營與長期呼吸器依賴患者家屬要求的照護品質角度來求取最佳的平衡點，作為以後長照制度政策擬定的參考。 研究方法 本研究採自然實驗法，以某地區醫院呼吸照護病房(RCW)自91年至95年接受中區健保局實地訪評四年來之相關品質統計資料，以描述性統計分析比較訪查前後對長期呼吸器依賴患者照護品質之差異影響。 研究結果 經過四年來健保局與審查醫師委員不辭辛勞的参與無數次會議，奔波於中彰投四縣市各鄉鎮間，為長期呼吸器依賴患者照護品質把關。但是研究結果顯示得到的效果是正面的，無論在死亡率、加護 2 病房回轉率、呼吸器脫離率、營養狀況以及壓瘡盛行率等重要照護品質指標均有明顯改進。 結論 由本研究結果得知，加入試辦計畫並且以實地訪查分級支付制度導入管理式醫療模式，確能有效改善對長期呼吸器依賴患者的照護品質。目前試辦計劃並未全面強制實施與考核，導致無論是試辦計畫內或計畫外之 RCW審查之過程面，與結果面品質皆不佳，無法於供給端控制，且影響醫療品質。建議應早日全面導入、強制實施，且從供給面著手，降低誘發需求與資訊不透明之問題的產生。希望本研究做為一個開端、指引，未來可擴大研究對象及個案數，作為未來長期照護規劃的參考。

關鍵字

長期呼吸器依賴患者、呼吸器依賴患者整合性照護系統、 呼吸照護病房、照護品質

並列摘要

Background: An Integrated Delivery System (IDS) for ventilator- dependent patients not only provided a complete managed care plan for the long-term ventilator-dependent patients, but also improved the quality of the medical care. Under the structure of IDS, the central branch of Bureau of National health Insurance (NHI) planned to monitor the medical care quality by site visiting and classified payment for the respiratory care ward (RCW). So the purpose of this study wants to compare the difference of care quality after the site visiting and classified payment for 4 years. The outcome will serve as a reference for the longterm care policy.
Methods: In this observational study, we analyzed the effectiveness of care quality before and after the introduction of site visiting & classified payment under the structure of “NHI Managed Care Demonstration Program for Ventilator Dependent Patients” （2002~2006）by central branch of NHI. We used descriptive statistics to measure the difference of care qulity of a local hospital in the central Taiwan from 2002 to 2006, which had joined the “NHI Managed Care Demonstration Program for Ventilator Dependent Patients” system, and received the site visiting for 4 years.
Results: The outcomes of the care quality revealed significant improvement after site visiting and classified payment including the mortality rate、ICU transfer back rate、ventilator weaning rate, nutrition 4
staus, and pressure sore morbidity in this local hospital.
Conclusion: The study demonstrated under the structure of IDS, the site visiting and classified payment is an effective method to monitor and promote the care quality of RCW by the experience of this studied hospital. Based on the successful results, we hope that this study will serve as a starting point to expand to all members of RCW, and serve as a reference of the long term medical care plans in the future.

並列關鍵字

long-term ventilator-dependent patients, integrated delivery system, respiratory care ward, site visiting, classified payment.

參考文獻

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