應用決策支援系統建構出院準備服務篩選流程之初探

Using a Clinical Decision Support System to Establish a Discharge Planning Service Flow: A Pilot Test

10.6142/VGHN.202006_37(2).0006

吳秀玲(Hsiu-Ling Wu)；黃郁珊(Yu-Shan Huang)；莊秋萍(Chiu-Ping Chuang)；周幸生(Shin-Shang Chou)

出院準備服務 ； 長期照護服務 ； 篩選工具 ； 臨床決策支援系統 ； discharge planning services ； long-term care services ； assessment tool ； clinical decision support system

榮總護理

37卷2期（2020 / 06 / 01）

156 - 166

繁體中文

因應高齡化社會失能人口快速成長，政府新增出院準備服務給付做為銜接長期照顧服務的基礎，同時擴大長期照顧體系服務範圍，而精準「需求評估」是出院準備服務連結長期照護資源成功之重要關鍵。本研究目的是開發出院準備服務資訊系統，建置出院準備服務需求評估篩選表，導入決策支援系統連結長期照顧服務資源，測試系統之可行性及資料一致性。研究分兩階段進行，第一階段由研究團隊整合專家臨床經驗、文獻查證及國家政策，撰寫「出院準備服務篩選評估表」及「出院準備服務及長期照護需求連結規則」初稿，由18位個管專家提出26項建議修改完成內容效度之建立，資訊室據此建置包括病人基本資料、評估項目及服務項目建議之三項功能資訊系統；第二階段利用2次專家焦點團體會議，對於系統功能進行1項修正，由院內系統資料庫中抽取線上30位個案，由3位專責個管師進行施測者間一致性信度檢測，整體Fleiss' kappa值為0.985，顯示有良好之信度。系統建議項目與個案實際出院去向相符者共28位，顯示一致性達93.3%。此出院準備服務評估篩選表適用大多數個案，但亦可維護病人個別性之功能，臨床護理師透過資訊系統決策支援輔助，能更正確及有效率的執行出院準備服務，是此研究的最大亮點。

The number of people with disabilities has increased rapidly with Taiwan's aging society. In response, the government has increased the provision of discharge planning services as the basis for connecting to long-term care services and expanded the scope of the long-term care system. Accurate needs assessment is critical for the successful linking of these two services. The purposes of this study were to develop a discharge planning information system with a discharge planning assessment tool, adopt a clinical decision support system for linking with long-term care service resources, and test the feasibility and data consistency of the system. The study was conducted in two phases. In the first phase, the clinical experience of experts, literature reviews, and government policies were integrated to draft the discharge planning assessment tool and the rules of connecting discharge planning and long-term care service resources. The 18 clinical experts provided 26 suggestions for modification, and an information system was established based on their suggestions. This system included three major functions, namely basic patient information, assessment items, and service resource suggestions. In the second phase, content validity was enhanced through two expert focus group meetings, during which amendments were proposed to modify the system function. A total of 30 cases were selected from the system, and three long-term care case managers assessed the cases to test the interrater reliability of the items within the system. The overall Fleiss' kappa value was 0.985, which indicated that the discharge planning assessment tool featured favorable interrater reliability. The system suggested that 28 cases matched their actual discharge destinations with a consistency of 93.3%. This discharge planning assessment tool is suitable for most cases, and it is able to maintain patient individuality. The clinical nurses were assisted by the decision support of the information system, and they could perform discharge planning assessment more accurately and efficiently, which is the biggest highlight of this study.

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