談全民健康保險提升急性後期照護品質試辦計畫

The Demonstration on Improving the Quality of Post-acute Care in Taiwan National Health Insurance

10.6540/NTJN.2015.2.001

韓德生(Der-Sheng Han)

急性後期照護 ； 中央健康保險署 ； 腦中風 ； Post-acute care ； National health insurance ； Stroke

新臺北護理期刊

17卷2期（2015 / 09 / 01）

1 - 9

繁體中文

急性後期照護是接續於急性醫療之後，為便利病人順利返回社區所提供之跨專業照護。台灣在急性照護方面有全民健康保險提供高滿意度服務，但在急性後期照護之服務模式之建立則尚不完全。中央健康保險署於2014年開始「全民健康保險提升急性後期照護品質試辦計畫試辦」，預計達成提升腦中風病患復健品質，並減少再住院率的目的。經過一年收案，全國六大健保分局共收錄病患2032位，平均住院日數為34.6日，病人收錄時的失能狀態以修正藍氏量表第四等占76%最多，巴氏量表分數平均為39.1分。與對照組相比，急性後期照護組之功能進展較佳、14日及30日內再住院率較低、死亡率較低。進一步檢討，此計畫有收錄病患數低於預期、評估工具過於繁瑣、以及長期照護轉介制度未建立致出院準備不完整的問題。整體而言，此試辦計畫有效達成降低再住院率與減少失能的目標；三項問題有待未來制度修正，讓此計畫更臻理想。

Post-acute care (PAC) is the multi-discipline care system that aims to increase patient’s functional status to return to community. Taiwan is famous for its National Health Insurance (NHI), which has a high coverage rate, high satisfaction, and low total expense. Nevertheless, the reimbursement for PAC is relatively limited. To provide better quality of PAC care and decrease readmission rate for the stroke patients, NHI started ‘The demonstration on improving the quality of post-acute care’ in 2014. A total of 2032 patients were recruited. The average length of stay was 34.6 days. Seventy six percent of patients was rated as 4 in the Modified Rankin Scale, and the average Barthel Index at admission was 39.1. Compared with the control group, the PAC group had a better functional status and lower readmission in both 14 and 30 days after discharge, and lower mortality. However, the program had issues in low recruitment rate, complicated evaluation instrument, and incomplete discharge planning due to fragmented long term care system. To conclude, the demonstration achieved its goal in reducing readmission and increasing functional status of stroke patients. Yet, the issues demand future modification.

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