台灣地區呼吸器依賴患者醫療體系及病患照護之回顧

The Current Status of Health Delivery System and Quality of Care for Patients with Long-Term Mechanical Ventilation in Taiwan

10.30035/TCCM.201003.0004

古世基(Shih-Chi Ku)；余忠仁(Chong-Jen Yu)

呼吸器依賴 ； 醫療體系 ； 照護品質 ； 整合性照護系統 ； Long-term mechanical ventilation ； Health delivery system ； Quality of care ； Integrated delivery system

重症醫學雜誌

11卷1期（2010 / 03 / 01）

25 - 31

繁體中文

加護病房重症病患人數年年增加，病情複雜情況與日俱增，也造成了呼吸器依賴患者佔用重症病床，每年相關疾病人數約在3萬多人，這群病人的確耗費了大量的醫療資源，中央健保局爲了改善此情形，整合呼吸器依賴患者之照護模式，於2000年設立了整合性照護系統(IDS, Integrated Delivery System)，導入管理式照護模式，來改善相關病患所衍生的醫療問題，以病患品質監控指標來看加護病房平均住院日數有下降，由33.3天下降至30.5天。本文就健保所設計的制度著手，進而探討呼吸器依賴患者於此照護體系下之相關預後，最後提出一些建言及待釐清的課題。

With the advancement of medical care, the trends in the increasing number of patients requiring long-term mechanical ventilation are universal, associated with complicated underlying diseases. The health expenditure and number of these patients had tripled or even more in recent decades. The Bureau of National Health Insurance deployed an organized health delivery system, IDS; Integrated Delivery System, to solve the problem. We have seen the improvement under the operation of this system with cost containment and more fluency in patient flow in the intensive care units. However, we should reconcile between the resource allocation and the quality of care in these patients. In the paper, we describe the current status of IDS and highlight some issues beyond the economic evaluations; furthermore, look into the patient care under the viewpoint of humane value.

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