長期照顧社區整合服務中心網絡合作共案之研究

Network Collaboration and Co-management in Long-term Care Community-based Integration Services Center

鄭雅菱(Ya-Ling Jheng)；林佳靜(Chia-Ching Lin)

個案管理 ； 網絡合作共案 ； 社區整合照顧服務 ； case management ； network collaboration and co-management models ； community care services system

台灣高齡服務管理學刊

5卷1期（2024 / 09 / 01）

41 - 70

繁體中文;英文

隨著臺灣人口結構改變，長期照顧服務需求增加，因而建構社區整合照顧服務體系，多元長期照顧服務之下突顯出體系中專業人員間網絡建置之重要性，然為求服務品質提升，社區整合照顧服務體系中個案管理普遍需與其他跨領域專業進行合作共案，本研究目的為：（1）分析社區整合型服務中心個案管理員工作內容；（2）探索社區整合照顧服務體系個案管理員的網絡單位和合作單位。（3）探討社區整合照顧服務體系個案管理的網絡合作與共案方式。研究方法為修正式德爾菲法，本研究邀請社區整合照顧服務體系中10名專業人員為研究對象，並運用研究者自行設計問卷進行調查，以了解社區整合照顧服務體系網絡合作與共案情形；結論包括：（1）個案管理員工作內容從建立信任關係至整合服務資源；（2）社區整合照顧服務體系個案管理員網絡單位有衛政、社政及民政等領域；其中，以長期照顧管理中心及社區單位為主；（3）網絡合作與共案方式則包含機制與影響因素，其中建立多元合作機制，如制訂標準作業程序、辦理訓練及建立跨專業合作資訊平台；影響因素以有建立團隊共識、溝通協調及制度規範為主。

The demand for long-term care services has increased, so the construction of a community overall care service system highlights the importance of network construction among professionals in the system. It is observed that case management in the community overall care service system generally needs to be co-documented with other majors, and the research objectives are: (1) to analyze the work content of case managers in community integrated service centers. (2) to explore the cooperative ranking of community overall care service system case management network units. (3) to explore the network collaboration and co-management models of case management of the community overall care service system. The research method is the modified Delphi method, and this study takes 10 professionals in the community holistic care service system as the research object, and uses the researchers to design their own questionnaires to investigate the network cooperation and co-case mode of the community holistic care service system. We found that: (1) the work content of case managers ranges from establishing trust relationship to integrating service resources. (2) the case manager network units include health administration, social administration and civil affairs, etc., (3) the mechanisms and influencing factors included the establishment of multiple cooperation mechanisms, the main influencing factors are team consensus, communication and coordination, and institutional norms.