運用臨床路徑提昇剖腹產照護品質

PROMOTING QUALITY OF CARE FOR PATIENTS WITH CESAREAN SECTION BY IMPLEMENTING CLINICAL PATHWAYS

在健保支付制度的改革之下，健保局自85年10月開始，對剖腹生產實施「論例計酬」，因此如何在確保醫療品質的同時，又能降低醫療成本，成為經營者所關切的課題。本專案之目的即在於評估剖腹生產臨床路徑之效益，以便瞭解臨床路徑對於品質管理及成本控制之影響。本專案設計採回溯性資料收集法，查閱實施臨床路徑前後之剖腹生產病歷，且各收集連續性38例之相關資料，加以分析。其結果如下：（一）護理品質方面：1.護理活動及護理指導之完整性增加，遺漏項目自11項降至8項，且遺漏率大為下降（P<0.05）；2.病患對護理活動及護理指導內容之滿意度增加，平均得分自3.17分增加至4.24分（滿分為5分）；3.護理指導評值表回收率自52.6%增加至94.7%，比較能評估指導成效；4.病歷內護理計劃書寫完整性增加，平均書寫項目自1項/人增加至6項/人，（二）平均住院天數自6.6天/人降至5.26天/人；超出6天之比例自55.3 %降至7.9 % 。（三）平均住院費用自31,410元/人降至29,383元/人；超過30,000元之比例自76.3 至36.9 % 。上述結果以X2-test或Student t-test檢定，均有顯著差異（P<0.05）。由此可見，臨床路徑確實能提昇照護品質及降低成本，值得繼續推廣。

This retrospective study was conducted to evaluate the efficacy of the ”Clinical Pathway” designed by ourselves, for managing patients underwent cesarean section in our OBS ward. Patients population were divided into two groups: GroupⅠ(n=38) without the application of clinical pathway, and Group Ⅱ (n=38) with application of clinical pathway.We compared the outcome of the two groups using c2-test and Student t-test (P<0.05 as statistical significant).Our results demonstrated that with the application of Clinical Pathway, there were better integration of nursing care and instruction. It was also cost-effective with both hospital stay and total cost, from an average of 6.6 days to 5.2 days (P<0.05), and from an average of NT$31,410/patient to NT$29,383/patient (P<0.05), respectively. Furthermore, there was better patients satisfaction for quality care. Our preliminary result in small number of patients showed that a successful clinical pathway had diverse advantages in medical care system.