「以病人為中心的專業照護合作模式」對腰椎椎間盤手術病人照護成效之探討

Measuring the Impact of a Patient且Focused Professional Collaborative Practice Model on HIVD Patient Outcomes

本研究的目的在從某醫學中心所建立「以病人為中心的專業照護合作模式」探討其實施前後的成效，以神經外科四個病房腰椎椎間盤脫出手術病人為研究對象，研究期間自民國89 年8 月l 日至90 年7 月31 日止，比較實施前後病人之住院天數、照護品質及醫療費用之差異。採類實驗研究方法：從實施後接受腰椎手術病人還取30 個個案為實驗組，對照組係依實驗組個案加以配對，配對控制變項色括病患年齡相差在正負5 歲以內、主治的醫師、手術名稱以及是否有過去病史等。以回溯性病歷審查法及從病患醫療費用電腦檔收集資料。研究結果顯示： （一）、腰椎椎間盤脫出手術病人之平均住院天數，由實施前的10.6 天減為實施後的6.6 天，縮短了4 天（P<0.05） ， （二）、醫療總費用平均每位個案由沌，338 元減為67 ， 846 元，減少8 ，492 元（P<0.05） ，其中以病房費、診察費、治療處置費及注射技術費四種有顯著減少（P<0.05） 0 （三）、醫療照護品質評量包括感染率、非計畫性再入院及併發症，兩組無顯著的差異。 研究結果有助於醫療機構採用以病人為中心的專業照護合作模式的參考，以提升病患照護品質及成效。The purpose of this study is to evaluate the effectiveness of care before and after the 'patient-focused professional collaborative practice model' in a medical center was established. The study subjects were L-spine laminectomy patients confined in four neuro-surgical units from August 1, 2000 to July 31 , 2001. The quasi-experimental study was performed to compare patients' length of stay, quality of care and medical charges for L-spine laminectomy patients. Patients were divided into two groups-those who were cared for using the 'patient focused professional collaborative practice model' as an experimental group and those who were not, as a control group. Age ( within 5 years) attending physician , surgical procedure and patient acuity matched the 30 controls. Retrospective chart review and medical charge data were used. The results of this study were (1). average length of stay decreased 4 days from 10.6 days to 6.6 days ( p<0.05 ) after implementing patient-focused professional collaborative practice model; (2). medical charges decreased 8, 492 NT dollars (p<0.05 ) from 76, 338 to 67, 846 NT dollars for each patient. The four charge items (room charge, test and examination, treatment procedure and injection ) were significantly decreased. (3). the quality of care as measured by rate of infection, unplanned readmission and complication was not significantly different between the two groups. Based on these findings, recommendations will be made to enable policymakers and nurse administrators to develop the 'patient-focused professional collaborative practice model' further, to improve the quality and effectiveness of patient care.