長期依賴呼吸器照護患者登錄系統成效評估－－以健保某區為例

Evaluation of the Registry System of Long-Term Ventilator-Dependent Patients – A Case Study of a Distric in Taiwan

為瞭解長期依賴呼吸器照護患者流向，有效管控醫院收治呼吸器照護患者，減少呼吸器不當利用，達到醫療費用合理成長，健保局陸續建置長期依賴呼吸器照護登錄系統。本研究以健保某區為例，為了瞭解醫院使用此系統之情形，並評估其成效，進行滿意度問卷調查。研究結果顯示系統建置後，確實能即時掌握呼吸器照護患者流向，提供實地訪評時之參考。調查結果發現，全部的使用者對系統提供之功能最為滿意，其次是畫面操作方便性；醫學中心對系統即時回應性及系統異常處理最為滿意，區域醫院及地區醫院均對系統提供之功能最為滿意；參加IDS試辦計畫之醫院則對指標資訊回饋性最為滿意，非參加IDS試辦計畫之醫院則對系統自動性最為滿意。系統建置前後呼吸器利用之影響成效上，系統建置後醫院呼吸器照護患者脫離率明顯提高，其中以醫學中心及無論是否參加IDS試辦計畫的醫院提高率均達統計上顯著差異；在醫院間互轉率上，亦有所降低，亦達統計上顯著差異。

To understand the flow of patients requiring prolonged mechanical ventilation, to efficiently control their admission so as to decrease unsuitable utilization of mechanical ventilation, and to achieve the rational growth of medical expenditure, the Bureau of National Healthcare Insurance has developed a registry system to assist hospitals to manage the long-term ventilator-dependent patients efficiently. With a case study of one district of National Health Insurance in Taiwan, the paper focuses on the usage and the effectiveness of the system through the questionnaires. The results show that the flow of the ventilator-dependent patients can be precisely traced, which can provide a reference for on-site queries. In addition, the result also shows the most satisfied part of the system is the function; next is the convenience to operate. In terms of different hospital levels, the real-time response and the exception handling are the top satisfied parts of the system for medical centers; the function provided by the system is the most satisfied part for regional and district hospitals; the feedback of indicators is the most satisfied part for the hospitals that join the IDS program; the automation of the system is the most satisfied part for the hospitals that do not join the IDS program. In addition, we study the effectiveness of the utilization of the mechanical ventilation before and after the usage of the system. The research shows that: (1) the ventilator-weaning rate after the implementation of the system is obviously higher than that before the implementation, which showed statistically significant difference in the medical centers and in hospitals with and without joining the IDS program; (2) the transfer rate between hospitals is obviously reducing, which also showed statistically significant difference.