「思覺失調症醫療給付改善方案」成效探討——以台灣北部某精神專科醫院為例

Effects of a pay-for-performance program for schizophrenia at a psychiatric hospital in northern Taiwan

目標：本研究旨在評價「思覺失調症醫療給付改善方案」介入，對有參與該方案的病人在精神科門診、住院、急診醫療利用之影響。方法：研究對象為台灣北部某精神專科醫院於2009-2013年參與「思覺失調症醫療給付改善方案」共2,236人，本研究資料來源為該醫院「醫療資訊系統」及「思覺失調症個案管理系統」等資料庫，以廣義估計方程式（Generalized Estimating Equation, GEE）方法進行成效檢定。結果：研究結果顯示：「思覺失調症醫療給付改善方案」介入顯著減少病人強制住院年發生次數、精神科急性病房年住院天數、精神科急性病房年住院次數、急診年使用次數；參與該方案的病人其門診年就診次數有稍下降然仍維持12次以上；然方案介入對病人六個月內精神科急性病房再住院次數無顯著影響。結論：建議持續推動「思覺失調症醫療給付改善方案」長期追蹤思覺失調症病人的疾病自我管理情形，以更積極提升精神醫療照護服務的品質，並預防病人疾病惡化。

Objectives: This study determined the effects of a “pay-for-performance program for schizophrenia” on patient utilization of the outpatient department, emergency services, and hospitalization. Methods: This study analyzed 2236 patients from a psychiatric hospital in northern Taiwan who joined the “pay-for-performance program for schizophrenia.” Two datasets were analyzed, including the 2009-2013 Hospital Information System and the Schizophrenia Case Management System. The Generalized Estimating Equation (GEE) method was used to determine the effects of the program on patient utilization measures. Results: The “pay-for-performance program for schizophrenia” significantly decreased the yearly incidence of compulsory hospitalization, days of acute psychiatric hospitalization, and annual emergency department visits. In addition, the number of psychiatric outpatient visits decreased significantly, but persisted at > 12 times per year. The number of 6-month readmissions to the acute psychiatric ward did not change significantly after implementing the program. Conclusions: Implementing the “pay-for-performance program for schizophrenia” enhanced self-management of schizophrenic patients, improved medical care outcomes, and prevented worsening of diseases.