某醫學中心運用臨床路徑於高齡長者照護之現況探討

The Use of Clinical Pathway on Elders in an Academic Medical Center in Taiwan

人口老化速度，台灣居全球之冠。65歲以上者超過總人數之12%，預估至2018年，高齡人口將佔全國人口達14%。為了提升高齡長者的就醫品質，國民健康署自2011年起鼓勵醫療機構參與「高齡友善健康照護機構認證」，希望透過醫療保健服務介面，增進長者身心健康與復健，給予符合其需求且有尊嚴的健康照護服務。可以預見高齡者被納入臨床路徑照護之比例將愈來愈多，因此本研究目的主要探討運用臨床路徑於長者照護之狀況（佔率、科別、路徑別），與65歲以下之病人做比較。本研究以2015年第一季（1-3月）進入臨床路徑之病人為研究對象，以比例來看，進入臨床路徑之高齡病人比例略低於全院進入臨床路徑病人之比例。此一現象可能與路徑多使用在同質性高、處置流程易標準化之病人，而高齡病人之變異性較高有關。而跳出路徑之長者比例較高，也許與長者之特性相關，如多重病因、隱藏性疾病、合併症較多、療效較差、復原緩慢等。因應高齡社會之來臨，發展針對老年病人設計的臨床路徑，是未來的趨勢。

Taiwan has the highest population aging rate in the world. Elders who are 65 years of age or more account for more than 12% of the population. Estimated to 2018, the elderly population will account for 14% of the population. In order to improve the quality of care for elders, the Health Promotion Administration has been encouraging healthcare organizations to participate in 'ageing-friendly healthcare organizations certified' since 2011. The ratio of the elders who are included in the care of clinical pathways is expected to be higher and higher. The purpose of this study is to explore the use of clinical pathways status in elderly care (accounting rate, divisions, and pathways), and to compare to patients who are younger than 65 years of age. In this study, we select the patients who entered the clinical pathways in the first quarter of 2015 (January-March) as our subjects. The ratio of the proportion of elderly patients who entered the clinical pathways is slightly less than the proportion of all the patients. This phenomenon may be related to clinical pathway that is frequently used in high homogeneity disease or standardized procedures. The higher percentage of variation in elderly patients may be related to the characteristics of the elderly, such as multiple causes, hidden disease, and comorbidity, less effective and slow recovery. In response to the advent of an aging society, the development of clinical pathways designed for elderly patients is the future trend.