以全人觀點設計一個機構式老人照護資訊管理系統

The Development of a Holistic-Based Nursing Home Information System

醫療科技進步及衛生水準之提升，使得人口平均餘命延長，高齡人口數量急遽攀升。台灣於1993年進入「高齡化社會」，預估在2050年老年人口比例將高達35.5％。加上工業化及都市化讓大家庭轉為小家庭，生育率也隨之下降，家人提供老人照護之意願逐年降低。有鑑於此，本研究以北部一大型安養機構為例，以全人的照護理念來規劃一個老人照護資訊系統，進而協助解決老人健康照護之問題。本研究以符合生心靈全面健康之長期照護思維，分析安養機構之長者要達到健康，即要達到包含生理、心理、飲食、居家環境健康四項需求，並藉此規劃了九個符合健康照護目標的子系統，包含生理資料收集系統、健康量表評估輸入系統、生活提醒與健康資料查詢系統、飲食建議提醒系統、個人多媒體中心、數位教育學習系統、健康狀況分析系統、異常狀況通報及追蹤系統等子系統。透過這些功能將整合機構的照護資訊，以改善過去不佳的作業效率。同時，我們也改變了過去評估資訊系統成功與否的方式，分別以使用者滿意度、改善照護成果、降低機構成本3個不同的面向來評估本系統的導入成效。實際導入本系統後，使用者對透過資訊科技來找出潛藏在長者背後的健康問題，系統提供具廣度及深度的報表及分析工具及立即反應住民的異常狀況，及時發生異常及時介入管控的特點很滿意。同時，系統讓平均作業流程時間減少15.79％至99.32％不等，可看出系統可減少手工照護作業的時間，讓照護者更有效率的提供照護服務並提升照護的品質；在改善照護成果方面，系統導入後，住民之血壓自主檢測達成率提升3％、血糖自主檢測達成率提升5.3％、非計畫性轉診住院率降低0.022％，因此，藉此系統我們也可以改善了自我照護的成果。本研究主要的貢獻性除了改變急性醫療機構資訊系統的功能開發思維，開發了許多適合長期照護之創新思考功能外，也改變過去系統導入成功與否之評估方式只單就系統操作者的滿意程度考量所造成的 偏頗，改採以全面性考量之評估方式，希望這樣的評估方式可以做為未來評估長照資訊系統時之參考。

Medical, scientific, and technological progress, as well as improved hygiene levels, has increased life expectancy in Taiwan. Consequently, the population is growing older. Taiwan became an advanced-age society in 1993, and the proportion of elderly people in the population is expected to reach 35.5% in 2050. We adopted the largest elderly-care facility in Taiwan as a case study, and implemented an information system for the care of elderly people, incorporating holistic concepts, to help solve the practical problems of the institute. In this paper we used a fishbone diagram to present an analysis of how to maintain good health in an elderly nursing institution. The analysis must meet the satisfaction requirements of physiology, psychology, diet, and housing environment. We designed a system in accordance with this analysis. Nine subsystems were designed to fit these requirements and improve on the poor performance of the manual, paperwork-heavy care model, before implementation of the system. The nine subsystems included: a physiological data collection subsystem; a health assessment entry subsystem; a diet recommendation subsystem; a recording subsystem of indoor activities; a health education subsystem; an activity arrangement subsystem; an information notice subsystem; a multimedia ccnter subsystem; a health status analysis subsystem; a notice subsystem; and an abnormal situation tracking subsystem. In this study, the measuring method of information systems successfully implemented in the past was changed. The effectiveness of the proposed system was assessed in terms of user satisfaction, improved health outcome, and reduced cost to the institute. After implementation of the system, users felt satisfied with functions as diverse as the reporting system, abnormal situation tracking, and the design of the immediate response plan. In addition, the system reduced operating procedure time by up to 15.79%. The blood-pressure self-detection rate for residents rose to 3%, the blood glucose self-detection rate reached 5.3%, and unplanned hospitalization rates decreased to 0.022%. This study provides a new approach to functional development of information systems in medical institutions, and develops numerous functions for long-term care institutes through innovative thinking. The study also improves on the biased method of assessment of the success of system implementation, which is based only on user satisfaction, by adopting a comprehensive assessment method. This method could be used as a reference for future long-term care information systems.