醫院整合醫學照護制度之國際經驗與對台灣的啟示

International experience with a hospital medicine care system and lessons for Taiwan

醫院整合醫學（Hospitalmedicine）照護制度是由固定群組的主治醫師，採完整交接班的方式提供住院病人整合醫療照護，並與醫療團隊成員共同照護住院病人，以改善醫院和醫療照護體系執行成效，期藉此能達到促進住院病人安全、提升照護品質和妥善運用醫療資源之目標。美國是最早推行此制度的國家，隨後英國、加拿大、新加坡和日本等國家相繼仿效，並依各國健康照護體系的特色，發展照護模式及規劃專科醫師培育訓練，台灣亦在2015年6月起以試辦計畫方式於部分醫院推行。本文回顧與整理主要國家發展醫院整合醫學照護制度的沿革和實施經驗，期許對台灣發展醫院整合醫學照護制度的啟發。從國際經驗來看，本文建議加強醫院整合醫學科醫師招募、教育訓練和專業發展、提昇醫院高層管理者支持程度，以及提高病人對醫院整合醫學科醫師的認知與態度等因應措施，使台灣能朝發展在地化醫院整合醫學照護制度之目標邁進。

A hospital medicine care system is a type of integrated care for inpatients provided by a fixed group of attending physicians with a complete handover system. They also work with other team members to take care of hospitalized patients in order to improve system performance. The objectives of this system are to promote the safety of inpatients, improve the quality of care, and utilize medical care resources more appropriately. The United States was the first country to implement this system, and was followed by the United Kingdom, Canada, Singapore, and Japan. Each country developed its care system and specialty training programs according to its own conditions. Taiwan also initiated a trial program in some hospitals in June, 2015. This paper reviews the development and practice experience of major countries with hospital medicine care systems, in hope of inspiring the development of hospital medicine in Taiwan. Based on international experience, the authors suggest strengthening the recruitment, training, and career development of hospital medicine specialists, elevating the degree of support from top management, and increasing the recognition by patients that hospital medicine specialists are key factors in helping Taiwan develop its own hospital medicine care system.