中重度肝硬化個案管理照護模式及成效評估研究

Effectiveness of Case Management Program on Moderate and Severe Liver Cirrhosis

目的：評估個案管理模式式對中重度肝硬化患者的照護成效及門、住院醫療費用之差異。方法：研究對象為中重度肝硬化住院病患，實驗組是實施肝硬化病患個案管理模式之個案，由專業照護團隊共同發展個案管理照護計劃，研擬病患之治療及照護流程。由個案管理師擔任研究者，負責收案，進行個案健康評估，聯繫及協調照護計劃，給予個案相關疾病衛教，並執行有計劃之持續性電話諮詢、追蹤和評值，共計收案45名。對照組為前一年傳統照護模式之相同條件肝硬化病患共計收案46名，其住院費用資料取自健保申報給付資料，對照組則採回溯方式收集。結果：1.個案管理模式有助於節省門診醫療費用，實驗組的年平均門診費用申請金額為6 ,254元，費用低於對照組8,891元。2.個案管理模式有助於節省住院醫療費用，實驗組的年平均住院費用申請金額為47,001元，花費低於對照組60,062元。3.個案管理模式有助於病患回診率之提升。4.個案管理模式所有病患對於疾病認知及飲食配合的答對率皆因衛教介入而提升答對率。結論：醫院若實施中重度肝硬化個案管理之模式，除有助於降低其住院與門診的醫療費用、提高病患出院後之返診率與疾病認知及飲食配合的答對率。

Objectives. This study compared the effective and healthcare costs of a 'case management model' with the 'traditional care model' for moderate to severe liver cirrhosis. Methods. We enrolled 96 patients hospitalized for moderate to severe liver cirrhosis during Jan. 2008-Nov.2009. Forty-five patients received care under case management model supervised by a specialized team of physicians, case managers, dietitians, pharmacists and social workers. Treatment logistics and subsequent care was formulated and implemented by this multi-disciplinary team led by a case manager who served as the hub of communication and coordination and conducted health education programs, follow-up phone calls, data collection and evaluations. The control group consisted of 46 patients of similar disease severities treated under 11traditional care model.' Health care expenditure data were collected from National Health Insurance claims reimbursement. Results. The average annual outpatient clinic expense under case management was NT$6,254, significantly lower than those treated by traditional care (NT$8,891). The average hospitalization expenditure of the case management group was NT$47,001, lower than that of the tradition care group (NT$60,062). The case management model reduced 14-day re-admissions and improved outpatient clinic follow-up compliances. Patients in the case management model demonstrated better disease awareness and diet control proficiency. Conclusions. Implementing case management model for the treatment of patients with moderate to severe liver cirrhosis may reduce hospitalization and outpatient clinic follow-up expenditure, improve compliances, reduce 14-day re-admissions as well as foster disease awareness and diet control. Further studies are needed to further identify total cost issues.