運用醫療資訊科技於跨團隊健康醫療照護平台建置──以慢性阻塞性肺疾病照護為例

Using a Medical Information Technology of Interdisciplinary Team for Health Medical Care–A Case on Outpatient Chronic Obstructive Pulmonary Disease Care

WHO2011年報告指出四大非傳染病（癌症、糖尿病、心血管疾病及慢性呼吸道疾病）占全球死亡人數63%。臺灣每年因慢性下呼吸道疾病死亡人數超過5,000人以上，年平均醫療費用約為新台幣9萬1千餘元。美國醫學研究機構（Institute Of Medicine, IOM）在2003年呼籲醫療專業人員教育要建立五項核心能力，跨領域團隊合作照護能力為其中之一；藉由不同領域團隊間的溝通，培養以病人為中心的照顧理念，降低醫療資源的重複與浪費。近年來，健康照護的需求由『治療』轉為『治療與照護並重』甚至有『照護超越治療』的情況，對健康醫療照護品質的期望也大為提升，醫療產業屬於資訊高度密集的產業，運用資訊科技提升工作效率及照護品質始終是各醫療機構積極努力的目標。本研究藉由衛生福利部中央健康保險署【全民健康保險慢性阻塞性肺病醫療給付改善方案】制度之實施，組織各專業醫療職類成員整合成跨領域團隊合作照護模式；包含醫師、醫事檢驗師、呼吸治療師、個案管理師，以病人為中心，設計開發資訊系統透過系統性的篩選規則，發掘出潛在病例加強病人疾病的管理，使病人早期診斷並獲得適當治療，減少急症及併發症的發生。以此模式介入慢性阻塞性肺疾病照護達一年以上之病人為例，對於患者的症狀、生活品質、運動能力、疾病自我認知及自我處置能力都有顯著的改善。 According to the World Health Statistics 2011 released by the World Health Organization, four types of noncommunicable diseases, including cancers, diabetes, cardiovascular diseases, and chronic respiratory diseases, accounted for 63% of all deaths worldwide. In Taiwan, over 5,000 persons die of chronic lower respiratory diseases every year, and the average medical expenses per patient per year reach NT$91,000. In 2003, the Institute of Medicine (IOM) in the U.S. proposed five core competencies needed for healthcare professionals, and working in interdisciplinary teams is one among them. Healthcare professionals are expected to be able to effectively communicate among teams in different fields, develop the concept of patient-centered care, and contribute to less redundancy and waste of medical resources. In recent years, healthcare needs have evolved, from the focus on treatment to an equal emphasis on treatment and care or even a greater emphasis on care, and the public also holds growing expectations for healthcare quality. As medical service is an IT-intensive industry, medical institutions always strive to improve work efficiency and healthcare quality by using information technology. In this study, we, based on the Improvement Program of National Health Insurance Payment for COPD (Chronic Obstructive Pulmonary Disease) Medical Treatment developed by the National Health Insurance Administration, Ministry of Health and Welfare, 1) formed an interdisciplinary integrated healthcare team, including doctors, medical laboratory scientists, respiratory therapists, and case managers and 2) designed a patient-centered information system, in order to systematically identify potential cases to facilitate disease management and give patients an early diagnosis and treatment, with an eye to reducing the risk of acute conditions and complications. We also observed that patients receiving this mode of care and intervention for a period of one year or longer have experienced significant improvement in symptoms, quality of life, motor ability, self-awareness of the disease, and self-management.