醫學中心應用個案管理模式推展出院準備服務之現況

Application of the Case Management Model for Discharge Planning in a Medical Center

為配合行政院衛生署推動病患出院準備服務計畫及因應健保給付制度逐漸轉向「論病例計酬」、「論質計酬」及「總額支付制度」，積極構思醫療服務模式的轉型。某醫學中心於民國九十年三月開辦「第一期個案管理師訓練班」，培訓八十一位個案管理師推展個案管理。緣於個案管理師是個案管理模式推展的靈魂人物，甄選條件中特別考量學、經歷及人格特質等，請各護理單位主管推派合適的護理人員參加；培訓內容包括二十四小時的課室教育訓練及一年的臨床實務訓練。推展上依專科屬性區分為外科照護、呼吸照護、婦幼照護及內科照護四大體系，各自發展不同重點的個案管理，透過跨專業的醫療團隊整合服務，使病患不僅在疾病急性期得到合宜療護，並積極提昇病患自我照顧能力與技巧，協助病患出院安置，確保出院後能獲得持續性照護。

The purpose of case management is to ensure that patients can receive appropriate care under a satisfactory critical path during their hospitalization for acute illness. In addition, patients can learn corresponding knowledge and techniques for self-care. Therefore, patients can be discharged from the hospital for home care or transferred to the long-term care institutions after their serious symptoms are relieved, and the quality of care can be obtained simultaneously. Case managers play an essential role in the implementation of case management in the health care institutions. Eighty-one case managers were strictly selected and well trained in a medical center for the establishment of a case management model in 2001. In total, 2,792 patients were recruited for the case management study by the selected case managers. In process of this study, the length of stay of each patient decreased from 10.38 days to 10.15 days and the turnover rate of each bed increased from 2.47 patients/month to 2.55 patients/month.