個案管理模式在婦癌病患照護之實施概況

The Application of Case Management Model to Women with Gynecologic Cancer

本專案報告之目的是分析婦癌病患之個案管理模式的推動過程與實施概況。自90年3月開始，某醫學中心婦科單位為推動整合性醫療服務理念(Integrated Delivery System:IDS)，而於急性醫療結構中引入個案管理模式，推動過程包括成立個案管理推動小組、個案管理師課程訓練、建構規劃及應用婦癌病患的個案管理模式，如制訂照護藍圖(即臨床路徑)、照護指南、出院計畫規劃及出院定期追蹤之作業流程。90年10月開始進入臨床實務操作階段，以初次診斷為子宮頸癌、卵巢癌、子宮內膜癌等三大婦癌為個案管理實施對象。經由兩個月實施之後，其結果為(1)共有47位婦癌病患接受個案管理照護模式；('2)平均住院天數以卵巢癌平均住院天數最長(Mean=15.4)；(3)平均住院醫療費用以卵巢癌的花費最高(Mean=150641)；(4)在出院追蹤六次電話追蹤中，隨者電話訪談次數而病患的問題逐漸減少，身體恢復越好，尤其以病患排泄功能恢復狀況，成效最為顯著；(5)病患對個案管理模式實施滿意度極高(Mean=202)，尤其以護理技能方面之滿意度最高。本專案以期藉由個案管理模式之推行，而落實整合型醫療服務理念，且提升病患生活品質與滿意度。

Aim: The aim of this project is to analyze the preparation and administration of the case management model for gynecologic cancer patients. Due to the promotion of integrated delivery system (IDS), the case management model has been accepted and used in the medical care structure for acute patients since March, 2001. The preparation includes the establishment of prompting animateur team, the training of case management coordinators, and profiles' construction with correlated utilities of case management model in gynecologic oncology patients. Parametrically, the case management, for example, is composed of the constitution of care map (i.e., clinical pathway), care guides, layout of discharge planning, and flowchart of regular follow-up after discharge. Materials & Results: It has, focus on the clinically practical operation, specificall, on three major gynecologic malignancies, which were initially diagnosed as primary cervical cancer, ovarian cancer, and endometrial cancer since October, 2001. After a two-month assessment, their results show that: (1)A total of 47 cases of gynecologic cancer underwent case management; (2)The average admission periods (mean = 15.4 days) for ovarian cancer is the longest one; (3)The average cost expense of admission (mean = NT$ 150,641) for ovarian cancer is the highest one; (4). As to follow-up after discharge, the recovering of urinary function reqres closer follow- up and more frequent counseling; (5)The satisfaction of case management for delivered patients scores the highest in the aspect of nursing skills. Conclusions: By means of case management promotion, the life quality and satisfaction scale of patients could be enhanced and elevated.