住院精神分裂症臨床路徑之發展

Development of Clinical Pathways for Hospitalized Patients with Schizophrenia

臨床路徑實施可提昇醫療品質及減低成本，已廣泛應用於醫療。本研究目的在探討精神分裂症住院過程中成果目標及臨床措施，並發展臨床路徑。研究方法為調查研究，先擬定臨床路徑，再根據其內容制定結構式問卷，問卷經信效度測試後進行問卷調查。收集資料採立意取樣，以榮民醫療體系三家甲級教學醫學中心，急性精神科病房所有醫療人員為對象，發出164份問卷，回收有效問卷130份，資料統計分析以Boxplot75﹪相對應值、Kruskal Wallis Test、Bonferroni Test進行分析，初步結果再經由10位精神醫療專家鑑定。研究結果：（1）精神分裂症臨床路徑醫療措施原100項簡化為65項因素。（2）成果目標原53項精簡為37項因素。（3）職責方面：護理師與醫師的職責最多。（4）本研究發展之臨床路徑，依據中央健保局醫療所應支付基本點數為49705點（元），醫院經營者要達收支平衡非常困難。本研究所發展之臨床路徑，可做為同等級精神醫療機構實施臨床路徑之參考，醫療保險相關機構，亦可參考本路徑，建立健保給付指標。建議將來可進一步將此路徑應用於臨床實務，並加以確認干擾因素，來印證或修正該路徑及分類標準。

Clinical pathway has been shown that this approach in patient care improves quality of care and reduces costs. The goals of this study were to evaluate our psychiatric clinical interventions, excepted patient outcomes, and to develop a clinical pathway for schizophrenic inpatients in our culture. Methods: A structural questionnaire was then formulated to ensure the clinical validity of the pathway. Multidisciplinary provider team members in three veteran general hospitals psychiatric inpatient units were given the questionnaire and rated the pathway on a five point scale. Of all the questionnaires that were returned, one hundred and thirty were included in the study. Data was screened and analyzed by ?boxplot 75% of the measures? Kruskal Wallis Test, and Bonferroni Test. The final product was reviewed and determined valid by 10 psychiatric experts. Results: Of 100 interventions of the clinical pathway 65 were validated. The 53 patient outcomes were modified to have 37 items.The data showed psychiatrists and nurses played most important roles in the treatment team.The study suggested the medical basic cost was 49705 points. That is very difficult to be revenue and expenditure balance for haspital menagement. This study could be a reference for psychiatric facilities as they plan to develop their clinical pathways provided important data for Health insurance companies to establish their diagnosis related group payment standard. Future studies are needed to apply the pathway to patient care and make modifications as necessary; and to identify variance that might interfere with the study results.