由個案管理到疾病管理到健康管理：社區護理如何因應？

From Case Management to Disease Management to Health Management: How Should Community Nurses Response to This Trend?

管理式醫療照護是近十多年來健康照護服務的的重要觀念與做法，文獻上也經常出現個案管理、疾病管理與健康管理的字眼。本文以管理學與醫療保健照護體系規劃的角度，嘗試分析上述三種管理之異同。簡言之，個案管理主要標的群體是少數醫療資源使用偏高的患者，所以屬於偏離管理。疾病管理主要針對一群罹患相同疾病的患者，比較屬於標準管理。健康管理則針對一群尚未罹患疾病但有高風險者，所以屬於外環境管理或權變管理。社區護理專業包括衛生局所的公衛護士、校護、廠護、居家護理及近幾年逐漸增加的醫院社區健康部護理人員與疾病衛教師，不同單位所從事的工作有相當多的重疊。為了避免醫療照護遞送的無效率，有必要釐清公部門與私部門對健康管理與疾病管理的角色與權責劃分。在基層公衛護理人力無法增加，而健康管理與疾病管理工作有增無減的情況下，善用健康資訊系統是重要關鍵。

Managed care is a newly emerging concept and innovation in the health care service field during the past decade. Terms like case management, disease management, and health management have been used frequently in recent published literature. This study aimed to use the framework of management and the healthcare delivery system to delineate the differences among these three terms. In summery, case management focus on those who use extremely high healthcare resources. It 's a kind of deviant management. Disease management focuses on a group of patients with the same disease, and it's a kind of standardized management. Health management, on the other hand, focuses on those who did have a disease. It's a kind of external environment or contingency management. There are many overlaps among community nurses, which include public health nurses in health stations and in the health bureau, nurses in schools or factories , homecare nurses, nurses in community health sections, and health educators in the hospital. 1t is needed to delineate the role and responsibility of each kind of community nurse to avoid the inefficiency in healthcare services delivery. If it is impossible to increase the staff in primary community nurses in the face of the increasing load of disease and health management, it is of paramount importance to make full use of the health information system.