複雜醫療照護需求兒童之協調照護

Coordination Care for Children with Medical Complexity

複雜醫療照護需求兒童被定義為，罹患一種或多種慢性疾病、在醫學上被評價為顯著脆弱，增加其對於健康與其他服務的需求，並導致醫療照護支出上升之兒童，其照護需求可歸納為可近性照護、協調性照護及全面性照護，且應著重於緩和慢性疾病之嚴重性、即時反應兒童與家庭需求、使兒童之功能性能力最大化，以避免使用無效或非必需的醫療資源為原則，照顧者之照護需求則出現於情緒調適和溝通，父母之出院準備可經由提供病情相關資訊，應用出院摘要等輔助工具來充實，為了改善父母之照護知能，以及對病童出院後之照護成效，出院規劃可納入「出院前訓練方案」、「護理師家庭訪問」、「安寧療護服務」等介入措施，有賴於政府對進階護理師，從事護理協調工作之支持程度。對此，政府應確保護理協調工作之落實，並將費用支出納入成本結構當中。研究者亦可汲取全面性照護計畫之核心觀念，妥善進行研究設計與結果測量，以實證角度強調護理協調之必要性，作為呼籲政府與各界促進護理協調工作，以滿足病童需求之立論基礎。

Children with medical complexity are defined as children with one or more chronic conditions that are medically evaluated as significant vulnerabilities, which increase their needs for health and other services, and leading to increased health care expenditures. The care needs of them can be categorized as proximate care, coordinated care, and comprehensive care. Children's care needs should be based on the principles of mitigating the severity of chronic illness, responding immediately to the needs of the child and family, maximizing the child's functional capacity, and avoiding ineffective or non-essential use of medical resources. The caregiver's care needs are reflected in emotional adjustment and communication. As for the parents’preparation for discharge, it can be supplemented by providing information about the child's condition and resorting to the discharge summary and other supporting tools. To better equip parents with caregiving knowledge and to improve the effectiveness of post-discharge care, discharge planning should include measures such as“pre-discharge training programs,􀞵“home visits by nurse practitioners,􀞵and“hospice care􀞵interventions. The effectiveness of these interventions depends on the extent to which the government supports advanced practice nurses in care coordination. In this regard, the government should continue to ensure that care coordination is implemented properly by including expenditures in the cost structure. Researchers may draw on the core concepts of comprehensive care programs and conduct appropriate study design and outcome measures to highlight the needs for care coordination from an empirical perspective. This is the basis for the argument calling on the government and the community to promote care coordination to meet the needs of these children.