南台灣某醫學中心推動住院整合照護模式之成效分析

Analysis of the Effectiveness of Promoting an Inpatient Integrated Care Services in a Medical Center in Southern Taiwan

目的：探討本院推動運用技術混合照護模式（Skill-Mixed）分級分工照護的住院整合照護服務之成效。
方法：本研究為回溯性研究，藉由健保申報資料及本院調查統計結果，利用描述性統計、獨立樣本t檢定及複迴歸分析統計分析探討本院推動住院整合照護服務之成效。
結果：自2023年9月至2024年4月執行住院整合照護服務計畫期間，共有135位病人參與計畫，以男性（85位，62.96%）居多，年齡以70-79歲病人（38位，28.15%）居多，其次則是60-69歲（31位，22.96%），總共服務2,038人次。在品質結構指標顯示全院推動住院整合照護涵蓋率21.80%。品質過程指標顯示住院整合照護病床平均使用率13.20%，從剛開始實施時的1.06%增至22.90%。品質結果指標顯示平均住院天數13.20天，病人住院人日數從16增至344；比較2024年第一季與2023年第四季的滿意度調查結果（5分法）顯示：病人/家屬對於推動住院整合照護服務計畫滿意度（分別為4.41分及4.42分，p = .9706）及護理人員滿意度（分別為4.03分及3.98分，p =.7443）無顯著差異，而在護理工作的感受中「有較多時間能為病人規劃照護計畫」則有統計上顯著提升（分別為3.96分及3.51分，p =.0437），但仍偏低。採用複迴歸分析結果顯示月收入所得3萬以下是影響病人/家屬對於推動住院整合照護服務計畫滿意度的重要因素；年齡是影響護理師滿意度的重要因素。在不增加護理師其他報表的情況下，照護輔佐人員平均記錄完整率可達到99.3%。
結論：台灣在因應高齡化、少子化、老老照顧、雙薪家庭請假陪病困難等因素衍生出許多照顧問題。本文分享我們運用住院整合照護模式之分級分工照護來加強病人照護之經驗，由病人/家屬滿意度高及住院整合照護使用率逐漸提高，可證實推廣此計畫之必要性，但因照護輔佐人力不穩定可能會影響護理人員滿意度的問題值得重視。期望能提供各醫療機構於醫療品質管理與不同照護模式運用之參考。

Purpose: To investigate the effectiveness of promoting the Inpatient Integrated Care (IIC) using the Skill-Mixed hierarchical division of labor care method in our hospital.
Materials and Methods：In this retrospective study, the data of National Health Insurance claims and the survey results in our hospital were analyzed using descriptive statistics, independent sample t -test and Multiple regression to explore the effectiveness of our hospital's promotion of the IIC.
Results：From September 2023 to April 2024, 135 patients participated in the program, and 2,038 patient-days of service provided. Most of the patients were male (n =85, 62.96%) and the majority of the patients aged 70-79 (n =38, 28.15%) and aged 60-69 (n =31, 22.96%). The quality structure indexes showed that the coverage rate of integrated inpatient care was 21.80%. The quality process indicators showed that the average utilization rate of inpatient integrated care beds was 13.20%, which increased from 1.06% at the beginning of implementation to 22.90%. The results of quality outcome indicators showed that the average hospital length of stay was 13.2 days, and the number of hospital patient-days increased from 239 to 380. Comparing the satisfaction survey results (5-Point Scale) between the first quarter of 2024 and the fourth quarter of 2023, the patients'/families' satisfaction to the IIC (4.41 vs.4.42, p =.9706) and the nursing staffs' satisfaction to the IIC (4.03 vs. 3.98, p =.7443) were similar; ''more time to plan care plans for patients'' in the nursing work experience reached a statistically significant improvement (3.96 vs. 3.51, p =.0437), but was still not satisfying. The results of the multiple regression analysis indicate that a monthly income of less than 30,000 NTD is an important factor influencing patient/family satisfaction with the implementation of the IIC, while age is an important factor affecting nurse satisfaction. Without adding extra reports from nurses, the average record completeness rate of nursing assistants reached 99.3%.
Conclusion：Taiwan has derived many care problems in response to factors such as an aging population, a declining birthrate, elderly care, and difficulties for dual-income families to take leave to accompany patients. The article shares our experience of using IIC with the skill-mixed hierarchical division of labor care method to facilitate patient care. The high patients'/families’satisfaction and the gradual increase in the utilization rate of IIC confirmed the necessity of promoting this program. However, the instability of auxiliary manpower might affect nursing staffs' satisfaction. We hope that our report could provide reference for other healthcare facilities in medical quality management and application of different care models.