整合跨領域醫療資源改善心臟衰竭照護品質

Improving Care Quality Following Heart Failure: A Multidisciplinary Approach

目的：運用品質改善活動來整合跨領域醫療資源以提升心臟衰竭的照護品質。 方法：透過籌組品管圈以課題達成型來整合跨領域醫療資源。主要指標包含心臟衰竭住院天數及三個月再 住院率。次要指標包含營養、復健會診率以及標準藥物開立率。 結果：品質改善前有36人（63.6 ± 14.4歲），改善介入15人 （59.4 ± 14.9歲）。平均住院天數10.6天下 降至 7.2天，三個月再住院率33.3%下降至0% （p<0.05）。營養、復健會診率則由3.9% 與47.2% 提升至 100%。後續一年的持續品質效果維持（共48人）心臟衰竭住院天數維持在6.8天，三個月再住院率則為 8.7%。 結論：跨領域團隊醫療為目前心臟衰竭的黃金治療指引，但整合並不容易。透過品質改善活動也許能提供 團隊一個較容易的方法來整合相關跨領域醫療資源。

 

Objectives: To implement multidisciplinary team care (MTC) and improve care quality for patients with heart failure (HF) through a task-oriented quality control story. Methods: We assembled a quality control circle (QCC) of various medical personnel to improve HF care quality. In-hospital patients with HF and reduced ejection fraction (HFrEF) were recruited for MTC. Quality indicators comprised length of hospitalization (LoH), 3-month rehospitalization rate, rate of consultation with a dietitian, rehabilitation engagement rate, and guideline-directed medication prescription rate. Results: The intervention involved 15 patients with HFrEF (age: 59.4 ± 14.9 years); the control group (before intervention) comprised 36 patients (age: 63.6 ± 14.4 years). After intervention, the LoH decreased from 10.6 to 7.2 days and 3-month rehospitalization rate decreased from 33.3% to 0% (p < 0.05). The rate of consultation with a dietitian increased from 3.9% to 100%, and the rehabilitation engagement rate increased from 47.2% to 100%. In the following year, the LoH and 3-month rehospitalization rate remained at 6.8 days and 8.7%, respectively. Conclusions: MTC is the gold-standard model for HF management, but diversities in specialist opinions may require improved communication. According to our experience, a QCC may provide straightforward integration of multidisciplinary resources, thus improving HF care quality.