E管系統提升B、C肝病人追蹤照護品質

Enhancing the Quality of Follow-Up Care for Patients With Hepatitis B and C Using an Electronic Reminder System: A 2016-2019 Hospital-Based Study

B、C型肝炎病人需要定期追蹤及檢驗疾病發展狀況，以及早發現肝癌。彰化基督教醫院胃腸肝膽科於2010年開始實行衛生福利部中央健康保險署（下稱健保署）追蹤照護計畫，過程中因病人病識感低，以及門診收案及追蹤流程複雜，截至2016年收案率14.6%、年度完整追蹤率28.8%，皆未達健保署設定的3項品質獎勵監測指標。透過E化之B、C肝照護管理系統，改善並簡化門診收案流程，提升個案管理師收案追蹤效率及提高病人遵從醫囑率，大幅提升了B、C肝病人照護品質。於2017年開始執行E化追蹤管理，2019年收案率提升至58.91%(4542/7710)，年度完整追蹤率達74.45%(3107/4173)。健保署評比2018年度品質獎勵榮獲中區第一名，本院是中區唯一獲得品質獎勵之醫學中心。

 

Patients with hepatitis B and C require regular follow-up to monitor disease activity and screen for the presence of hepatocellular carcinoma. Since 2010, Changhua Christian Hospital has implemented a hepatitis B and C care plan guided by the National Health Insurance Administration (NHIA), Ministry of Health and Welfare (MOHW). The rates of patient enrollment and follow-up between 2010 and 2016 were unsatisfactory. The annual enrollment and follow-up rates were only 14.6% and 28.8%, respectively, in 2016, falling below the three quality indicator standards established by the NHIA. The absence of insight into patient disease and the complexity of patient enrollment and follow-up procedures were identified as the main problems. Therefore, in 2017, we developed a strategy for improving and simplifying the patient enrollment process, enhancing the efficiency of the case managers involved in patient enrollment and follow-up, and increasing the rate of medical compliance. An electronic follow-up reminder system was implemented to enhance our quality of care among patients with hepatitis B and C. Thus, in 2019, the annual enrollment and follow-up rates had dramatically increased to 58.91% (4542/7710) and 74.45% (3107/4173), respectively. Because of the improved care management system, our hospital was the only medical center in central Taiwan that won an NHI Quality Award in 2018.