建立以人為本的居家醫療服務

Establish a Person-Centered Medical Home Model of Care

以器官疾病為導向的片斷式醫療服務模式正面臨各種挑戰，包括醫療費用高漲、醫療可近性不佳及照護品質欠佳。美國發展出一個創新的醫療照護模式：「以人為本的居家醫療服務」(Person Centered Medical Home, PCMH)，在PCMH的原則之下，美國退伍軍人健康管理局提供「與病人結盟的照護團隊」(Patient Aligned Care Teams, PACT)，透過個人化的評估了解病人的需求，以團隊的治療方式、積極的溝通及合作方式提供一個有效率、全面性、具可近性及連續性的社區照護模式，進而 提升醫療品質、減少醫療費用、改善病人、家屬及醫療團隊對於醫療服務的整體感受。對於有多重性慢性病及失能的患者，「維持病人獨立生活的居家服務」(Independence at Home, IAH)及「與老年患者結盟的照護 團隊」(Geriatric Patient Aligned Care Team, Geri PACT)提供以居家照護 為基礎的整合照護。在品質及給付方面，透過病人照護品質指標訂定，結合保險給付，建立推動模式。在成效方面，不管是PCMH、PACTs、GeriPACT或IAH模式，只要是以全人照護為本，並以社區為主要場域，提供各項民眾所需的整合服務，整體成效都是相當理想的，不僅費用支出減少，照護品質更為提升，值得我國推動居家醫療參考。

The organ- and disease-specific healthcare service model has been facing various challenges, notably increased medical costs, limited accessibility, and unsatisfactory healthcare outcomes caused by its fragmentary nature. An innovative medical care model,“Patient-Centered Medical Home” (PCMH), has been developed in the United States. Observing the principles of PCMH, the U.S. Veterans Health Administration introduces the “Patient Alliance Care Team” (PACT) to cope with the unmet needs. PACT develops patient-centered, tailor-made care plans to meet patients’ needs with team-based assessment and treatment, offering efficient, comprehensive, accessible and continuous services with active communication and teamwork cooperation to improve quality of care, reduce medical costs and alleviate burden of care for patients, caregivers, and healthcare staff. Independence at Home (IAH) and the Geriatric Patient Aligned Care Team (GeriPACT) are two alternative models providing home-based primary care for patients with multi-morbidity and disability. Indicators of PCMH have been developed and used as criteria for reimbursement. Despite their existing differences, PCMH, PACT, GeriPACT and IAH are all able to improve the quality of care and reduce of healthcare expenditure by promoting person-centered and community-based integrated care; they undoubtedly deserve the consideration of policymakers who are seeking innovative approaches for turning a new page of long-term care in Taiwan.