提升急性後期照護居家模式之收案率

Improving the Utilization Rate of Home-Based Post-Acute Ca

急性後期照護為近年重要衛生政策，本案欲使用品管圈手法提升急性後期照護居家模式之收案率，執行期間自2021年3月至2022年2月，目的為協助失能住院病人返家並持續於居家環境中改善生活能力。經現況分析，居家模式收案率為40.12%，未收案原因以「希望續住本院一般病房」占比87.63%為最多，經解析與真因驗證，將「擔心返家沒有能力照顧」、「病人與家屬意見分歧」、「居家輔具未備妥」與「人員不知病人何時已符合收案資格」列為真因。介入改善對策有「提升照顧能力」、「製作醫病共享決策輔助工具」、「設計常用輔具介紹單」及「追蹤回報與資訊整合」。對策執行後居家模式收案率提升至61.54%，病人出院獲得更妥適安排與資源，在附加效益上，對執行同仁可增加工作之滿意度，對醫院能拓展新業務並建立品牌效益，對病人能明顯改善日常生活功能，以巴氏量表評估，分數由47.5分進步至61.8分(p < 0.05)，此改善成果期能提供醫療照護參考。

Post-Acute Care (PAC) is an important healthcare policy in recent years. This study aims to use quality control circle to improve the enrollment rate of home-based PAC for disabled hospitalized patients to return home and to improve their living abilities in a home environment. Based on the current analysis, the enrollment rate for home-based PAC was 40.12%, with the most common reason for not enrolling was the desire to continue hospitalization, accounting for 87.63%. Through analysis and verification of the actual reasons, the real reasons for not enrolling were identified as concerns about the patient's ability to take care of themselves at home, disagreements between the patient and family members, lack of preparation for home care aids, and lack of awareness of the patient's eligibility for enrollment. The intervention strategies included enhancing the care ability of caregivers, creating shared decision-making tools for rehabilitation plan, designing commonly used aids introduction sheets, and setup tracking and information integrative system. After the implementation of the strategies, the enrollment rate of home-based PAC increased to 61.54%, patients were discharged with more appropriate arrangements. There were additional benefits such as an increase in job satisfaction for the staff. The hospital was also able to expand its business and establish its brand, and patients were able to significantly improve their daily living functions, as indicated by an improvement in Barthel Index score from 47.5 points to 61.8 points (p < 0.05). These results can provide reference for medical care.