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題 名 | 個案管理模式之建立與評價 |
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作 者 | 陳玉枝; 邱臺生; 劉曉梅; 劉春菊; 陳雪芬; | 書刊名 | 榮總護理 |
卷 期 | 12:4 1995.12[民84.12] |
頁 次 | 頁338-350 |
分類號 | 419.39 |
關鍵詞 | 個案管理; 重要路徑; 住院天數; 醫療費用; 病患滿意度; Case management; Critical path; Length of stay medical fee; Patient satisfaction; |
語 文 | 中文(Chinese) |
中文摘要 | 全民健保實施後,將逐步採用論病例計酬支付方式,為因應醫療給付制度之改變,以有效控制醫療費用,維持醫療照護品質。本研究的目的在建立個案管理模式,以良性攝護腺肥大症為對象。探討下列諸問題:(一)病患平均住院天數;(二)病患住院醫療費用;(三)病患對護理服務滿意度;(四)病患接受護理指導成效。 研究期間自民八十三年七月至八十四年六月。研究方法:(一)建立個案管理模式,以全責護土任個案管理者,訂定照護計畫;(二)對象,凡診斷為良性攝護腺肥大者列為收案對象;(三)研究工具照護重要路徑表、照護變異記錄表、病患滿意度問卷表及護理指導評值表。問卷經信度測試後使用,效度採專家效度,信度以折半信度α=.97。以不記名方式填寫。資料收集由個案管理者記錄照護變異原因及住院天數。共收案60位,其中33位行經連道攝護腺切除術,15位行診斷性切片手術,12位未手術。研究結果顯示:(一)病患院天數平均6.9天較實施前8.59天減少1.69天;(二)住院醫療費用平圾每位個案58,821元,較實施前78,687元節省19,866元;(三)病患病意度100%在滿意以上的程度;(四)護理指導達成率為98%。研究結果可提供醫院管理者改善作業型態,整合各科疾病診療標準規範,推廣照護重要路徑於高危險、高成本病患應用之參考。 |
英文摘要 | Since the Case Payment System should become in a few years the mainstream of the National Health Insurance System that has been implemented this year. This study tries to develop a model of case management as a means to cope with this change in payment policy, with strict cost-effect control while maintaining the quality of care. Taking patients with Benign Prostate gland Hypertrophy (B.P.H) as subjects studied, this study plans to investigate the following issues: 1) length of hospital stay, 2) average of medical fee for each patient, 3) patient satisfaction with nursing care, and 4) outcomes of nursing instruction. From July 1994 to June 1995, a total of 60 patients with BPH, including 33 having TURP operation, 15 with diagnostic biopsy and 12 who were not operated, were included. The case management model took the primary nurse of each individual patient as case manager to make the care plan. Tests were performed with the aid of instruments such as critical path, variance sheet, patient satisfaction questionnaire and nursing instruction evaluation form. Validity was evaluated with expert validity, and reliability was set at Spearment Brownα=.97. Data were collected by case managers on an anonymous base. The findings included: 1) the decrease of L.O.S. from an average of 8.59 days to 6.9 days, 2) the decrease of average medical fee form NT$78,687 to 58,821 3) 100% patient satisfaction, and 4) 98% compliance rate of nursing instruction. The results thus obtained are highly referential to the management for their efforts to integrate health care standards and to develop the critical path for high-risk or high-cost patients. |
本系統中英文摘要資訊取自各篇刊載內容。