「思覺失調症醫療給付改善方案」成效探討-以北區某精神專科醫院為例
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2015
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本研究旨在評價「思覺失調症醫療給付改善方案」介入，對有參與該方案的病人在精神醫療利用之門診、住院、急診之影響。研究對象為北區某精神專科醫院於2009-2013年參與「思覺失調症醫療給付改善方案」共2,236人，本研究資料來源為該醫院「醫療資訊系統」及「思覺失調症個案管理系統」等資料庫，以廣義估計方程式(Generalized Estimating Equation, GEE)方法進行成效檢定。研究結果如下：
一、 參與「思覺失調症醫療給付改善方案」的病人其精神科門診年就診次數有稍下降，然病人仍維持每年12次以上門診。
二、 「思覺失調症醫療給付改善方案」介入可顯著減少病人強制住院年發生次數、精神科急性病房年住院天數、精神科急性病房年住院次數。
三、 「思覺失調症醫療給付改善方案」介入無顯著減少病人六個月內精神科急性病房再住院次數、急診年使用次數。
建議持續推動「思覺失調症醫療給付改善方案」，長期追蹤思覺失調症病人的疾病自我管理情形，將有助於照護實務的規劃以建立病人穩定且長期就醫的規則性及降低精神科的再住院率，盼能進一步降低醫療及社會成本的耗費，為病人帶來更好的生活品質。
This study aims to examine the effects of “Pay-for-Performance program for schizophrenia” on patients’ utilization of outpatient, emergency services, and hospitalization. This study analyzed 2,236 patients from a psychiatric hospital in northern Taiwan that joined the “Pay-for- Performance program for schizophrenia”. Two datasets including 2009-2013 Hospital Information System and Schizophrenia Case Management System were analyzed. The Generalized Estimating Equation (GEE) method was conducted to examine the effects. I. After implementation the “Pay-for-Performance program for schizophre- nia”, patients’ psychiatric outpatient visits significantly decreased but maintained more than 12 outpatient visits per year. II. The “Pay-for-Performance program for schizophrenia” had positive impact on decreasing patients’ yearly incidence of compulsory hospitalization and days of acute psychiatric hospitalization. III. Patients’ numbers of six-month readmission to the acute psychiatric ward and annual emergency department visits were not significantly different after implementation. It is suggested continually implementing the “Pay-for-Performance program for schizophrenia” which could enhance the practice of medical care in order to establish regular visit and to lower rehospitalzation. Hopefully, it might further reduce medical and social costs and then bring better life quality to the patients.
This study aims to examine the effects of “Pay-for-Performance program for schizophrenia” on patients’ utilization of outpatient, emergency services, and hospitalization. This study analyzed 2,236 patients from a psychiatric hospital in northern Taiwan that joined the “Pay-for- Performance program for schizophrenia”. Two datasets including 2009-2013 Hospital Information System and Schizophrenia Case Management System were analyzed. The Generalized Estimating Equation (GEE) method was conducted to examine the effects. I. After implementation the “Pay-for-Performance program for schizophre- nia”, patients’ psychiatric outpatient visits significantly decreased but maintained more than 12 outpatient visits per year. II. The “Pay-for-Performance program for schizophrenia” had positive impact on decreasing patients’ yearly incidence of compulsory hospitalization and days of acute psychiatric hospitalization. III. Patients’ numbers of six-month readmission to the acute psychiatric ward and annual emergency department visits were not significantly different after implementation. It is suggested continually implementing the “Pay-for-Performance program for schizophrenia” which could enhance the practice of medical care in order to establish regular visit and to lower rehospitalzation. Hopefully, it might further reduce medical and social costs and then bring better life quality to the patients.
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思覺失調症, 論質計酬, 個案管理, 醫療利用, 成效, Schizophrenia, Pay-for-Performance program, Case management, Medical utilization, effect