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標題: | 駐院專責主治醫師值班病房與住院醫師值班病房的
成本與效益比較 Cost and effectiveness comparison between wards under hospitalists’ and residents’ services |
作者: | Chong-Jen Yu 余忠仁 |
指導教授: | 黃崇興 |
關鍵字: | 駐院專責主治醫師,住院醫師工時,夜間專責主治醫師, hospitalist,work hour of residents,nocturnist, |
出版年 : | 2016 |
學位: | 碩士 |
摘要: | 本研究為探討能處理台大醫院急診壅塞以及住院醫師工時限制的病房醫師照護制度。目前臺大醫院急診後送病房存在兩種制度,一為創傷醫學部整合醫學科由駐院專責主治醫師主導的整合照護模式(7A/D病房);一為內科部由主治醫師+住院醫師的傳統照護模式(7B病房)。駐院專責主治醫師照護模式被認為可有效縮短住院日與控制醫療花費。但在加計人事成本考量後,兩種照護模式究竟孰優孰劣,必須要經由科學化的成本與效益分析來決定。而是否有第三種模式存在,如合併駐院專責主治醫師/專科護理師與傳統主治/住院醫師團隊的執業模式,能以較低的成本取得一樣良好的醫療品質與病人預後,是本研究想要回答的問題。
我們收集2014年1月1日到2014年12月31日間入住7A/D與7B病房的病人資訊,比較兩種照護模式在品質指標(住院日,死亡率,30天再入院率),醫療費用收入,病房成本,與病房損益的差別。納入分析的有1,859位7A/D病房病人,6027B病房病人。研究結果顯示全駐院專責主治醫師結合專科護理師全時照護的作業方式,在病床週轉率,急診病人收治人數與病房收入都優於內科傳統上以主治醫師+住院醫師照護的組合,但因為人事成本高昂,不具經濟效益。而任何嘗試結合兩種現行制度的選項,與傳統內科的照護方式比較,都會增加急診病人收治與病房收入,且有較全駐院專責主治醫師模式為高的正損益。如增加考量住院醫師工時限制,選擇兩組駐院專責主治醫師+專科護理師及兩組主治醫師+住院醫師,再加上夜間值班主治醫師所組成的組合,應該是因應台大醫院急診壅塞與住院醫師工時的最適方案。 This study aims to identify a service system in general medical ward in order to deal with the work hour reduction of resident and emergency department overcrowding of the National Taiwan University Hospital (NTUH). Currently, there are two different service systems in the general wards of NTUH for patients admitted from the emergency department. One is the holistic care model in 7AD wards led by hospitalists of the Department of Traumatology, the other is the traditional care model in7B ward led by internists and residents of the Department of Internal Medicine. The hospitalist service model has been shown superior to internist model in reducing length of stay and medical expense. However, after taking the issue of high personnel cost into account, a cost and benefit analysis is mandatory to identify the superiority of two service model. Whether there will be a third model, such as a mixed model of combing both hospitalist/nursing specialist and traditional internist/resident, can be established to achieve a similar level in quality of care and patient outcome as hospitalist is the key purpose of this study。 We retrospectively collected the medical information of all patients admitted to 7AD and 7B wards from Jan 1st to Dec 31st 2014, comparing the quality indices (length of stay, in-hospital death, readmission within 30 days), medical expense (including that paid by NHI and from patients’ own pocket), all costs (direct and indirect) of the service and the profits (by calculation) between these two service models. There were 1859 patients being admitted to 7A/D and 602patients to 7B ward in the study period. The results confirm that the hospitalist/nursing specialist service model is indeed superior to internist/resident service model in length of stay, bed turnover, number of patients admitted from emergency department and lower medical expense. However, due to a much higher personnel cost, the hospitalist model has no economic benefits. Comparing to the internist model, all of the 5 mixed models significantly increase the number of patients admitted and the income from health care, and also provide better economic benefits than hospitalist model. Putting the compliance to resident work hour limitation into consideration, a mixed model with 2 teams of hospitalists/nursing specialist and 2 teams of internists/residents, and 0.5 nocturnist (1 nocturnist for 2 wars), will be the best resolution to help NTUH solving both the overcrowding of emergency department and the work hour reduction of residents. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/78227 |
DOI: | 10.6342/NTU201600396 |
全文授權: | 有償授權 |
顯示於系所單位: | 商學組 |
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