從平衡計分卡觀點探討醫療服務品質之改善： 以一所公立醫學中心為例

Abstract

為因應高齡化多重疾病、醫療與健康照護多元需求，我們必需“翻轉”傳統的醫療照護模式，開創以病人為中心，病人參與的智慧醫療，提供完整性(Complete)、持續性(Continuity)、創新性(Creative)之3C全人全程健康照護。平衡計分卡學習成長構面的整合性資訊系統，為因應高齡化社會病人所面臨多重慢性疾病之衝擊，創新提出完整性、持續性、創新性之3C醫療服務概念。所謂○1完整性，個案管理強調多科整合與協同合作的整合模式，提供「以病人為中心」完整全人照護；○2持續性，為滿足民眾需求，從病人入院起接受本院個案管理全程照護，返家後亦由出院準備服務個案管理小組協助持續追蹤，如有需求盡速給予合適的醫療照護服務建議；○3創新性，在資訊系統輔助下，建置多項系統，包括追蹤分享管理系統、多元繳費方式、雲端藥歷智慧應用、個人健康紀錄、高風險病人識辨系統等，透過此類創新系統提供更多服務。本院從24大類個案管理中優先整合7項個案管理(心臟病、腫瘤、糖尿病、高齡、中風、住院全人整合及出院準備服務)，強化「以病人為中心的全人全程管理」之理念，建構「從心出發-創新3C全人全程健康照護」，並有效連結來院前、在院中、離院後各照護服務資訊系統：整合疾病管理，提供完整健康照護，本院103年策略地圖醫療品質與病人安全主題，設定整合個案管理系統建置齊備之目標，創新建置個案追蹤管理分享系統，整合糖尿病、腫瘤、高齡、中風、心臟病、住院全人整合、出院準備服務等7項個案管理系統，達到智慧收案，個管師收集符合收案條件者自動帶入病人基本資料及診斷資訊，以利個案管理師收案評估，減少人工重覆作業。 本論文以平衡計分卡系統加上創新的資通訊技術，整合民眾就醫的流程，具體效益如下：(1)便捷多元掛號與查詢門診看診進度APP深獲好評，為民眾節省8,753小時等候時間；(2)與民間廠商共同合作開發新語音查詢系統服務，導入民間業者服務能量，省去龐大系統採購與維護費用及減少護理同仁接聽電話時間，創造三贏；(3)透過不限銀行繳費，省去繳費的時間；(4)建置個案管理系統後，民眾對個管師高度肯定，5分滿意度達4.43分，104年門診滿意度90.6%較前一年顯著提升，個管師對於個案管理系統高滿意度；(5)建置健保雲端藥歷系統，藉由系統提示與交互作用攔截，有效降低跨院所或同院所六大藥理重複用藥率，獲得健保署雲端藥歷創意競賽第一名及醫策會智慧醫院獎項殊榮；(6)中風急性後期照護服務人數與醫療品質優於全國；(7)24小時全方位諮詢中心服務，照顧民眾無時差。 本模式實為提供病人完整性、持續性、創新性之3C全人全程整合個案管理照護服務，展新的醫病溝通良好工具，建立病人與本院良好夥伴關係，提升健康照護品質。

In order to cope with the multiple illness of aging, medical and health care needs, we must 'converse' the traditional medical care model, to create a patient-centered, patients involved in the wisdom of medical, to provide integrity (Complete), continuity (Continuity) Creative (Creative) of the 3C health care. Balanced Scorecard system can grow the integrated information system, in order to respond to the impact of multiple chronic diseases in the elderly society, the integrity of innovative, innovative and innovative concept of 3C medical services. The so-called integrity, case management emphasizes the integration of multidisciplinary integration and collaborative model, providing 'patient-centered' holistic care; continuous, to meet the needs of the people, from the patient admitted to the hospital case management full care, After the family is also prepared by the Dispatch Service Case Management Team to assist in continuous tracking, if necessary, as soon as possible to provide appropriate medical care services recommendations; innovative, with the help of information systems, the establishment of a number of systems, including tracking and sharing management system, , Cloud pharmacy application, personal health records, high-risk patient identification system, through such innovative systems to provide more services. We have prioritized 7 case management system (heart disease, cancer, diabetes mellitus, stroke, hospitalization, hospitalization and discharge preparation) in 24 major case management cases. We have strengthened the concept of 'patient-centered whole person management' , The construction of 'starting from the heart - innovative 3C health care', and effectively linked to the hospital, in the hospital, after the care of the care service information system: integrated disease management, to provide a complete health care, Map of medical quality and patient safety theme, set the integration of the case management system to build a complete goal, innovation to build a case tracking management sharing system, integration of diabetes, cancer, age, stroke, heart disease, hospital integration, discharge preparation services 7 The case management system, to achieve the wisdom of the case, a division to collect the conditions of compliance with those who automatically bring the patient basic information and diagnostic information to facilitate the case manager to assess the assessment, to reduce manual repetitive operations. In this paper, the Balanced Scorecard system with innovative information technology, integration of public medical treatment process, the specific benefits are as follows: (1) convenient multi-registration and consultation outpatient clinic progress APP well received for the people to save 8,753 hours waiting time (2) to work with private manufacturers to develop new voice query system services, import civil service services, save the huge system procurement and maintenance costs and reduce nursing colleagues to answer the phone time to create win-win; (3) through unlimited bank payment (4) the establishment of case management system, the people of a pipe teacher highly sure, 5 points satisfaction up to 4.43 points, 104 years outpatient satisfaction 90.6% significantly higher than the previous year, a division (5) the establishment of health insurance cloud drug system, with the system prompts and interaction interception, effectively reduce the cross-hospital or the hospital with six pharmacological repeat rate, access to the Health Department of the cloud drug calendar creative competition (6) the number of stroke patients with acute post-care services and medical quality is better than the national; (7) 24-hour all-round consultation center service Take care of the people no time difference. This model is to provide patients with integrity, continuity, innovative 3C full integration of the case management services, a new tool for the exchange of medical knowledge, the establishment of patients with the hospital good partnership to enhance the quality of health care.