社區醫院整合長期照顧之推行模式：台大金山分院個案研究

Abstract

背景：台大金山分院在台大醫院體系內的定位，是社區型的地區醫院。本研究欲從社區醫院的角度出發，探討並比較人口日益老化之現況之下，社區醫院從醫療服務到長期照顧，歷經的轉變過程，與未來的發展方向。 目的：瞭解社區醫院參與社區居家及長照計畫的背景與原因，並描繪社區醫院在社區居家及長照計畫的內容與社區整合。 方法：本研究採用個案研究法，預計以現有政府統計資料、醫院營運資料、佐以醫院員工之訪談口述補充，分析台大金山分院嘗試的創新照護模式，及因應人口老化與政府醫療及社福政策，醫療服務之策略與經營策略的調整。 結果：以地理交通、就醫族群結構、目前全民健保支付方式綜合評估，台大金山分院雖然以成為社區型地區醫院為重點發展項目，但至民國108年止，每年仰賴政府及台大總院的補助下仍持續赤字。金山分院以社區醫院之樞紐地位，本著先前因應地方特性所發展的社區安寧、全院志工模式為基礎，在居家醫療及長期照顧政策轉變時期，發揮整合能力，在北海岸地區推動「北海英雄計畫」，聯合區內服務單位發展從預防失能開始的長照創新模式，提供了北海岸偏區高品質的完善照護環境。 結論：社區醫療、居家照護、長期照顧皆非社區醫院獨立可完成的工作，需要許多政府及民間資源投入，鼓勵創新模式之發展，尋求醫院永續經營，也期待交通與網路通訊基礎建設的布建，將科技導入偏鄉，加強醫療及照護資源之可近性，提升健康照護品質。

Background: The positioning of National Taiwan University Hospital (NTUH) Jinshan Branch within NTUH system is a community-based regional hospital. . From the perspective of community hospitals, this study intends to explore and compare the changing process and future development direction of community hospitals from medical services to long-term care under the aging population. Objective: To understand the background and reasons why a community hospital participating in home-based medical services and long-term care plans. Further to describe the content and the ability to integrate of a community hospital in home-based medical services and long-term care plans. Method: This study adopts the method of case study. By analyzing the data of the statistics of the aged population, home-based medical services, long-term care plan, hospital operation data, and interviews with hospital staff. How did NTUH Jinshan Branch, the only hospital in the North Coast area of Taiwan, developing innovative care models, medical services and management strategies, trying to make every adjustment to the aging society and the medical and social welfare policies of the recent years. Results: Based on the comprehensive assessment of geographic characters, the local population composition, and the current national health insurance payment system, although the NTUH Jinshan Branch focuses on becoming a community-based regional hospital, it has not been able to solve the financial loss situation so far (2019). The deficit continues despite the financial support from the government and the National Taiwan University General Hospital. Based on the previous credit such as the “We are all Enthusiastic Volunteers model” and the “Community-Based Palliative Care model” of Jinshan Branch, the hospital exerts its integration capabilities during the transition period of the home-based medical care and long-term care policies. Followed by new pilot project of “Integrated Long-Term Care Sites of Home Care and Long-Term Care in the North Coast of the New Taipei City' (integrated care model extends infinitely from death to birth), the agencies and institutions in the joint area is integrated to provide a cross-regional, cross-professional and inter-institutional care, starting from prevention of disability. The innovative model provides a high-quality and perfect care environment on the north coast area. Conclusion: Community medical activities, home-based medical services, long-term care programs and the sustainability of the hospital are all cooperative tasks that could not be complete by a single community hospital. They require a lot of official and private resource to encourage the development of innovative models. The deployment of transportation and mobile/wireless network infrastructure to introduce technology are also expecting to the rural area, to strengthen the accessibility of medical and care resources, and improve the quality of health care.