在宅急症與居家醫療之服務流程改善與科技導入探討

Abstract

本研究聚焦於台灣高齡化社會下，醫療資源失衡與人力短缺挑戰所引發之照護轉型需求，針對在宅急症（Hospital-at-Home）與居家醫療服務進行制度盤點與流程優化探討。透過質性研究方法，訪談十三家不同類型之醫療與照護機構，彙整服務流程與管理瓶頸，並運用服務藍圖與營運構面分析，系統性描繪現行制度下的斷點與潛在改善方向。

研究首先指出，現有政策與制度設計中，病患接觸遠距或在宅照護之服務節點過於片段，缺乏一致化的收案條件與資訊整合機制，導致流程協作困難與醫療人力負荷沉重。在照護執行階段，機構普遍面臨 IoT 設備效能不穩、照護人力調度困難、緊急應變責任歸屬不清等問題，進一步降低整體服務可近性與持續性。研究亦發現多數機構對生成式 AI 在風險預測與病況整合上的應用潛力抱持高度期待，惟實務導入仍受限於法規與系統架構。

本研究提出五項研究建議：其一，於收案初期導入智能輔助工具，提升跨單位協作與資源導向；其二，建立以病人為中心之資訊整合與授權機制，強化照護透明度與可近性；其三，推動區域型支援網絡與互助制度，減緩單一機構人力壓力；在照護過程中逐步發展風險感知與預警機制；其五，透過政策誘因鼓勵科技業者參與醫療照護數位轉型，形成制度與產業的雙向推動。期望本研究之流程分析與制度建議，能為未來遠距照護政策與在宅急症制度提供具體、可行且病患導向之改進基礎。

This study focuses on the urgent need for healthcare transformation in Taiwan amid an aging society, where imbalances in medical resource distribution and workforce shortages are becoming increasingly prominent. It investigates the current institutional frameworks and process optimization opportunities for Hospital-at-Home (HAH) and home-based medical services. Utilizing qualitative research methods, the study conducted interviews with thirteen diverse healthcare and care organizations, compiled service processes and operational challenges, and systematically visualized existing service gaps and potential improvements through service blueprints and operational framework analysis. The findings reveal that under the current policy and institutional design, patient access points to remote and home-based care are fragmented, lacking standardized intake criteria and integrated information systems. These issues result in collaboration inefficiencies and increased burdens on medical personnel. During the care delivery phase, organizations commonly face challenges such as unstable performance of IoT devices, staffing difficulties, and unclear responsibilities in emergency responses, all of which hinder service accessibility and continuity. Furthermore, many institutions express high expectations for the potential of generative AI in risk prediction and clinical data integration, although practical implementation remains constrained by regulatory and system limitations. The study offers five key recommendations: (1) introduce intelligent support tools at the intake stage to enhance cross-institutional coordination and resource alignment; (2) establish patient-centered information integration and authorization mechanisms to improve care transparency and accessibility; (3) promote the development of regional support networks and collaborative assistance systems to alleviate the manpower burden on individual institutions; (4) gradually develop risk-sensing and early warning mechanisms throughout the care process; and (5) implement policy incentives to encourage participation from the tech industry in the digital transformation of healthcare services. This study aims to provide concrete, feasible, and patient-oriented strategies for improving future remote care policies and HAH systems.