醫療機構呼吸照護病房營運模式與照護品質之探討

Owing to the raise of aging population and the advancement of acute medical care technology, ventilator dependent patients have been increased in recent years, consequently the number of respiratory care wards (RCW) was increased dramatically. However, as a result of the development of respiratory care system, it has been criticized by the poor quality which affected the outcome of acute severe patient care. Besides, some hospitals have business difficulties and apply inadequate adaptive business model because of their size and financial constraints. In order to achieve the proper care for the ventilator-dependent patients, and to reduce the burden of patients’ family, and to effectively use relevant health care facilities and resources, and ultimately to improve the quality of acute medical care and respiratory care, Taiwan governments had implemented policies considering the integration of resources, cost control, and quality control, and moreover released the newest version of hospital accreditation in the early of 2011. New standards in the version are to guide and monitor health care organizations with RCWs the continuous quality improvement in respiratory care. Respiratory care has become an important issue. The aims of this project are to explore the business situation of RCWs, and to have a better understanding of the difficulties in running these kinds of hospitals and the impacts on acute medical care quality, followed by proving specific recommendations to the implementation of the newest hospital accreditation. Research method consists of the following major steps: (1) design the study framework based on a holistic healthcare systems relationship model which was developed according to the system theory, (2) literature review to establish a better understanding of implemented policies and regulations for respiratory care, and the health care utilization and the quality indicators in relevant researches, (3) define and classify business models of running respiratory care wards in hospitals using national health insurance (NHI) database, (4) compare the quality differences between hospitals with different sizes, regions, public and private hospital using NHI database for respiratory care, to define "respiratory care ward driven hospital " by analyzing NHI database and compare the quality differences within this group, (5) conduct hospital surveys to understand their structure factors and operation details, and the necessity of setting up acute medical ward and their business difficulties, (6) compare the differences between the standards requirement of hospital accreditation (Chapter 2.4) and the identified health care quality indicators from using NHI database, and to provide specific suggestions to the newest hospital accreditation based on a cross check with the result from hospitals survey.