Implementation and Evaluation of the Registry System of Long-Term Ventilator-Dependent Patients: A Case Study of Some Branch of Bureau of National Health Insurance in Taiwan

• Main Authors: Yu-Tzu Chuang, 莊玉資
• Other Authors: Fan Wu
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/10126672977933901218

碩士 === 中國醫藥大學 === 醫務管理學研究所碩士班 === 94 === 　　To understand the flow of patients requiring prolonged mechanical ventilation and to efficiently control them admitted to hospitals. Both can decrease unsuitable utilization of mechanical ventilation and archive the rational growth of medical expenditure. Therefore we have to develop computer-aided system to manage assist hospital administrator for managing efficiently. In view of this, we take “Central Region Branch, Bureau of National Health Insurance” as example to plan and implement the register system of patient with prolonged mechanical ventilation. And we also evaluate effects of the system. 　　After discussion, modification and testing the system many times, the register system is finished and implemented in hospitals successfully at 1 July 2005. Furthermore we evaluate user satisfaction by on-line questionnaires to understand the condition of using the system in hospitals. We collect 50 valid questionnaires and the rate of return is 83.33%. In addition, we estimate the effects for the utilization of mechanical ventilation between before and after using the system. And we use insurance claims data for patients with mechanical ventilation to analysis. The data is analyzed by t-test for independent samples, Chi-square test and One-Way ANOVA besides by descriptive analysis. 　　The result of user satisfaction survey shows that functions of the system are the most satisfied for all users. The second is convenience of system operation. Moreover, for hospitals, Medical Centers are satisfied with the real-time response of system and exception handling of system. Regional hospitals and district hospitals both are satisfied with functions of the system. But hospitals with joining IDS program are satisfied with feedback of indicator information. System automation is for hospitals without joining IDS program. Besides, the result of system implementation shows that we can control the flow of patients with mechanical ventilation in real time and provide the reference information for flow-up in the field. To use the system can not only save time of human operation and of visit patients but archive efforts that hospitals rationally control to receive patients with mechanical ventilation. Furthermore, through setting up security mechanism of network, the system can achieve the efforts of controlling at any time by feedback of related information and indicators in real time. And it also can achieve the security of protection personal data of patients in open networks. 　　The research is found that the effects for the utilization of mechanical ventilation after implementation are better than before. Patient data collected from our register system are all more completed than data from systems of IDS program. It improves the problem of incompletion information of the system of IDS program. In addition, the results also show a weaning rate of patients requiring mechanical ventilation obviously increases after implementation. Among hospitals, for Centers of Medical Sciences and those join IDS program or not, a rate of increasing is statistically significant difference. And a transfer rate also decreases after implementation. For local hospitals and those without joining IDS program among hospitals among hospitals, a rate of decreasing is statistically significant difference. 　　According to the results that the research obtained, we address several suggestions as follows: (1) for Bureau of National Health Insurance, It should be a way toward simplifying operational interface of system to accord with user friendly and to easy use it. And the system could be added more exception handling. (2) The experience and effects in the process of system development and implementation could be as the reference model for building the similar system. And also the system could be popularized other branches or technique can be shared. (3) Hospitals should enhance the internal management. To decrease the mistakes of register can avoid poor quality of information. (4) Researchers could be toward the way of medical quality in the future. It should be more worth that collecting more Medical indicator to be used for clinical analysis.