建構中醫日間留院觀察照護模式

賴榮年
國立陽明大學
臺灣中醫過去數十年來，長期侷限於門診基層醫療工作，近年來積極建構中醫住院照護模式。然而我們都知道急診照護、留觀及連接到住院的連續性照護模式，尚未完整的運用於中醫的照護模式，導致中醫照護模式較少涵蓋非住院的急症病患；另外，近年來，中央健保局推動的亞急性照護模式，也不一定能適用於目前中醫的門、住診服務模式，因此我們主張可建構中醫日間照護模式，提供非住院的急症病患及亞急性照護病患，可於中醫部門留院並以中醫藥療法治療，觀察病情轉歸提供最適切療診的中醫照護模式。對於需要急診留觀但未達亟需住院標準的病患而言，中醫日間照護是一個可以補强門診及住院不足的照護模式。並且，在中醫住院保險給付前，中醫日間照護模式是一個以較低成本，即可推廣到各個通過評鑑中醫科部的訓練模式，可以大大提昇中醫見實習生及住院醫師照護急、重症病患的能力。因此，本研究目的在評估中醫日間照護，能否提昇門診照護品質及住院費用下降的照護模式。藉由收集資深中醫師運用中醫藥療法診治「非住院性急症」或「亞急性」(Sub-acute) 病症的經驗、病案、療法、藥方等資料，並且召開專家共識會議，訂出15種適合中醫日間留院觀察照護的病種，製作中醫臨床照護指引小冊(guideline)。然後實際執行中醫日間留院觀察照護收治「非住院性急症」或「亞急性」(Sub-acute) 病症病，追蹤評估其使用中醫療法前後之療效。
關鍵字：中醫藥、亞急症、非住院性急症、日間照護

The Study of Healthcare Quality for the Day Care Ward in Traditional Chinese Medicine

Lai JN
National Yang-Ming Nuiversity
Traditional Chinese medicine (TCM) has been growing in popularity and has offered an important alternative or complement to health care in many countries and have been an important part of health care for hundreds of years in Taiwan. Though the system of TCM is logical and scientific in its own way, it is a separate system from modern Western medicine and provide only outpatient and admitted services in Taiwan. As we all konw, millions of people will eventually be admitted into the hospital through the emergency department to receive continued care which does not exist in TCM healthcare system. In addition, TCM healthcare system also does not provide subacute care which is a level of care needed by a patient who does not require hospital acute care, but who are medically fragile and require special services, such as acupuncture therapy, herbal stearm inhalation therapy, and/or Chinses medicne treatment than is provided to the majority of outpatients. We propose to build a TCM day care ward which is specially designed for patients who require a short stay of several hours before and after TCM interventions or procedures. It provides a one-stop service, including sub-acute care of chronic or complex conditions associated with aging, post-chemotherapy disconfort, chronic illness or disability, and non-hospital based urgent care. This design will avoid unnecessary hospital admissions and promote high quality of TCM healthcare. And the result of research can provide the powerful evidence-based information to strive for the day-care ward in TCM and the information can be the objective and reliable material in teaching.
關鍵字：Traditional Chinese Medicine, Sub-acute, non-hospital based urgent care, day care ward