[[alternative]]The Effectiveness of Case Management for the Burn Patients in a Medical Center

[[abstract]]本研究採類實驗設計研究法，以探討實施個案管理模式於燒燙傷病患之成效（減少住院天數、降低醫療費用、增進病人對服務的滿意度及自我照護認知與行為執行正確率）。研究分二階段進行，第一階段發展及實施個案管理模式；第二階段以類實驗設計（Quasi-Experimental Design）評值實施個案管理模式之照護成效。研究對象為台北市某醫學中心之燒燙傷病患，以立意取樣於九十一年四月至七月收取未接受個案管理模式組病患30名，再於九十一年八月至十一月實施個案管理的同時，收取接受個案管理模式組病患20名。研究工具包括：個案基本資料表、燒燙傷居家自我照護之認知程度、燒燙傷病患對醫護人員服務之滿意度問卷、燒燙傷病患居家自我照護行為評值表。資料採用Statistical Package for the Social Sciences（SPSS）9.0套裝軟體及EPI-INFO統計軟體進行資料處理與分析包括：描述性統計以平均值、標準差、百分比；推論性分析以卡方考驗（Chi-Square test）檢定、t-test來考驗實驗組及控制組兩組病患個人基本特性；以重複測量Generalized Estimating Equations (GEE) model考驗燒燙傷病患出院後對居家自我照護能力認知程度，另外以t-test比較燒燙傷病患實驗組與控制組照護成效（平均住院日數、平均住院醫療費用、病患滿意度、出院後居家自我照護行為執行正確率）之差異情形。 研究結果顯示：接受個案管理模式組之平均住院日數較未接受個案管理模式組平均住院天數減少2.72天，且在平均住院醫療費用方面也減少32,244.78元。兩組在燒燙傷病患自我照護認知程度、病患對醫護人員服務之滿意度、病患出院後對居家自我照護行為之執行正確率結果顯示：接受個案管理模式之燒燙傷病患均較未接受燒燙傷病患組有顯著改善。 經由個案管理模式的實施，可提供燒燙傷病患較完整的照護方針，發揮醫療團隊顯著之成效，做為病患照護的結果指標，並可依此模式推展於其他高成本高數量個案。[[abstract]]The purpose of this two-stage study was to provide the hospital-based case management model for the burn patients and to evaluate its effectiveness ( reduce the length of stay, LOS；reduce the medical cost；increase the patient’s satisfaction) in a medical center by using a quasi-experiment design. With the purposive sampling method, data were collected for the control group of 30 patients from April 2002 to July 2002 and for the experimental group of 20 patients from August 2002 to November 2002. Four measurements were used for the present study as follows：Patient’s Essential Data List (PEDL), Home Care Cognition Questionnaire(HCCQ) for the burn patients, Satisfaction Questionnaire(SQ), and Home Care Behavior Questionnaire(HCBQ) for the burn patients. Statistical Package for the Social Sciences（SPSS）9.0 software packages and EPI-INFO software were used for coding and data analysis which included statistical techniques such as mean, standard deviation, percentage, Chi-Square test , t-test, and Generalized Estimating Equations (GEE) model. Result show that shorter length of stay, LOS (decreased 2.72 days) and less cost (decreased 32,244.78 NT dollars) were evidenced by implementing the case management for burn patients. Besides, the knowledge and behavior of home care for burn patients and satisfaction of healthcare were improved significantly. Execute case management, can accommodation complete guideline for care, educe the effectiveness of medical team and outcome measurement for patient care. Furthermore the model can expand to another high cost high volume patients