腦中風的高死亡率及高殘障率造成家庭社會的沉重負擔，為提升中風照護品質，自2003年全世界興起Get With The Guidelines Program (GWTG)風潮，健保署也於2014年推動「急性後期照護計畫，Post-Acute Care，簡稱PAC」，使病人功能回復達到最佳化。高雄榮民總醫院由12個跨部科專家，組成中風全人團隊，採用「醫療照護失效模式及效應分析」 「Healthcare Failure Mode & Effects Analysis，簡稱HFMEA」手法，檢視高雄榮總急性腦中風照護流程，針對住院照護、全人評估、全人會議及全人照護等四項流程進行危害分析，找出中風照護流程中系統問題，共發現7個失效模式及69項失效原因。我們擬訂四項對策，包括「建立急性腦中風個案管理系統」、「改善急性腦中風病人住院全人評估作業」、「改善急性腦中風病人召開全人會議作業」、「改善急性腦中風病人跨領域全人照護品質」，經由研究過程中團隊精心執行上述四項對策，運用首創之創新作法，來進一步提升腦中風跨領域全人照護品質。本研究分析三個時期相關資料，包括研究進行前期(從2014年1月1日至2016年3月31日) 、研究進行期(從2016年4月1日至2020年12月31日)、研究後蹤期(從2021年1月1日至2021年12月31日)，共計5,899位中風病人資料。本研究設定兩個主目標及四個次目標來提升腦中風全人照護。主目標1「急性腦中風PAC下轉率」目標設定15%，由研究進行前的12.3%，提升至研究進行中的17.0%，更進步至研究後追蹤的22.9%，超越預設目標值15%，進步率達到86%(P<0.001)，本院腦中風PAC下轉率連續3年榮獲全國第一名。主目標2「急性腦中風符合PAC適應症下轉率」，標竿學習美國62.6%的比率，由研究進行前的42.7%，提升至研究進行中的62.6%，更進步至研究後追蹤的77.1%，超越預設挑戰美國62.6%的目標值，進步率達到81%(P<0.001)。

The high mortality and disability rate of stroke causes a heavy burden on society. In order to improve the quality of stroke care, Get With The Guidelines Program (GWTG) trend rise since 2003 and the Taiwan National Health Insurance Administration launched the "Post-Acute Care Program, referred to as PAC", to maximize functional recovery of stroke patients. We organize a stroke holistic team of expertise from 12 clinical units. We use the "Healthcare Failure Mode & Effects Analysis" (HFMEA) method, to examine the current stroke care process, focusing on f inpatient care, holistic assessment, holistic meeting and holistic care. A total of 7 failure modes and 69 failure causes were identified. Four solutions, including "Establish an acute stroke case management system ", "Improve the holistic assessment of stroke patients", "Improve the operation of stroke holistic conferences" and "Improve the Quality of multidisciplinary holistic stroke care" were formulated and implemented comprehensively. The statistical analysis was carried out in the pre-study period (from January 2014 to March 2016), the study period (from April 2016 to December 2020), and the post-study follow-up period (from January 2021 to December 2021), a total of 5,899 stroke patients. The main goal 1, "the PAC transfer rate of stroke", was set at 15%, which increased from 12.3% before the study, to 17.0% during the study, and further improved to 22.9% after the study, exceeding the preset target value 15%, and the improvement rate was 86% (P<0.001). The main goal 2, "The PAC transfer rate of stroke patients fit with PAC indications", was set at 62.6%, has increased from 42.7% before the study, to 62.6% during the study, and further improved to 77.1% after the study, surpass the preset target of 62.6%, and the improvement rate was 81% (P<0.001).
Keywords: Stroke, Holistic care, Healthcare failure mode and effect analysis, Innovative intelligent information system, Post-Acute care

論文審定書 i
致謝 ii
摘 要 iii
Abstract iv
目錄 v
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 5
第一節 中風現況及照護發展 5
第二節 指引遵從準則計畫 5
第三節 急性後期照護計畫-腦血管疾病 8
第四節 醫療照護失效模式與效應分析 10
第三章 研究方法 12
第一節 成立腦中風全人照護團隊 12
第二節 主題選定 13
第三節 研究架構與繪製流程圖 14
第四節 數據收集 16
第五節 執行危害分析 19
第六節 對策擬定 22
第七節 對策實施與檢討 24
第四章 研究結果 28
第一節 研究進行期及研究後追蹤期數據收集 28
第二節 有形成果(主目標) 28
第三節 有形成果(次目標) 31
第四節 無形成果(雷達圖) 35
第五節 創新手法與標竿學習 36
第六節 經濟效益 41
第五章 結論與建議 42
第一節 結論 42
第二節 檢討與建議 44
參考文獻 46

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