| Abstract: | An Integrated Delivery System (IDS) for ventilator-dependent patients not only provided a complete managed care plan for the ventilator-dependent patients, but also improved the quality of the medical care while reducing its cost.
Purpose: The purpose of this study was to understand the thoughts and the psychological impact to the family members who took care of the long-term ventilator-dependent patients during the process of managed care. Firstly, the study examined the factors in choosing the location of care; either Home Care or Respiratory Care Ward. Secondly, the study analyzed the cost of the Home Care or the Respiratory care ward, from the points of the view of patients’ families. Finally the study examined the families' needs as regards long term managed care and their intentions as regards home care. The outcome will serve as a reference for the long term care policy.
Method: The methods used to conduct the study included qualitative research, in depth interviews grounded theory, and the semi-constructed interviews as instructions for data collection.
Target: At a local teaching hospital in the central Taiwan, the subject of the study are the families of the patients who were tracheotomy-patients on a ventilator, transferred from respiratory care center (RCC) down to either respiratory care ward (RCW), or to long term mechanical ventilation home care. There are 8 persons in total, 4 in the Respiratory Care Ward group and 4 in the Home Care group.
Result: The outcomes were divided to the individual analysis, cross-case analysis, and the comparison of different medical care models.
In term of the thoughts and the psychological impact to the families, most of the Home Care group experienced the fear, sadness, depression, and unfamiliar with ventilators. One of the family members thought it was unreasonable since the step down was decided by the number of days, instead of the situation of the patient. But in the end, they all accepted the reality.
On the other hand, the family members of the Respiratory Care Ward group were more concerned with the lack of labor and money, and choose the Respiratory Care organization. The factors affect them to choose the location of the respiratory care organization were: the characters, acknowledge, and the psychological emotion burden of the family members; the facilities to take care of the patients; the ability of the family member to take care of the patients; the characters of the patients; living environment; social support; and financial situation.
Both groups had the initial hope that the patients would get better. The Home Care group was more optimistic than the Respiratory Care Ward group. Both groups suffered negative emotions, facing the pressure from the illness or the financial burden.
In the long run, the family members of both groups got worried. They worried if the expense will be too much to handle. The cost of managed care, Home Care cost was about NT$40,000 to 65,000, while Respiratory Care Ward cost was about NT$30,000 to 40,000 total each month. This includes the expense of hiring a foreign labor. It paid NT$20,000 to 25,000 to the respiratory agent. Clearly, the cost of Home Care group is more than Respiratory Care Ward group.
Both the Home Care and Respiratory Care Ward groups claimed the current governments policies was not good enough, lack of reality, it was difficult to apply the social benefits. And the most important is: both groups were hoping to receive cash assistance.
As far as the social benefits of respite care and home service, both groups thought those benefits were unnecessary. If they had the chance to choose their care location, neither group would change their decision.
Conclusion: The study had used the in depth interviews and data analysis, it had constructed a blue map to reflect the needs of the long-term ventilator-dependent patients and their families. It is hoped that this study will serve as a starting point to examine the possibilities. By expanding the number of members and study cases, this can serve as a reference of the long term medical care plans in the future. |
