Background: An Integrated Delivery System (IDS) for ventilator- dependent patients not only provided a complete managed care plan for the long-term ventilator-dependent patients, but also improved the quality of the medical care. Under the structure of IDS, the central branch of Bureau of National health Insurance (NHI) planned to monitor the medical care quality by site visiting and classified payment for the respiratory care ward (RCW). So the purpose of this study wants to compare the difference of care quality after the site visiting and classified payment for 4 years. The outcome will serve as a reference for the longterm care policy.
Methods: In this observational study, we analyzed the effectiveness of care quality before and after the introduction of site visiting & classified payment under the structure of “NHI Managed Care Demonstration Program for Ventilator Dependent Patients” （2002~2006）by central branch of NHI. We used descriptive statistics to measure the difference of care qulity of a local hospital in the central Taiwan from 2002 to 2006, which had joined the “NHI Managed Care Demonstration Program for Ventilator Dependent Patients” system, and received the site visiting for 4 years.
Results: The outcomes of the care quality revealed significant improvement after site visiting and classified payment including the mortality rate、ICU transfer back rate、ventilator weaning rate, nutrition 4
staus, and pressure sore morbidity in this local hospital.
Conclusion: The study demonstrated under the structure of IDS, the site visiting and classified payment is an effective method to monitor and promote the care quality of RCW by the experience of this studied hospital. Based on the successful results, we hope that this study will serve as a starting point to expand to all members of RCW, and serve as a reference of the long term medical care plans in the future.
