以遠距視訊系統會診顯著減少離島地區空中緊急醫療轉送及有效節
省經濟成本之研究
Significant reduction of emergency air medical transport (EAMT) service in remote island of Taiwan with physician consultation and telemedicine
中文摘要
世界各國在其偏遠離島地區之醫療品質相對於都會地區有明顯之落差，為解決城 鄉差距並兼顧現實狀況及經濟效益，遠距醫療逐漸成為偏遠離島地區健康照護的 一種方法。早自電話發明時，就被應用於遠距醫療，加上近年來由於通訊科技的 進步，電話視訊已被普遍應用於醫師人力及醫療設備缺乏的的偏遠離島地區。台 灣之地理特性為離島眾多、中央高山，而離島偏遠地區因為海水阻隔之地理因 素，人力設備缺乏而品質落後，遇有急重症病況只得依賴空中醫療轉送，但空中 醫療轉送之成本極高，因此產生健康照護及傷害防治之衛生政策問題。由於我國 空中醫療轉送之病患及家屬無須付費，故轉送案件逐年增加，政府每年編列預算 逾二億元均無法有效解決偏遠離島地區之空中醫療轉送問題。本研究之目的是探 討全天候使用遠距醫療視訊系統配合專業審查制度如何提升離島地區空中醫療 轉送品質及節省政府經濟成本效益。研究方法採回溯法，以澎湖地區為對象，調 閱民國 88 年 11 月 1 日至 92 年 8 月 31 日空中緊急醫療轉送案件資料進行統計分 析。統計分為二階段，分別為使用遠距醫療視訊系統配合審核制度之前及之後二 階段。研究項目包括空中醫療轉送病患之性別、年齡、疾病分類、空中醫療轉送 每月平均申請及轉送航次、接受醫院資料分析、飛航責任空域分析、未核准病患 追蹤、醫療意外事件記錄、所需經費比較...等。研究結果發現此二階段之病患在 性別、年齡、疾病別等，均無顯著差異。轉送病患以男性居多;年齡層分布集中 於老年族群以及小孩;第二階段平均年齡較第一階段有老化的趨勢;轉送原因兩階 段均以疾病居多（76.5%；77.4%），創傷病人較少（23.5%；22.6%）；轉送專科 皆以內科疾病最多、其次為依序外科疾病、兒科疾病、婦產科疾病。轉送航次在 第二階段每月平均申請航次顯著下降，較第一階段減少 5.9 航次(19.6 航次降至 13.7 航次)，減少 30.1%，每月平均實際轉送航次也顯著減少 7.1 航次(19.6 航次 降至 12.5 航次)，減少 36.2%，且跨區轉送至責任區域外的醫院之情形也較第一 階段顯著減少(自 16.1%降至 1.5%);以醫院等級區分，第二階段轉送至地區醫院 的比例顯著減少；評估其經濟效益，每月平均節省政府花費 142 萬元、每年 1704 萬元;且未發生醫療糾紛事件。本研究評估遠距醫療結合空中緊急醫療諮詢機 制，發現第一階段無管控機制之空中轉送不僅跨區轉送較多，並造成政府大量的 花費，第二階段諮詢醫師使用遠距醫療系統後顯著減少澎湖地區 36.2%之空中醫 療轉送且無任何醫療意外事件發生。本研究為國內外首次探討全天候使用遠距醫
療同步急診會診並評估審查空中醫療轉送之必要性及可行性，研究結果顯示不僅 可以顯著減少飛行航次，而且病患均轉送至最近最合適之醫院，所有案件均無發 生醫療法律糾紛及飛安事件，每年節省政府巨額預算，符合經濟效益並達成安全 的空中醫療轉送。
英文摘要
Background: Demand for emergency air medical transport (EAMT) services have increased in recent years. However, the high costs of these services have raised questions on the benefit to patient outcomes. In this study, we evaluate the effectiveness of video-telemedicine for the preflight screening of patients for air medical transports
Method: A prospective cohort study. Medical records of patients transported from the Penghu Islands to Taiwan were retrospectively collected from November 1999 to October 2002 (Stage 1). In addition, we collected medical records of patients who were preflight-screened by physicians using video web cameras from November 1, 2002 through August 30, 2003(stage 2). The intervention in stage 2 included a set of protocols and screening criteria for EAMT implemented by the National Aeromedical Consultation Center (NACC). In stage 1, there were no standardized protocols or screening guidelines for EAMT. The EAMT system before implementing preflight screening and telemedicine was mostly based on patient’s requests and their health condition determined by the treating medical officers (TMO).
Results: A total of 822 transfers were included in this study. Patient demographic backgrounds in the 2 groups were similar on gender, age, disease classification, and types of illnesses. Patients in stage 2 were significantly older than those in stage 1. In a comparison of flight frequencies between the 2 stages, the results revealed a 36.2%
reduction of EAMT applications in stage 2. The flight approval rate was 91.2%. The intervention in stage 2 also presented a significant reduction in cross-zone transport (16.1% to 0.1% to the northern Taiwan region). Within-zone transfers increased from 74.9% to 88.3%. Cost analysis showed that physician triage in stage 2 resulted in a total annual savings on EAMTs of NT$17,040,000.
Conclusions: This study demonstrates the physician-assisted preflight screening using video-telemedicine significantly reduced the frequency of unnecessary air medical transports and consequently led to reduced costs. Video-telemedicine can be an essential tool to support physicians in decision-making for patient screening.
