2024年11月27日 – 台北，台灣 November 27, 2024 – Taipei, Taiwan
澳洲居家醫療學會（HITH Society of Australasia）會長暨Cabrini Health感染預防與控制主席詹姆斯·波拉德醫師（Dr. James Pollard），於台灣在宅醫療學會舉辦的重要研討會中，深入分享了澳洲30年來推動居家醫療（HITH）的寶貴經驗。本次研討會適逢台灣於2024年7月啟動全國性在宅急症照護試辦計畫，意義深遠。
Dr. James Pollard, President of the Hospital In The Home (HITH) Society of Australasia and Chair of Infection Prevention and Control at Cabrini Health, delivered invaluable insights into Australia’s 30-year journey in hospital-at-home (HITH) care during a landmark seminar organized by the Taiwan Society of Home Health Care. This timely event comes as Taiwan has just launched its national health insurance pilot program for hospital at home in July 2024.
澳洲在宅住院的30年發展歷程 Australia’s Three-Decade Journey in Hospital-at-Home Care
波拉德醫師介紹，澳洲的居家醫療計畫自1990年代初啟動，旨在為日益壓力重重的醫療系統提供永續的解決方案。該計畫從治療蜂窩性組織炎和深靜脈血栓等低複雜性病例起步，逐漸擴展到涵蓋多種安全的居家醫療服務。
「在醫院出現之前，所有醫療都是在家中進行的，」波拉德醫師提到，並解釋1980年代的技術進步將醫療集中於醫院內。「如今，隨著現代技術和完善系統的應用，我們能夠在患者家中安全地提供醫院級的醫療服務。」
Dr. Pollard recounted how Australia’s HITH program, initiated in the early 1990s, evolved as a sustainable solution for the nation’s overstretched healthcare system. Beginning with low-complexity cases like cellulitis and deep vein thrombosis, the program gradually expanded its scope to manage diverse medical conditions safely at home.
“Before hospitals, all healthcare was home-based,” Dr. Pollard explained, highlighting how technological advances in the 1980s centralized care in hospitals. “Now, modern systems and technologies have enabled us to safely deliver hospital-level care back in patients’ homes.”
成功模式與顯著成效 A Proven Model with Measurable Success
目前，澳洲的居家醫療服務已在各州和地區廣泛實施，並根據當地需求調整運作模式。波拉德醫師指出，早在2009年，維多利亞州的居家醫療服務每晚已能治療500名患者，相當於一家大型虛擬醫院的規模。
他強調了該計畫的多項成效：
- 死亡率降低，相較於一般住院治療
- 再入院率下降
- 患者滿意度提升
- 醫療資源運用效率提升
Today, HITH services are embedded across Australia’s states and territories, each tailored to local needs. By 2009, the state of Victoria alone treated 500 patients per night through HITH services – equivalent to the capacity of a large virtual hospital.
Dr. Pollard underscored the program’s key achievements:
- Lower mortality rates compared to in-hospital care
- Reduced readmission rates
- Enhanced patient satisfaction
- Optimized use of hospital resources
成功關鍵：在宅住院的五核心要素 Blueprint for Success: Key Components of HITH
波拉德醫師分享了建立有效居家醫療服務的幾個重要元素：
- 優質的醫療管理：由多專業團隊主導
- 全方位的支援：包括藥事服務及專業輔助醫療
- 可靠的藥物傳遞系統
- 全天候的服務 : 提供完善的緊急應變機制
- 以患者安全為核心 :確保周密的標準作業流程
Dr. Pollard shared essential elements for effective hospital-at-home programs:
- Strong medical governance led by multidisciplinary teams
- Comprehensive support services including pharmacy and allied health
- Reliable medication delivery systems
- 24/7 care availability with emergency escalation pathways
- Focus on patient safety through meticulous protocols
資金與價值導向的醫療模式 Funding and Value-Based Care
澳洲居家醫療成功的基石在於其資金模式，將此服務定位為住院替代醫療。「這並非廉價的照護，而是以價值為導向的醫療，兼顧患者利益和醫療系統的可持續性，」波拉德醫師強調。
A cornerstone of Australia’s HITH success has been its funding model, structured as hospital substitution care. “It’s not about cutting costs; it’s about delivering value-based care that benefits both patients and the system,” Dr. Pollard emphasized.
台灣的居家醫療發展機遇 Taiwan’s Opportunities in Hospital-at-Home
波拉德醫師也為台灣的居家醫療計畫提供了重要建議：
- 充足的資金支持：將居家醫療視為醫院等級的服務，而非長期照護。
- 以醫療為主導的模式：確保由醫師主導的團隊及居家訪視。
- 針對性疾病管理：初期可集中於以下範疇：
- 感染（蜂窩性組織炎、泌尿道感染、肺炎）
- 術後照護
- 慢性病管理
- 科技應用：善用遠端監測及其他數位醫療工具。
As Taiwan embarks on its own HITH journey, Dr. Pollard highlighted critical strategies for success:
- Adequate Funding: Treat HITH services as hospital-level care, not long-term care.
- Medical-Led Models: Ensure physician-led teams and home visits.
- Targeted Initial Focus: Begin with conditions such as infections, post-surgical care, and chronic disease management.
- Leverage Technology: Use remote monitoring and digital tools to enhance care.
展望未來 A Vision for the Future
波拉德醫師對台灣推行居家醫療的準備狀態表示樂觀，並提到目前台灣已有722例居家住院案例，為未來發展奠定了堅實基礎，並表示「台灣在這個領域擁有巨大的發展潛力，我非常期待未來幾年的進展。」
Dr. Pollard expressed optimism about Taiwan’s readiness for HITH care, noting the 722 home-hospitalized cases already treated in the country as a promising foundation. “Taiwan has a tremendous opportunity to lead in this space, and I’m eager to see its progress over the coming years,” he said.
此次研討會展現了在宅醫療計畫在優化醫療資源、緩解醫院壓力的同時，仍可維持高品質照護的巨大潛能。波拉德醫師以激勵人心的訊息作結：「每個地方都能實現居家醫療，但成功的關鍵在於建立完善的系統、充足的資金，以及對患者安全的承諾。」
The seminar underscored the potential of hospital-at-home programs to revolutionize healthcare delivery, offering high-quality care while alleviating pressure on hospital capacity. Dr. Pollard concluded with an inspiring message: “Anyone can implement hospital-at-home care with the right systems, funding, and commitment to patient safety.”
隨著全球醫療系統面臨愈發嚴峻的醫院容量挑戰，台灣在宅醫療的邁進不僅是醫療模式的重要變革，澳洲30年的寶貴經驗也為其提供了明確的指引。
As Taiwan prepares for this transformative healthcare shift, Australia’s three decades of HITH experience serve as a guiding light for success.
隨著全球醫療保健系統應對不斷增長的需求，台灣在宅急症照護的轉變可能會樹立新標準，展示創新的護理模式如何在保持安全和品質的同時應對現代醫療保健挑戰。
As global healthcare systems grapple with rising demands, Taiwan’s move toward hospital-at-home care could set a new standard, demonstrating how innovative care models can meet modern healthcare challenges while maintaining safety and quality.
