護理之家住民轉住院率的整體分析

The Hospitalization Frequency of Nursing Home Residents-A Comprehensive Analysis

冼鴻曦(Hong-Hsi Hsien) ； 李英俊(Ying-Chun Li) ； 馬震中(Chen-Chung Ma) ； 盧玉強(Yuk-Keung Lo)

《台灣老年醫學暨老年學雜誌》 7卷1期 (2012/03) Pp. 37-64

https://doi.org/10.29461/TGG.201203.0003

摘要

目的：探討護理之家住民入住急性病房的情形，並分析可能發生轉住院事件的危險因子。方法：收錄南部某區域教學醫院附設護理之家的住民共329人為研究對象，以病歷回顧法收集整理機構內的病歷資料進行統計分析。結果：男女性住民各佔42.9%與57.1%，住民的平均年齡為78.1歲，個別住民發生轉住院的次數最少為0次，最多為18次，平均每90天的住院頻率為0.4次。住院的主要診斷以感染症為數最多，佔76.3%。個別疾病則以肺炎佔45.5%、泌尿道感染佔20.0 %、上腸胃道出血佔10.3%，為排名前三位最常見的住院診斷。以單因子變異數分析發現性別、年齡、依賴程度與長期臥床、有氣切管、有鼻胃管、意識程度、營養不良、貧血、血清白蛋白數值、血清膽固醇數值、是否罹患肺部疾病、腎臟病、失智症、骨折疾病，以及病房類型等變項與轉住院的發生頻率均有顯著的差異。多變量迴歸分析得知對轉住院頻率具有顯著預測力的變項如下：男性、年齡、有肺部疾病者、長期臥床者以及迷你營養評估分數。標準化迴歸係數顯示，男性住民、年齡越大者、有肺部疾病者以及長期臥床者有比較高的轉住院傾向，迷你營養評估分數較高的住民有比較低的轉住院傾向。結論：性別、年齡、肺部疾病、長期臥床及營養狀況為影響轉住院頻率的獨立因子，是值得重視並可作為未來提升護理之家照護品質的參考。

關鍵字

護理之家住民 ； 轉住院率 ； 危險因子

並列摘要

ObjectiveThe demand for long-term care facilities has been escalating in response to the ever-increasing geriatric population. How to reduce the hospitalization frequency of nursing home residents thus emerges as a significant indicator for the quality of long-term care.MethodsThe study enrolled 329 residents who had stayed for more than 90 days at a hospital-based nursing home in southern Taiwan prior to March 31, 2011. Their medical records were reviewed retrospectively. Data were analyzed using descriptive statistics (correlation and one way ANOVA) to examine the effects of the residents' and the facility's characteristics on the probability of hospitalization. Multiple linear regression was used to study the risk factors and the predictors of hospitalization.ResultsOf the 329 residents, 141(42.9%) were male. The average age was 78.1. 33.7% of the residents died in the facility. Individual number of hospitalizations ranged from 0 to 18. The average hospitalization frequency was 0.4 in each 90-day period. Infectious disease was the major cause of hospitalization. The three leading causes of hospitalization were pneumonia (45.5%), urinary tract infection (20.0%), and upper gastrointestinal bleeding (10.3%). Correlation analysis found age positively correlated to hospitalization frequency. Hemoglobin level, serum albumin level, serum cholesterol level, body mass index, mini-nutritional assessment score and mini-mental status evaluation score disclosed a negative correlation with hospitalization frequency. Multiple linear regression identified male gender, age, lung diseases, bedridden status, and mini-nutritional assessment score as the significant predictors of hospitalization frequency.ConclusionResults of the study indicate that gender, age, lung diseases, bedridden status, and nutritional status of nursing home residents were significant predictors of their hospitalization frequency. These results might assist in the quality improvement of long-term care facilities in the future.

並列關鍵字

nursing home resident ； hospitalization frequency ； risk factors