心臟衰竭病患出院準備服務之成本與成效評值

Costs and Effectiveness Evaluation of Discharge Planning for Patients With Heart Failure

張治瑤(Chih-Yau Chang)

指導教授 ： 張文英

臺北醫學大學/護理學院/護理學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00062

摘要

因心臟衰竭（Heart Failure）之高盛行率、高死亡率及高復發率的特性，導致病患健康受威脅及社會經濟承受高負擔，故建立一套完善的出院準備服務計劃以提升心臟衰竭的照護是必要的。本研究目的旨在比較出院準備服務照護組與例行照護組之心臟衰竭病患返家後生活品質與出院後三個月內再入院率、非計劃性門診及急診就診率與醫療成本的差異。
本研究採前測-後測實驗設計（Pretest-posttest experimental design），以民國九十三年六月至九十五年十二月間，經心臟專科醫師診斷為心臟衰竭之病患為研究對象。病患依住院時間之順序，分為出院準備服務照護組及例行照護組。資料收集後，以描述性統計及推論性統計包括百分比、個案數、平均值、標準差、獨立樣本t檢定、卡方檢定、Mann-Whitney U test及配對t檢定進行分析，以比較兩組病患生活品質與出院後三個月內再入院率、非計劃性門診及急診就診率與醫療成本之差異。
本研究共收集出院準備服務照護組13人，例行照護組12人。結果出院準備服務照護組病患之平均年齡為75.7歲，其中以男性居多有9人（69.2%），教育程度以高中（職）居多有7人（53.8%），且非獨居者多有10人（76.9%），而以從未吸菸者居多有9人（69.2%）及從未飲酒者12人為最多（92.3%）。心臟衰竭之級數則以第Ⅲ、Ⅳ級病患居多有7人（53.8%）。而例行照護組病患之平均年齡為76.3歲，其中以女性居多有7人（53.8%），教育程度以國中（含）以下居多有8人（66.7%），且非獨居者佔多數有11人（91.7%），而從未吸菸者居多有9人（75.0%）及從未飲酒者11人為最多（91.7%）。心臟衰竭之級數則以第Ⅰ、Ⅱ級居多有7人（58.3%）。以上變項，兩組皆無顯著差異（p > .05）。在生活品質方面，出院準備服務照護組病患於返家後之平均生活品質得分從0.62分提升為0.92分，而例行照護組從0.63分提升為0.80分；但在自覺整體健康狀態上，出院準備服務照護組之平均分數從53.8分提升為70.38分，例行照護組從51.2分提升為65.67分，且兩組在統計上有顯著之差異（p = .02）。在再入院方面，出院準備服務照護組有1人（7.7%），而例行照護組有3人（25.0%）。非計劃性門診就診方面，出院準備服務照護組無，而例行照護組有2人（16.7%）。非計劃性急診就診方面，出院準備服務照護組有1人（7.7%），而例行照護組有1人（8.3%）。在醫療成本上，每一位心臟衰竭病患接受出院準備服務照護所需要之醫療成本為NTD 29,376元，而每位病患接受例行照護所需要之醫療成本為NTD 63,577元，例行照護組為63,577元。以上變項，兩組皆無顯著差異（p > .05）。
本研究發現出院準備服務照護組病患返家後之生活品質有較例行照護組病患高之趨勢，而出院準備服務照護組病患之出院後三個月內再入院率、非計劃性門診及急診就診率與醫療成本有較例行照護組病患低之傾向。因此，本研究不僅可做為醫院管理者建構其他疾病出院準備服務之參考，亦可作為未來研究者在探討病患出院準備服務相關研究時的探討依據。

關鍵字

出院準備服務 ； 心臟衰竭 ； 成本 ； 成效

並列摘要

With the high prevalence, high mortality, and high recurrence of heart failure (HF), patient’s health have threatened and social cost has burdened. So, developing a complete discharge planning to improve HF care is necessary. Therefore, the aims of this study were to compare the differences in the quality of life, re-admissions, unscheduled outpatient visits, emergence department visits, and the medical costs between discharge planning (DP) group and usual care (UC) group during the three months after hospital discharge.
The design was pretest-posttest experimental. Data were collected from June of 2004 to December of 2006. Samples were recruited from as being diagnosed by the cardiologist, as being a patient with hart failure, and as who met the criteria for inclusion. Samples were then assigned to DP group or UC group at the time of hospital admission. After data collection, descriptive statistics and inferential statistics including independent t-test, χ2, Mann-Whitney U test and Paired t-test were used to compare the differences in quality of life, re-admissions, unscheduled outpatient visits, emergency department visits, and medical costs between groups.
There were 13 patients in DP group and 12 in UC group. For the DP group, the mean age was 75.7 years, 9 (69.2%) were males, 7 (53.8%) had senior high school education, and 10 (76.9%) were not living alone. Nine (69.2%) were non-smoker and 12 (92.3%) were non-drinker. And 7 (53.8%) were NYHA (New York Heart Association) functional class Ⅱ. In contrast, in the UC group, the mean age were 76.3 years; 7 (53.8%) were females, 8 (66.7%) had junior high school education or lower, and 11 (91.7) were not living alone. Nine (75.0%) were non-smoker and 11 (91.7%) were non-drinker. And 7 (53.8%) were NYHA functional class Ⅲ. However, no significant differences were found between groups on above variables (p > .05). For the quality of life, the mean score was increased from 0.62 to 0.92 in DP group, from 0.63 to 0.80 in UC group. Moreover, the mean score of VAS was increased from 53.8 to 70.38 points in DP group, from 51.2 to 65.67 points in UC group. However, a significant diference was found between groups (P<.05). For the readmissions, there was 1 case (7.7%) in DP group, 3 cases (25.0%) in UC group. For the unscheduled outpatient visits, there was no visit in DP group, 2 cases (16.7%) in UC group. For the emergency department visits, there was 1case (7.7%) in DP group, 1 case (8.3%) in UC group. For the mean medical costs, there was $29,376 in DP group, and $ 63,577 in UC group. But no significant differences were also found between the groups on above variables (p > .05).
The findings of this study demonstrate that the quality of life was higher in DP group than that of UC group, and the re-admissions, unscheduled outpatient department visits, emergence department visits, and the medical costs during three months after hospital discharged was fewer in DP group than that of UC group. Thus, the result not only provides consultation for hospital managers to develop other disease discharge planning, but also contributes to future research in the field of DP for future scholars.

並列關鍵字

discharge planning ； heart failure ； costs ； effectiveness

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