- 期刊
台灣東部某醫學中心復健科病患長期住院因素之探討
Factors Associated with a Long Stay in the Rehabilitation Department of a Medical Center in the Eastern Taiwan
摘要
Objective: To investigate the current status and variability of general inpatients and those requiring longer stays. The reasons for extended hospitalization are explored to identify risk factors for this patient group so as to establish a screening reference for medical service providers. Patients and Methods: The research target of this retrospective design was the rehabilitation department of a medical center in the Hualien-Taitung region of Taiwan. In total, there were 568 inpatients during 1999 to 2001. After excluding the deceased, the unreachable, those with an incomplete history in their medical charts, and those with a length of stay (LOS) of less than 7 days, 335 patients were recruited as the sample. The main disease/condition category types included cerebrovascular accident, traumatic brain injury, and spinal cord injury. Patient data were collected and analyzed through a questionnaire inquiring about demographic data and admission data as well as a daily activity index. Results: LOS differed by categories of age, the statistically significant sequence, the presence of caregivers during the hospital stay, and the admission route (p ＜ 0.05); by the post-discharge attendant expense, supplemental medical insurance, and the length of intensive care unit stay (p ＜ 0.01); and by LOS in other departments, the referral source, the type of surgery, the number of impaired functions, the number of treatment items, the activity of daily living (ADL) score at admission/discharge, and the ADL progress during the hospital stay (p ＜ 0.001). Multiple regression analysis detected 7 important factors affecting the length of extended hospitalization, including the number of impaired functions, the frequency of consultation by the rehabilitation department, the level of motor function disability, supplemental medical insurance, the diagnosis, the ADL score at admission, and treatment items. These variables accounted for 59.2% of the variance in LOS. Conclusions: Based on these results, a screening mechanism can be established to identify high-risk patients who may be more likely to experience a long hospital stay. Such a mechanism, together with discharge planning interventions and reasonable control of hospital days, could improve the efficiency of hospital bed utilization. It can also provide a reference standard for the national health insurance policy in planning case payment schemes for rehabilitation care.
並列摘要
Objective: To investigate the current status and variability of general inpatients and those requiring longer stays. The reasons for extended hospitalization are explored to identify risk factors for this patient group so as to establish a screening reference for medical service providers. Patients and Methods: The research target of this retrospective design was the rehabilitation department of a medical center in the Hualien-Taitung region of Taiwan. In total, there were 568 inpatients during 1999 to 2001. After excluding the deceased, the unreachable, those with an incomplete history in their medical charts, and those with a length of stay (LOS) of less than 7 days, 335 patients were recruited as the sample. The main disease/condition category types included cerebrovascular accident, traumatic brain injury, and spinal cord injury. Patient data were collected and analyzed through a questionnaire inquiring about demographic data and admission data as well as a daily activity index. Results: LOS differed by categories of age, the statistically significant sequence, the presence of caregivers during the hospital stay, and the admission route (p ＜ 0.05); by the post-discharge attendant expense, supplemental medical insurance, and the length of intensive care unit stay (p ＜ 0.01); and by LOS in other departments, the referral source, the type of surgery, the number of impaired functions, the number of treatment items, the activity of daily living (ADL) score at admission/discharge, and the ADL progress during the hospital stay (p ＜ 0.001). Multiple regression analysis detected 7 important factors affecting the length of extended hospitalization, including the number of impaired functions, the frequency of consultation by the rehabilitation department, the level of motor function disability, supplemental medical insurance, the diagnosis, the ADL score at admission, and treatment items. These variables accounted for 59.2% of the variance in LOS. Conclusions: Based on these results, a screening mechanism can be established to identify high-risk patients who may be more likely to experience a long hospital stay. Such a mechanism, together with discharge planning interventions and reasonable control of hospital days, could improve the efficiency of hospital bed utilization. It can also provide a reference standard for the national health insurance policy in planning case payment schemes for rehabilitation care.