- 期刊
提升心臟衰竭病人執行心臟復健比率之成效
Effectiveness of Improving the Cardiac Rehabilitation Uptake Rate in Patients with Heart Failure
摘要
心臟復健能改善心臟衰竭病人不適症狀及生活品質，但本院心臟復健比率僅22.7%，分析比率低原因為心臟復健流程無全院規範、復健環境及衛教工具不完善、團隊溝通紀錄不健全，及無提醒機制有關。此專案目的為提升心臟衰竭病人執行心臟復健比率至30%，並希望改善紐約心臟學會（New York Heart Association, NYHA）心臟衰竭分級（Functional Classification, Fc）期別，增加六分鐘行走測試（6-Minute Walking Test, 6MWT）距離及左心室射血分率（Ejection Fraction, EF）分數，擬定解決辦法有：1.修訂心臟復健收案標準作業流程規範2.舉辦團隊在職教育宣導3.規劃並開設心臟復健整合門診4.重新改建專屬心臟復健中心5.優化心臟復健決策輔助工具，導入醫病共享決策6.建置資訊智慧化管理。專案藉由流程再造有效提升復健比率至81.8%，進步率260%、目標達成率137%。進一步依t檢定分析發現，在心臟復健六個月後，NYHA分級改善（p=.021）、6MWT距離增加（p=.001）及EF提升（p=.003），和未執行心臟復健相比皆有進步且達到顯著差異，不僅達到專案目的，更提高心臟衰竭病人之生活品質。
並列摘要
Cardiac rehabilitation can alleviate the discomfort experienced by patients with heart failure and improve their quality of life. However, the cardiac rehabilitation uptake rate in the case hospital was only 22.7%. Analysis revealed that the low uptake rate was attributable to the lack of hospital-wide standards for the cardiac rehabilitation process, inadequate rehabilitation environment and health education tools, incomplete team communication records, and the lack of reminder mechanisms. Accordingly, the goals of this project are to increase the cardiac rehabilitation uptake rate of patients with heart failure to 30% and improve their New York Heart Association (NYHA) functional classification (Fc), 6-minute walking test (6MWT) distance, and left ventricular ejection fraction (EF) scores. The following solutions were proposed: 1.Revise the standard operating procedure for cardiac rehabilitation admission. 2.Arrange on-the-job training and education for the team. 3.Plan and establish an integrated cardiac rehabilitation clinic. 4.Renovate a dedicated cardiac rehabilitation center. 5.Optimize the cardiac rehabilitation decision support tool and introduce shared decision-making. 6.Construct an information intelligent management system. The project effectively increased the rehabilitation uptake rate to 81.8% through process re-engineering, achieving a 260% improvement rate and 137% goal achievement rate. Further analysis with the t-test revealed that after 6 months of cardiac rehabilitation, considerable improvements were observed in NYHA Fc (p=.021), 6MWT distance (p=.001), and EF (p=.003) scores, which improved significantly relative to the scores before the rehabilitation. Overall, the project goals were achieved successfully, and the quality of life of patients with heart failure was improved.