以病患與家屬為中心的出院準備工具之開發：以台灣中部某區域醫院為前導測試

Development of a patient- and family-centered discharge planning tool: a pilot study at a regional hospital in central Taiwan

張郁屏(Yu-Ping Chang) ； 余養豪(Yang-Hao Yu) ； 鍾國彪(Kuo-Piao Chung) ； 陳雅美(Ya-Mei Chen) ； 董鈺琪(Yu-Chi Tung) ； 蔡欣芸 ； 郭年真(Nien-Chen Kuo) ； 游宗憲(Tsung-Hsien Yu) ； 楊名廷(Ming-Ting Yang) ； 邱琬育(Wan-Yu Chiu) ； 張子晏(Tzu-Yen Chang) ； 林澤宏(Tse-Hung Lin)

《台灣公共衛生雜誌》 42卷5期 (2023/10) Pp. 478-493

https://doi.org/10.6288/TJPH.202310_42(5).112025

摘要

目標：發展與驗證以病患與家屬為中心的出院準備評估問卷（Patient- and family-centered discharge planning tool, PFC-DP）之信效度。方法：以初步發展的PFC-DP問卷，包含自我照顧能力等自評現況與需要更多協助之評估，以台灣中部某家醫院50歲以上的病患進行工具信效度測試，包括出院後一個月的預測效度。結果：共收案200位。本問卷各構面的自評現狀和需要更多協助程度之Cronbach's α值分別介於0.71-0.95和0.93-0.98。驗證性因素分析困難程度與需要更多協助都呈現良好適配度。工具共有六個構面（身體恢復的資訊需求、衛教資訊、社會支持、個人照護、行動能力、家事活動等），共31題。自評個人照護（p＜.01）、行動能力（p＜.05）、家事活動（p＜.05）越困難，其出院後一個月內急診與再入院次數會越多，其他健康狀況也更差。當自評個人照護越需要更多協助，一個月內再入院次數也增加，行動能力也越差（p＜.05）。結論：本工具有良好信效度，可以應用於補足從專業角度的出院準備並提升病患出院後的健康成效。但此研究僅為工具信效度初探，未來可以更大與多元樣本測試與驗證。

關鍵字

以病人與家屬為中心 ； 出院準備服務 ； 工具測試

並列摘要

Objectives: In this pilot study, we developed a patient and family-centered discharge planning tool (PFC-DP) for assessing hospital discharge readiness from the perspectives of Taiwanese patients and their families. Methods: From a hospital in central Taiwan, we enrolled patients aged ≥50 years. Their current self-care status and requirement for additional support before discharge were assessed using the newly developed PFC-DP tool. A follow-up assessment was conducted 30 days after discharge to obtain data on relevant health outcomes. Using these data, the validity and reliability of our tool were examined. Results: In total, 200 patients completed pilot surveys. The Cronbach's alpha values of items on participant characteristics and on the requirement for additional support were 0.71-0.95 and 0.93-0.98, respectively. A confirmatory factor analysis revealed the validity of the tool when it was formulated to have 31 questions across 6 domains (self-care information, health education, self-care ability, mobility, ability to complete household chores, and social support). Patients who had reported more difficulties in self-care ability (p < .01), mobility (p < .05), and ability to complete household chores (p < .05) had more readmissions and worse health outcomes after discharge. Furthermore, patients who had reported requiring more mobility support had more readmissions and worse mobility after discharge (p < .05). Conclusions: The PFC-DP tool is valid and reliable, and it can complement discharge planning and enhance post discharge health outcomes. Large-scale studies involving populations outside of Taiwan are warranted.

並列關鍵字

patient and family-centered ； discharge planning ； tool test

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