出院準備服務：出院後不同照護模式的選擇、再入院率、死亡率的分析

Discharge Planning: Care Model, Re-admission Rate, and Mortality Rate after Discharge

史麗珠(Lai-Chu See) ； 莊凱嵐(Kai-Lan Chuang) ； 黎慧芳(Hui-Fang Li) ； 王惠玄(Hui-Hsuan Wang) ； 胡文潔(Wen-Chieh Hu) ； 王曉慧(Siao-Huei Wang) ； 蔡玉霞(Yu-Hsia Tsai) ； 鄭學慧(Shiue-Huei Jeng)

《中山醫學雜誌》 22卷1期 (2011/03) Pp. 23-33

https://doi.org/10.30096/CSMJ.201103.0003

摘要

背景：出院準備服務在縮短病患住院天數、減少醫療成本、增加病患滿意度都有不錯的成效，但出院後照護模式的選擇、再入院率、死亡率的報告則非常有限。目的：北部某區域醫院自2006年8月有專任個案管理師負責出院準備服務，本文整理此醫院有接受出院準備服務的內外科病患的資料，包括選擇的照護模式、2個月內再入院率及死亡率，探討此三個結果變項的影響因素。方法：回溯及鍵入2006年8月至2007年7月的資料，作統計分析。出院後選擇照護模式之多變量分析採Polychotomous regression，再入院率及死亡率則採Cox's proportional hazard model。結果：共206位病患的資料納入分析(85.5%)。出院後選擇照護模式以回家組98人(47.6%)最多，其次為居家護理組66人(32.0%)，安養護機構組42人(20.4%)。多變量分析結果顯示，巴氏量表分數、糖尿病病史、意識與照護模式之選擇達顯著意義。2個月內再入院率為112%，95%信賴區間為6.9~15.5%。多變量分析結果顯示，照護模式、巴氏量表分數、照護者與病患關係與再入院率達統計顯著意義。2個月內死亡率為5.8%，95%信賴區間為2.6~9.0%。只有褥瘡與死亡率有達統計顯著意義。結論：本論文提供接受出院準備服務病患於出院後照護模式選擇、2個月再入院率及死亡率的統計結果。研究發現，巴氏量表得分落在完全依賴者、有糖尿病病史或是意識狀態為嗜睡者，選擇居家照護或是安養護機構的機會較回家高。巴氏量表得分在完全依賴者、選擇安養護機構、由非親屬照顧，再入院的機率就越高。有褥瘡者的死亡風險顯著高於沒有褥瘡者。

關鍵字

出院準備服務 ； 照護模式選擇 ； 再入院率 ； 死亡率 ； 個案管理

並列摘要

Background: Although many studies report positive effects of discharge planning with regard to length-of-stay, health expenditures, and patient satisfaction during hospitalization, it is unclear what occurs after these patients are discharged from the hospital. Aims: This study examined data from one regional hospital which employed a full-time case manager to perform discharge planning since August 2006. Three outcome variables after discharge were focused, including care model chosen (going home, home care, nursing home), 2-month re-admission rate, and 2-month mortality rate for those who received discharge planning services from August 2006 to July 2007. Methods: Data between August 2006 and July 2007 was retrospectively reviewed. We used polychotomous regression analyze care model chosen and Cox's proportional hazard model for re-admission and mortality rates. Results: A total of 206 (85.5%) observations were collected. After discharge, going home (98, 47.6%) was the most common care model chosen by the participants, followed by home care (66, 32.0%), and institution or nursing home (42, 20.4%). Multivariate analysis revealed that the Bathel Index (BI), DM history, and consciousness level to be significantly associated with the care model chosen after discharge. The re-admission rate within 2 months was 11.2% (95% confidence interval (CI)=6.9-15.5%). Multivariate analysis revealed that the care model chosen, BI, and the relationship between the care giver and the participants were significantly associated with the re-admission rate. The mortality rate within 2 months was 5.8% (95% CI=2.6-9.0%). Only the incidence of bedsores was significantly associated with mortality. Conclusion: We provided statistics about the care model chosen, readmission rate within 2 months, and mortality within 2 months for patients who received discharge planning services. We found that patients, who were totally dependent based on their BI, had DM, and were unconscious, were more likely to choose home care or nursing home after discharging from the hospital. The readmission rate was higher in patients who were totally dependent based on their BI, chose nursing home, were taken care by non-relatives. The mortality rate was higher in patients with bedsores than those without bedsores.

並列關鍵字

discharge planning ； care model chosen ； re-admission rate ； mortality ； case management