住院病患傷害性跌倒的影響因素與其醫療資源耗用之相關性

Correlation between Risk Factors and Resource Utilization in Fall-Related Injuries among Hospitalized Patients

陳玉枝(Yu-Chih Chen) ； 林麗華(Li-Hwa Lin) ； 簡淑芬(Su-Fen Chien)

《志為護理-慈濟護理雜誌》 1卷3期 (2002/09) Pp. 66-77

https://doi.org/10.6974/TCNJ.200209.0066

摘要

本研究的目的：（一）確立影響住院病患傷害性跌倒的生理因素：（二）評估住院病患傷害性跌倒與藥物治療的關係：（三）評估住院病患傷害性跌倒與其住院天數及醫療費用之相關性。採回溯性個案控制(Case-Control)的方法。以參加台灣醫療品質指標計畫(TQIP)之醫學中心及區域醫院，各取三家為研究對象。於民國90年6月1日至8月31日住院期間內發生有正式紀錄之傷害性跌倒病患，俟跌倒組病患出院後，非跌倒組依控制變項（年齡±10歲、性別、診斷、跌倒事件發生前住院天數、疾病嚴重度）進行回溯性個案配對，共94對（合計188名病患）。研究工具包括傷害性跌倒組及非跌倒組之基本資料問卷表、意識狀態評估表(Glasgow Coma Scale)及疾病嚴重度量表(Charlson Comorbidity Score)。資料來源為病患跌倒紀錄表、病歷紀錄及健保醫療費用中報資料。研究結果：（一）跌倒生理因素：病患血色素低及最近一年跌倒超過一次以上者，與傷害性跌倒有顯著的相關：（二）跌倒與藥物因素：24小時內服用鎮靜安眠劑及跌倒前四天服用抗組織胺藥物，與傷害性跌倒有顯著的相關：（三）平均住院天數：傷害性跌倒組比非跌倒共且多6.4日：（四）住院總醫療費用：傷害性跌倒組比非跌倒組多23，339.2元。研究結果可提供護理人員評估高危險病患的參考及採取防範措施，以確保病患安全及減少醫療資源的耗用。

關鍵字

跌倒 ； 傷害性跌倒 ； 住院天數 ； 醫療費用

並列摘要

The purposes of this study were as follows: (1) to identify correlates of fall-related injuries among hospitalized patients; (2) to evaluate the risk for falls associated with exposure to drugs; (3) to estimate the additional length of stay and total charges associated with the fall-related injury of a hospitalized patient. The writer performed this retrospective case- control study in a Taiwan Quality Indicator Project (TQIP) at each of three medical centers and community hospitals. Ninety-four patients had been reported as having fallen and received injuries, after being admitted between June 1, 2001 and August 31, 2001. The 94 controls were matched by age (within 10 years), gender, diagnosis, pre-event length of stay and patient acuity. The study tools included an incidence report, the Glasgow Coma Scale and Charlson Comorbidity Score. Resource utilization data were obtained from each hospital's financial database. The results of the study indicated: (1) low hemoglobin and history of falls (within the previous 1 year) were correlated with a fall (P＜0.05); (2) the use of sedative/hypnotic agents within the previous 24 hours, and the use of antihistamine groups within 4 days were correlated with a fall; (3) falls were correlated with an increased length of stay; those who fell stayed 6.4 days longer than controls did; (4) those who fell had total charges NT$23,339.20 higher than did controls. Fall-related injury was associated with substantially increased resource utilization. The writer identified risk factors which will benefit nurses in assessing patients, and thus prevent falls.

並列關鍵字

fall ； fall-related injury ； length of stay ； medical fee