整合照護團隊對急性腦中風病人照護成效之探討-以某醫學中心為例

Exploring the Effect of Integrated Care Team for Patients with Acute Stroke in a Medical Center

陳哲維(Che-Wei Chen)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2019年)

https://doi.org/10.6342/NTU201902419

摘要

背景與目標：腦血管疾病是造成全球人口死亡與失能的主要原因，其伴隨的支出更是沉重負擔。綜觀近年各國指標及臨床應用，跨領域之團隊照護，已成為目前趨勢。本研究藉由腦中風病人之相關指標，探究腦中風整合照護團隊是否增進病人之整體照護成效。

研究方法：以某醫學中心之病歷資料庫、院內資訊系統及個案管理檔案，將2017年1月至2018年6月之個案(566位)，作為腦中風整合照護團隊介入前之組別；2018年7月至2019年3月之個案則作為介入後之組別(276位)，利用其登錄之腦中風照護指標，進行多變量分析。

研究結果：團隊介入後有改善的照護指標，急診照護方面，包括蜘蛛膜下腔出血中風病人在接受手術前或未接受手術到院6小時內有接受嚴重度評估及美國國家衛生研究院腦中風量表(National Institute of Health Stroke Scale, NIHSS)評估完成率；住院照護方面，包括巴氏量表(Barthel Index, BI)及改良Rankin量表(Modified Rankin Scale, MRS)評估完成率、心房顫動病人使用抗凝血藥物及病人接受復健評估或治療；出院照護方面，包括急性中風病人14日內非計畫性再入院率及NIHSS量表出院評估完成率。

結論與建議：根據研究結果，急性腦中風病人之照護成效與整合照護團隊介入，無論急診、住院或出院照護，均有指標呈現改善。建議未來研究者可增加預後指標、住院天數或費用等項目，以提供更全面之探討。

關鍵字

急性腦中風 ； 整合照護團隊 ； 醫療品質 ； 照護指標 ； 照護成效

並列摘要

Background: Cerebrovascular disease is one of the primary causes of death and disability worldwide and responsible for significant financial expenditure. Major indicators and clinical applications of countries in recent years show that intergrated team care for patients has become a significant trend. This study uses relevant indicators of patients with acute stroke to discuss whether an integrated care team could improve the holistic efficacy of patient care.

Methods: This study accessed the medical database, the information system, and case management files of a medical center and identified 566 cases from January 2017 to June 2018 as the pre-intervention group, and 276 cases from July 2018 to March 2019 as the post-intervention group. The stroke care indicators registered in the database were used for multivariate statistical analysis.

Results: There are significant improvement in multiple care indicators after the intervention of the integrated care team. In emergency care, the severity assessment before operation or unoperated within 6 hours upon arrival of stroke patients caused by subarachnoid hemorrhage, and completion rate of the National Institute of Health Stroke Scale(NIHSS) have improved. In inpatient care, completion rate of Barthes Index(BI), completion rate of Modified Rankin Scale(MRS), using anti-coagulant medication on patients with atrial fibrillation, and taking rehabilitation assessment or treatment have improved. In discharge care, unplanned 14-day readmission rate and completion rate of the National Institute of Health Stroke Scale(NIHSS) have improved.

Conclusions: With the intervention of the integrated care team, research results show that indicators of the care efficacy of acute stroke patients increased in emergency care, inpatient care, and discharge care. It is recommended that future researchers can include prognostic indicators, duration of hospitalization, and expenditure for a more comprehensive study.

並列關鍵字

Acute Stroke ； Integrated Care Team ； Quality of Care ； Health Care Indicators ； Efficacy of Care

參考文獻

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