個人收入、早期復健與缺血性腦中風病人照護結果之相關性

Associations of Individual Income and Early Rehabilitation with Outcomes for Patients with Ischemic Stroke

孫偉宸(Wei-Chen Sun)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2016年)

https://doi.org/10.6342/NTU201602860

摘要

研究背景：腦血管疾病為我國第三大主要死因，個人收入、早期復健可能與中風照護結果有關。
研究目的；探討個人收入、中風出院後早期復健與照護結果之關係。
研究方法：本研究使用全民健康保險研究資料庫百萬抽樣承保歸人檔進行分析，以2009年至2011年台灣急性缺血性腦中風出院病人為研究對象，照護結果變項包括一年內再住院及一年內死亡。統計方法以Cox比例風險模式，分析個人收入、出院後早期復健與照護結果之間的相關性，並且控制病患及區域特性。
研究結果：研究樣本數為4150人，個人收入較高，有較低的一年內死亡與再住院的風險，中風出院後早期復健上，有接受早期復健的中風病人，一年內死亡風險較低。針對出院後接受早期復健的病患，於門診復健者，相較於住院復健者，有較低的一年內再住院與死亡風險，除此，在基層診所復健者，相較於醫院復健者，有較高的一年再住院風險。
研究結論：個人收入低、出院後未接受早期復建，與出院後照護結果差有關，再者，於門診復健相較住院復健者，有較佳的照護結果，以及在醫院復健相較診所復健者，有較低的1年再住院風險。

關鍵字

缺血性腦中風 ； 復健 ； 照護結果

並列摘要

Background：Cerebrovascular disease is the third most common cause of death in Taiwan. Personal income and early rehabilitation may be related to the stroke care outcome.
Objectives：The objective of this study was to understand the relationship between individual income, early rehabilitation and outcomes after stroke.
Method：This study analyzed samples of 1 million beneficiaries of the Longitudinal Health Insurance Database, a data subset of the National Health Insurance Research Database, to investigate discharged patients that experienced an acute ischemic stroke in 2009–2011. The variables affecting the stroke care outcomes included the risks of readmission within 1 year and death within 1 year. Through the Cox proportional hazards model, the correlations among personal income, early rehabilitation, and treatment outcome were determined. The control variables were the patient and local characteristics.
Result：The patients with high personal income exhibited low risks of readmission or death within 1 year. The patients receiving early rehabilitation exhibited low risks of death within 1 year. Moreover, the patients receiving outpatient rehabilitation exhibited lower risks of readmission and death within 1 year than did those receiving inpatient rehabilitation, and the patients receiving rehabilitation in primary care clinics demonstrated higher risks of readmission within 1 year than did those receiving rehabilitation in hospitals.
Conclusion： The patients with low personal income and without receiving early rehabilitation have poor outcomes after stroke. Moreover, the patients receiving outpatient rehabilitation are better than receiving inpatient rehabilitation, and the patients receiving rehabilitation in hospitals demonstrated lower risks of readmission within 1 year than did those receiving rehabilitation in primary care clinics.

並列關鍵字

ischemic stroke ； rehabilitation ； outcomes of care

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