缺血性腦中風病人非計畫性再住院相關因子的探討-以某醫學中心為例

Exploring the Association of the Relative Factors of Unplanned Readmission for Patients with Ischemic Stroke in a Medical Center

王斐慈(Fei-Tzu Wang)

指導教授 ： 鍾國彪 ； 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(2017年)

https://doi.org/10.6342/NTU201701762

摘要

研究背景：於2015年，由醫策會的「醫療品質指標管理中心」規畫並辦理「醫院品質績效量測指標系統與落實品質改善計畫」推動第二階段，新增中風病人層級的指標。而「非計畫性再住院」被認為是醫療機構重要的結果評值成效指標之一，如何降低非計畫性再住院的發生一直是醫療機構所重視的議題。

研究目的：瞭解缺血性中風病人非計畫性再住院的病人特性，以及探討中風病人層級過程面指標的組合分數與30/90天非計畫性再住院之間的關係。

研究方法：本研究資料來源取自於臺大醫療體系醫療整合資料庫、P4P中風指標登錄表，及臺大總院腦中風個案管理檔進行本研究的資料分析。以2015年10月~2016年9月出院之缺血性腦中風病人為研究母體，利用複羅吉斯迴歸模型，探討缺血性腦中風病人層級過程面指標的兩種組合分數(原始分數加總、70%標準法)與30/90天內是否有非計畫性再住院的關係及可能影響之相關因素。

研究結果：病人分布情形為男性占59%，平均年齡68.78歲。病人層級過程面指標的兩種組合分數分別與30天內非計畫性再住院達統計上顯著相關(p = 0.0195 ; p = 0.0298)。病人危險因子部分，抽菸/心臟相關疾病分別與30天內/ 90天內非計畫性再住院達統計上顯著相關(p = 0.0497 ; p = 0.0299)。

結論與建議：缺血性腦中風病人30天內非計畫性再住院的預測因子有照護過程組合分數與抽菸，90天內非計畫性再住院的預測因子為心臟相關疾病。建議未來可探討不同層級別/嚴重度/年齡層的分組對於缺血性腦中風病人30天內/90天內非計畫性再住院之影響是否有不同程度上的差異，若能進一步與全國的健康資料串聯更佳，便能獲得較完整的病人流向追蹤。

關鍵字

缺血性腦中風 ； 非計畫性再住院 ； 組合分數 ； 照護過程 ； 醫療品質

並列摘要

Background: In 2015, the "Hospital Quality Performance Measurement Index System and Implementation Quality Improvement Program" was developed and implemented by the "Center for Quality Management of Healthcare Indicators", which is part of the Joint Commission of Taiwan. Findings from the second stage of this program were used to increase the effectiveness of patient level indicators of stroke. Furthermore, "unplanned readmission" was found to be an important indicator of medical institution quality. Therefore, determining how unplanned readmission rates can be reduced has become an important area of health management research.

Objectives: In this study, we sought to elucidate the characteristics of patients who experienced unplanned readmission for ischemic stroke. We also explored associations between composite process scores (which are used to determine the effectiveness of patient-level indicators) and unplanned 30- and 90-day hospital readmissions in ischemic stroke patients.

Methods: This study investigated a retrospective cohort of ischemic stroke patients who were discharged from the hospital between 2015 and 2016. For this analysis, we used data from the Medicine Integrated Database maintained by the National Taiwan University Hospital Healthcare System, pay-for-performance documents, and case management files of stroke patients. Specifically, we applied multiple logistic regression modeling to investigate how various hospital- and patient-level factors affect unplanned readmission rates for ischemic stroke.

Results: In this study, 59% of the patients were male, and the mean age of all patients was 68.78 years. We identified significant correlations between the two composite scores (Row Sum Score & 70% Standard) describing patient-level process indicators and unplanned readmissions within 30 days (p = 0.0195 ; p = 0.0298). Considering
patient risk factors, smoking and heart-related disease were significantly correlated with unplanned readmission within 30 days and 90 days (p = 0.0497 ; p = 0.0299), respectively.

Conclusions: For ischemic stroke patients, composite scores and smoking were found to be predictors of unplanned readmission within 30 days; heart-related disease was found to be a predictor of unplanned readmission within 90 days. We suggest that future research on ischemic stroke patients investigate different hospital levels, degrees of stroke severity, and patient age groups in order to further elucidate the adverse effects of unplanned readmission within 30 and 90 days. We also suggest that future researchers include data from the National Health Insurance database in their analysis order to obtain results that are as robust and generalizable as possible.

並列關鍵字

ischemic stroke ； unplanned readmission ； composite score ； process of care ； quality of care

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