腦中風者在醫院入出院與長期照顧機構能力回復之探討

研究背景與目的：腦血管疾病為國人10大死因的第4位。腦中風患者若能妥善治療、積極復健及配合訓練日常生活活動(activities of daily living, ADL) 功能，就能儘早回復能力。隨著病發後急性期至恢復期時，接受照顧服地點會在居家、醫院及長期照顧服務機構間轉移。因此本研究指在探討腦中風者存活率分析及腦中風者在醫院和長期照顧機構間的日常生活功能(ADL)轉移模式。研究方法：本研究利用長照入出院準備通報及衛生福利部照顧服務管理資訊平台資料，以在2018年1月1日至2019年7月31日彰化縣因腦中風住院的長照、入出院50歲以上者為對象，分析腦中風入院者之存活分析追蹤世代、日常生活功能(ADL)變化趨勢追蹤世代。研究結果：一.腦中風患者存活率分析: 存活分析資料共計5,798人，男性比例佔56.5%；初次中風入院的年齡分布以80至84歲最高，而活動能力不好、活動能力好及活動能力很好的比例分別為42%、27%及30% 二.日常生活功能(ADL)變化趨勢之三階段轉移模式分析：觀察區間內日常生活功能評估重複大於第於2次者共1,497人，男性、女性分別佔57.2、42.8%，女性多集中於75-90歲的年齡層、男性年齡層分布則較分散；分析日常生活功能(ADL)轉移速率與不同機構間轉移的情況，持續在長照機構的轉移速率最低，代表身體功能有機會變好；而針對其他轉移模式，皆是身體功能變差的速率較高，特別是對於機構間的轉移(醫院至長照機構及長照機構至醫院)，整體身體功能變差的轉移速率皆高出許多。三.本研究結果發現居家、醫院及長期照顧服務機構間轉換會增加功能退化的風險，未來減少腦中風者機構間的轉移是政策的首要目標。研究結論：高齡者的疾病複雜度高，不僅需要較多的照顧，其接受照顧服務的地點亦經常於居家、醫院及長期照顧服務機構間轉換。因此，醫療服務體系與長期照顧體系加速適切地整合與協調是立即重視的核心議題。

關鍵字

腦中風；長期照顧；出院準備服務；日常生活功能；寇斯回歸；存活分析

並列摘要

Background and purpose： Cerebrovascular disease (CVD) is the fourth leading cause of death among Taiwanese. If stroke patients can be properly treated, actively rehabilitated trained for activities of daily living (ADL) function, they will be able to recover as soon as possible. From the acute stage to the recovery stage, patients might move among places, including homes, hospitals and long-term care institutions, for different care services. Therefore, the survival rate and the transfer model of ADL between the hospitals and long-term care service agencies of CVD patients were analyzed in this study. Methods： The data from the hospital admission and discharge planning system, and the Care Services Management Information Platform of the Ministry of Health and Welfare were used in this study. The subjects of the study were those aged 50 and over who were hospitalized for stroke and were admitted to and discharged from the hospital in Changhua County from January 1, 2018 to July 31, 2019. This study analyzed the survival analysis of stroke patients and the changing trend of ADL. Results： 1.Survival analysis of stroke patients: A total of 5,798 people were enrolled in the survival analysis. The proportion of men is 56.5%; The age distribution of first stroke admission were the highest in 80 to 84 years old. The proportions of poor, moderate, and good function were 42%, 27%, and 30%, respectively. 2.Analysis of the three-stage transfer model of the changing trend of ADL: In the observation interval, there were 1,497 people who were repeatedly assessed by ADL more than 2 times. Males and females accounted for 57.2 and 42.8% respectively. Women were mostly in the age group of 75-90 years old, while the distribution of men's age group is more scattered. The ADL transfer rate of stroke patients who continue to stay in long-term institutions is the lowest, which means that their physical functions have a chance to improve. For other transfer modes, older adults’ physical transfer rate were higher, which indicated that their function were more likely to deterioration, especially for the transfer between institutions between hospital to long-term care service agencies and from long-term care service agencies to hospital. the transfer rate of deterioration of overall physical function is much higher. 3.The results suggested that the transition between homes, hospitals, and long-term care institutions will raise the risk of functional deterioration. In the future, reducing the transition of stroke patients between institutions is the primary goal of the health care policy. Conclusions： Older adults’ disease treat and management is highly complex, and they did not only require more care, but also the more likely to move from places to places for their care. Our study examined older adults’ physical function change during their transfer among homes, hospitals and long-term care institutions. Our findings indicated that older adults’ physical function were more likely to deteriorate during transfer between long-term care and acute care systems. Therefore, promoting integration and coordination of the acute care service system and the long-term care system shall be a priority for future policymaking.