第2型糖尿病病患非計劃性再入院之主要預測因子

Predicators of Unplanned Readmission of Patients with Type 2 Diabetes Mellitus

高金盆(Chin-Pen Kao)

指導教授 ： 邱啟潤

高雄醫學大學/護理學院/護理學系研究所/碩士(2010年)

https://doi.org/10.6832/KMU.2010.00026

摘要

目的：第2型糖尿病是一種全身的疾病，臨床上會出現多樣的慢性合併症，本研究探討糖尿病病患出院30天內非計劃性再住院率及其重要預測因子。
方法：本研究採用病例對照研究法，以2008年在南部某醫學中心出院之第2型糖尿病病患為樣本，病例組為第2型糖尿病病患出院30天內非計劃性再住院者，對照組為第2型糖尿病病患出院30天內無再住院者；對照組與病例組抽樣比例為1：2，將年齡（± 5歲）與性別配對後，再隨機選取病例組149位，對照組298位，並進行病歷資料的查閱。
結果：第2型糖尿病病患非計劃性再入院率為10.02%（674/6725），非計劃性再入院之預測因子為：居住在一般鄉村鄉鎮（OR=0.50, 95% CI: 0.30-0.85, p< .05）、共病症指數（OR=1.33, 95% CI: 1.16 -1.57, p< .001））、前一年住院次數（OR=2.11, 95% CI: 1.47-3.03, p< .001）、視網膜病變（OR= 2.62, 95% CI: 1.08-6.37, p< .01）、血糖值（OR=1.01, 95% CI: 1.00-1.01, p< .01），出院時有傷口存留（OR=0.29, 95% CI: 0.15-0.53, p< .001）、住院天數（OR=1.07, 95% CI: 1.02-1.12, p< .01）、接受輔具使用指導（OR=2.71, 95% CI: 1.27-5.75, p< .01）及接受糖尿病衛教（OR=0.75, 95% CI: 0.67-0.85, p< .001）。
結論：應將共病症指數、前一年住院次數納入出院準備高危險群的篩檢收案的必要項目，加強糖尿病病患血糖的控制與監測，定期做眼底檢查，確實執行傷口照護及輔具需求的評估與指導，並落實糖尿病衛教指導，住院天數愈久之病患應加強出院準備的準備計畫，以降低第2型糖尿病病患出院30天內非計劃性的再入院。

關鍵字

糖尿病 ； 再入院 ； 出院準備服務 ； 病例對照研究法

並列摘要

Objective: Type 2 diabetes mellitus (DM) is a chronic systemic disease with multiple organ complications including arteriosclerosis, neuropathy, nephropathy and retinopathy. To investigate the readmission rate and significant predicting factors of readmission from discharged diabetic inpatients in a medical center in Taiwan.
Research design and methods: A case control study was conducted in a medical center in southern Taiwan. Patients who were discharged from a medical center and were diagnosed with type 2 DM from 2008 January 1 to 2008 December 31 were recruited. A 1:2 individual-matched case-control study was conducted. Individuals of discharged type 2 DM inpatients in a medical center were matched on sex and age (±5 years old) of cases were selected as controls. 148 type 2 DM patients with unplanned readmission history of 30 days after discharge were recruited to join the experimental group; 298 type 2 DM patients without unplanned readmission history of 30 days after discharge were recruited to join the control group. Data will be collected through medical records.
Results: Study results found that the readmission rate of type 2 DM in the study population was 10.02% (674/6725). The significant predicting factors of readmission were residents in general village（OR=0.50, 95% CI: 0.30-0.85, p< .05）; Charlson comorbidity index score （OR=1.33, 95% CI: 1.16 -1.57, p< .001）; the numbers of hospital admission one year ago（OR=2.11, 95% CI: 1.47-3.03, p< .001）; retinopahty（OR= 2.62, 95% CI: 1.08-6.37, p< .01）; the plasma glucose（OR=1.01, 95% CI: 1.00-1.01, p< .01）; wound at dishcarge（OR=0.29, 95% CI: 0.15-0.53, p< .001）; length of stay（OR=1.07, 95% CI: 1.02-1.12, p< .01）; learning device education（OR=2.71, 95% CI: 1.27-5.75, p< .01）and diabetes education program （OR=0.75, 95% CI: 0.67-0.85, p< .001）.
Conclusions: The results of this study may enhance Charlson comorbidity index score and the numbers of hospital admission one year ago to the determinants of preparing discharge risk group among DM patients. As a result, effective strategies of blood sugar control, regular retina examined, wound care learning device education and long-term admission periods can be developed, and the readmission rate of the DM patients may be reduced.

並列關鍵字

diabetes mellitus ； readmission ； discharge planning service ； case-control study

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease, 40(5), 373-383.

ㄧ、中文部份

行政院衛生署（2007）．台灣糖尿病防治推動現況與展望．2009年10月16日取自http://www.bhp.doh.gov.tw/bhpnet/portal/Them_Show. aspx?Subject=200712250014&Class=2&No=200712250083

行政院衛生署（2009，5月22日）．2005-2008國民營養健康狀況變遷調查．2009年10月16日取http://nahsit.survey.sinica.edu.tw/node/19

李美璇、潘文涵、張新儀（2007，10月16日）．台灣地區老人營養健康狀況調查1999-2000台灣老人糖尿病之盛行現況．2007年10月16日取自http://www.ibms.sinica.edu.Tw/~pan/nahsit/ nahsit2 /publication/dm.doc