南部某高齡醫學中心老年病人非計畫性再住院原因之探討

Factors affecting the unplanned readmissions of elderly patients in a Geriatric medical center

邱群芳(Chun-Fang Chiu)

指導教授 ： 李逸

義守大學/醫學院/醫務管理學系/碩士(2015年)

https://doi.org/10.6343/ISU.2015.00317

摘要

目的：本研究旨在瞭解南部某高齡醫學中心老年病人出院後非計畫性再住院情形，並分析其出院後90天內非計畫性再住院的相關因素
方法：本研究為病歷回溯（Retrospective）研究設計，利用醫院電腦醫療資訊（NISS）系統審閱病歷資料，收集2012年1月至2014年12月期間曾在某醫學中心高齡醫學科病房住院之65歲以上病人資料，並逐一登錄在自擬式「病人資料表」中。本研究利用單變量分析篩選出90天內非計畫性再住院潛在因子後，再以多變量羅吉斯迴歸（Logistic regression）分析這些危險因子。
結果：扣除不符合收案條件者，總共得樣本366位。研究對象平年齡83.1±6.8歲。男性264人（72.1%）女性102人（27.9%）。在語言溝通方面以國語為主（244人、66.7％）。依住院中第一診斷碼做疾病系統分類，前三個住院主要診斷分別為一般老年症狀群（24.3％）、骨骼及關節疾病（19.1％）與感染相關性疾病（11.5％）。入院來源以急診比率較高(75.4%)。研究對象14天內、30天內、60天內與90天內非計畫性再住院率分別為4.9%、9.6%、13.9%與20.2%。以多變量羅吉斯迴歸（Logistic regression）分析顯示：研究對象年齡≧85歲者比65~75歲者有較低的90天內非計畫性再住院率(32.6% vs 16.7%，OR=0.32，95%CI：0.14-0.72，P=0.007)；前次住院入院途徑經由急診入院者比門診入院者有較高的90天再住院率（23.6% vs 10.0%，OR=2.45，95%CI：1.11-5.42，P=0.026）；研究對象罹患惡性腫瘤(佔30.4％)、心臟病(佔28.1％)、腎臟病(佔36.5％)、慢性肺病(佔30.5％)、血色素質值低於11.5mg/dl者 (佔26.9％)有較高的住院後90天內分計畫性再住院情況，其勝算比(95%CI）分別為2.21(1.09-4.49)、1.93(1.09-3.41)、2.65(1.31-5.33)、2.18(1.08-4.39)與1.91(1.06-3.45)。
結論：影響老人非計畫性再住院的因素，案除了年齡與急診入院外，惡性腫瘤、心臟病、腎臟病、慢性肺病史、血色素質檢驗值＜11.5mg/dl亦是90天非計畫性再住院的獨立預測因子。因此，醫護人員在臨床老人照護上需針對罹患不同慢性疾病的老年病人，給予營養與慢性疾病的整合醫療照護，以有效改善老年病患非計畫性再住院問題。

關鍵字

老年 ； 非計畫性再住院 ； 羅吉斯迴歸分析

並列摘要

Background: Re-hospitalizations for elderly patients are an increasing health care burden, and readmission rates are considered to be an indicator of quality in health care management. Nonetheless, limited information about unplanned re-hospitalizations for the elderly is available in Taiwan. The purpose of this study was to understand the rate of unplanned re-hospitalizations and to identify the related risk factors in a geriatric medical center in Taiwan.
Methods: A case-control study was conducted. The elderly patients hospitalized in a geriatric medical center in south Taiwan from January 1st, 2012, to December 31st, 2014 were selected. The eligible cohort of patients was divided into two groups: patients who were readmitted within 90 days (the re-admitted group) and those who admitted but not readmitted within 90 days of discharge (non-readmitted group). All data were analyzed by the SPSS for windows software package. The chi-square tests were used to compare the demographic and clinical data between the two groups, while the multiple logistic regression was used to determine the possible risk factors.
Results: All 366 elder people were analyzed. Of them, 264 (72.1%) patients were male, while 102 (27.9%) patients were female. The means of age was 83.1±6.8 years. The first three major diagnoses of admission were general geriatric syndrome (24.3％)、skeletal disease (19.1％) and infection (11.5％). Most patients hospitalized from emergency room (75.4%). The unplanned re-admission within 14 days, 30 days, 60 days and 90 days were 4.9%、9.6%、13.9% and 20.2%, respectively. Compared with the young-old people (65-74 years), the odds ratio of the oldest-old people (≧85 years ) was 0.32 (95%CI：0.14-0.72，P=0.007). The other significant factors that were associated with the unplanned re-admission within 90 days included the pathway of admission (via emergency room , OR=2.45, 95%CI：1.11-5.42，P=0.026）, malignant tumor (OR=2.21, 95%CI：1.09-4.49), heart disease (OR=1.93, 95%CI：1.09-3.41),kidney disease (OR=2.65, 95%CI：1.31-5.33), chronic lung disease (OR=2.18, 95%CI：1.08-4.39) and the lower value of hemoglobin (＜11.5mg/dl , OR=1.91, 95%CI：1.06-3.45).
Conclusion: We identify the elder patients who are prone to readmission within 90 days. We suggested that the healthcare providers should aware of these risk factors when caring the elder people. Such high patients may also be allocated to an intervention program that would minimize the rate of readmission and reduce the overall cost of patient care and the burden in health service.

並列關鍵字

the elderly ； unplanned re-admissions ； Logistic Regression analysis

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