中部某區域醫院執行出院規劃之成效探討

Study on the effectiveness of hospital discharge planning in Central Taiwan

柏惠雯(Hui-Wen Po)

指導教授 ： 邱怡玟

中山醫學大學/醫學院/護理系長期照護碩職專班/碩士(2021年)

https://doi.org/10.6834/csmu202100028

摘要

爲落實長期醫療照護及提昇病患後續照顧之服務理念，院方推動出院規劃小組，並結合醫療團隊提供個案管理，保障病患高品質照護。本研究目的旨在比較中部某區域醫院執行出院規劃之個案管理模式與主護護理模式兩種不同模式之成效差異，包含住院天數、再入院情形、後續資源利用及存活情形等。採病歷回溯性研究設計，針對某區域教學醫院自2017年至2018年，接受出院規劃的病人為研究對象。以病歷資訊系統資料庫及衛生福利部照顧服務管理資訊系統進行資料收集，探討其醫療及後續照護利用情形。研究結果發現ADL≦60分、帶有管路、慢性病控制不良、主要照顧者能力不足等因素容易導致超長住院；男性和帶有管路者30天內再入院之風險較高，且男性、年齡≧75歲、ADL≦60分、帶有管路、有壓傷或非清潔傷口、具經濟問題、主要照顧者能力不足、14天內與30天內再入院者的出院後死亡情形明顯提升，而二種不同出院規劃模式在各項出院成效的指標上則無明顯差異。雖然個案管理的介入對減少病人的住院天數、再入院率等沒有影響，但提早照會出院規劃個管師有助於病人返家後持續性的照顧與相關資源的利用。

關鍵字

出院規劃 ； 個案管理 ； 主護護理 ； 成效指標

並列摘要

In order to implement the service of long-term medical care and improve patient continuity care, the hospital promoted discharge planning and provided case management in conjunction with the medical team to ensure high-quality care for patients. The purpose of this study was to compare the effectiveness of the case management model and the primary nursing care model of a regional hospital in central Taiwan, including inpatient days, readmission status, follow-up resource utilization, and survival status, etc. A retrospective study design based on medical records, and the patients who received the discharge plan from 2017 to 2018 in a regional teaching hospital were the research objects. Used the the medical record information system database and the care service management information system of the Ministry of Health and Welfare to collected data and explored the patients’ medical and follow-up care utilization. The results of this study showed that factors such as ADL≦60 points, with catheters, poor control of chronic disease, and insufficient capacity of the caregivers could potentially lead to longer hospitalizations. At the same time, men and those with catheters have a higher risk of re-admission within 30 days. Moreover, males, age ≥ 75 years old, ADL ≤ 60 points, with catheters, pressure sores or unclean wounds, financial problems, insufficient capacity of caregivers, and those who were re-admitted within 14 days and 30 days after discharge were significantly increased mortality after discharge. However, the two different discharge planning models had no significant differences in the indicators of discharge effectiveness. Although the intervention of case management had no effect on reducing the inpatient days and the readmission rate, if the medical staff could consult the case manager for discharge planning earlier, it will help patients’ continuous care and use related resources after returning home.

並列關鍵字

discharge planning ； case management ； primary nursing care ； effectiveness indicators

參考文獻

一、英文文獻

1.Atienza, F., Anguita, M., Martinez-Alzamora, N. (2004). Multicenter randomized trial of a comprehensive hospital discharge and outpatient heart failure management program. Europeancc journal of heart failure ,6(5), 643-652. https://doi.org/10.1016/j.ejheart.2003.11.023

2.Bridger, C. M., Smith, S. E., Saunders, S. T. (2017). Saving lives and saving money: The role of North Carolina Health Departments in medicaid managed care. North Carolina Medical Journal, 78(1), 55-57. https://doi.org/10.18043/ncm.78.1.55

3.Brown, J. R., Chang, C. H., Zhou, W., MacKenzie, T. A., Malenka, D. J., Goodman, D. C. (2014). Health system characteristics and rates of readmission after acute myocardial infarction in the United States. Journal of the American Heart Association, 3(3). https://doi.org/10.1161/JAHA.113.000714

4.Case Management Society of America( 2016). Standards of Practice for Case Management. Little Rock, Arkansas.