以系統性回顧探討住院腦中風病人之出院安置地點

A Systematic Review on Discharge Destinations for Patients with Stroke

李林富(Lin-Fu Lee) ； 林彣芷(Wen-Chih Lin) ； 周偉倪(Willy Chou)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 81-96

https://doi.org/10.6315/TJPMR.202012_48(2).0002

摘要

前言：影響住院腦中風病人出院動向的因素是複雜且多元的，本研究利用文獻回顧方式，系統性地分類統整相關研究資料，探討單因子的重要性與多因子（multivariable）的預測效能。方法：本研究透過PubMed及Cochrane Library電子資源，利用stroke、discharge destination 等關鍵字搜尋2005年至2018年相關文章，並限制為原著論文及英文撰寫。結果：經篩選後共19篇納入本研究探討，相關因素歸納為年齡、性別、生活習慣、婚姻家庭、經濟社會、共病症、腦中風型態、認知與生理功能、醫療情況與地理環境，共10類別；所有研究支持年齡較小或生活功能較好者有更大機會返回居家（p＜0.05），大部分研究也顯示女性在出院後入住機構比例較大。多因子預測相關性質研究共9篇符合納入探討，其研究方法均應用羅吉斯迴歸建立模型，預測效能AUC為0.68至0.89；年齡、功能獨立量表（Functional Independence Measure, FIM）及巴氏量表（Barthel Index, BI）為常用且顯著影響之研究變項。結論：出院後不同安置地點對腦中風病人後續之生活功能與照顧花費會有明顯差異，本研究系統性歸納過往實證結果，可以提供醫療單位合宜的決策輔助，在出院準備及長照資源協助下提升病人返回居家的可能性，落實在地老化的健康照護理念。

關鍵字

腦中風（stroke） ； 出院安置地點（discharge destination）

並列摘要

Introduction: Complex and diverse factors affect the placement of patients with stroke after they are discharged from hospitals. In this study, a systematic review of relevant literature was performed to compile related research data and explore the importance of individuals factors and the overall predictive power of multiple variables. Methods: Electronic resources from PubMed and the Cochrane Library were used along with keywords such as ＂stroke＂ and ＂discharge destination＂ to search for relevant articles published between 2005 and 2018. Only original research articles written in English were selected. Results: A total of 19 articles were selected to compile 10 factors, namely age, sex, living habits, marital status, socioeconomic status, comorbidity, stroke type, cognitive and physiological functioning, medical conditions, and geographical environment. All of the studies supported that patients who were younger, or had better daily functions were more likely to return home following hospital discharge (p ＜ 0.05). Most studies reported that female patients were more likely to be institutionalized after hospital discharge. Nine studies adopted multivariable logistic regression to construct their models, in which age, Functional Independence Measure scores, and the Barthel Index were widely used variables that exhibited significant effects. The predictive power was assessed using the area under the receiver operating characteristic curve, which ranged between 0.68 and 0.89. Conclusions: Discharge destinations for patients with stroke considerably affect their subsequent daily life functioning and care costs. The results of the systematic review performed in this study can serve as a reference for medical units to make appropriate decisions. Sufficient discharge preparation and long-term care resources increase the likelihood of patients returning home after hospital discharge, realizing the healthcare goal of aging in place.

並列關鍵字

stroke ； discharge destination

參考文獻

紀珮君、宋琇鈺、周承瑤等:一位腦中風失能病患出院準備服務之護理經驗。弘光學報 2008；(54): 41-52。

West T, Churilov L, Bernhardt J. Early physical activity and discharge destination after stroke: a comparison of acute and comprehensive stroke unit care. Rehabil Res Pract 2013;2013: 498014.

郭麗敏、徐亞瑛、江慧玲等:出院準備服務對中風老人主要照顧者生活品質的影響。實證護理 2005；1(1): 35-44。

楊雅如、李俊賢、李君碩等: 物理治療師參與出院準備服務居家訪視之經驗分享。北市醫學雜誌 2018；15(1): 125-31。

陳儀倩、陳妤靜、呂孟倫等:協助一位腦中風個案出院準備服務的經驗。高雄護理雜誌 2018；35(1): 150-60。