缺血性腦中風病人復健強度與照護結果之關係—以某醫學中心為例

Relationship Between Rehabilitation Intensity and Outcomes for Patients with Ischemic Stroke in a Medical Center

陳芊宇(Chien-Yu Chen)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2020年)

https://doi.org/10.6342/NTU202001490

摘要

背景：腦中風是造成全球人口死亡與失能的主要原因之一，因此病患在中風後之黃金時間內接受復健治療非常重要，探討復健強度與醫療照護成效的研究並不多，且復健治療強度的定義方式有待更為精確，照護結果的探討也應更為全面。
目的：本研究透過更精確的復健強度定義，探討缺血性腦中風病患在住院期間所接受之「復健治療強度」，與其出院後30日與90日內的醫療成效指標：「非計畫性再入院」、「再急診」間之相關性。
方法：利用「臺大醫療體系醫療整合資料庫」以及「P4P病人層級中風指標登錄檔」，以2015年10月至2017年9月間首次因腦中風住院，20歲以上之缺血性腦中風病患為研究對象，並利用複邏輯斯迴歸探討住院復健治療強度與病患出院後30天以及90天內之急診與非計畫性再入院之相關性。
結果：研究樣本共有1072人，住院期間接受高強度復健者，有較低的出院後30日急診、90日急診、與30日非計畫性再入院情形。
結論：較高強度的復健強度可以降低中風病患出院後30日、90日之急診以及30日非計畫性再入院的發生。

關鍵字

缺血性腦中風 ； 復健強度 ； 照護結果 ； 非計畫性再入院 ； 出院後再急診

並列摘要

Objective: Stroke is one of the leading causes of death and disability in the world, it is therefore important for patients to receive rehabilitation treatment during the golden time after a stroke. However, there have not been many studies examining rehabilitation intensity and health care outcomes, the definition of rehabilitation intensity needs to be refined, and the study of care outcomes should also be more comprehensive.
Methods: In this study, a more precise definition of rehabilitation intensity was used to examine the correlation between the “rehabilitation intensity” of ischemic stroke patients during hospitalization and the indexes of their medical outcomes within 30 and 90 days after hospital discharge: “unplanned readmissions” and “emergency department revisits”. Using data from the Medicine Integrated Database maintained by the National Taiwan University Hospital and P4P Patient-Level Stroke Index Registry, ischemic stroke patients aged 20 years or older who were hospitalized for the first time for stroke between October 2015 and September 2017 were selected to investigate the correlation between the intensity of inpatient rehabilitation treatment and patients' emergency department revisits and unplanned readmissions within 30 and 90 days after discharge using multivariate logistic regression.
Results: The study sample consisted of 1072 patients. Those who underwent high-intensity rehabilitation during their hospitalization had lower rates of 30-day and 90-day emergency department revisits and 30-day unplanned readmissions after discharge.
Conclusion: Higher rehabilitation intensity can reduce the chances of 30-day and 90-day emergency department revisits and 30-day unplanned readmissions in stroke patients after discharge.

並列關鍵字

Ischemic Stroke ； Rehabilitation Intensity ； Outcomes ； Unplanned Readmission ； emergency department visit after discharge

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