中部某區域醫院執行出院規劃之成效探討

柏惠雯

doi:10.6834/csmu202100028

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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 , Masters　　Advisor：邱怡玟　　

繁體中文 DOI： 10.6834/csmu202100028

出院規劃；個案管理；主護護理；成效指標； discharge planning ； case management ； primary nursing care ； effectiveness indicators

Abstract │ Reference (100) │ Altmetrics

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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.

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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.

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