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建立高齡榮民病人轉銜服務照護模式之成效分析

Establishing an Effective Care Model of Transition Services for Elderly Veterans Patients

摘要


The purpose of this study was to evaluate the effectiveness of transition services for elderly veterans patients. This study was a quasi-experimental design. Elderly veterans inpatients were selected from a medical center in Taipei. This study randomly assigned patients to experimental group (n=86) or control group (n=84) by convenience sampling. The experimental group received transition services; case managers visited these patients daily. After patients were discharged into veterans' home, the case managers also visited them 6 times. The health care plan was set up by managers and the medical team of these patients. Upon discharge, the case managers contacted the medical team in the veterans' home to achieve sustainable health care. The control group received health care from the ward's case manager. The instrument included Geriatric Depression Scale (GDS), Barthel Index Scale (BIS), and service satisfaction. Demographic data were collected by the transition case manager. The unplanned reentry emergency rate, within 3-day, and 14, 30, 90, 180-day unplanned readmission rate after discharged were also collected. The service satisfactions of two groups were significantly different (t=4.20, p=.000). The study showed the patients' depression level had improved significantly (p=.03) at the second month after discharge and the satisfaction had increased significantly (p=.04) at the first month after discharge in the experimental group. Although there was no significant difference for BIS and unscheduled re-admission (p>.05), the score of BIS in experimental group was higher than the one in the control group. Moreover, the percentage of re-hospitalization in the experimental group was lower than the one in the control group. As those mentioned above, the establishment of a model of transition services not only improved depression level and elevated satisfaction, it also increased patients' daily activity and showed benefit in decreasing rehospitalization.

並列摘要


The purpose of this study was to evaluate the effectiveness of transition services for elderly veterans patients. This study was a quasi-experimental design. Elderly veterans inpatients were selected from a medical center in Taipei. This study randomly assigned patients to experimental group (n=86) or control group (n=84) by convenience sampling. The experimental group received transition services; case managers visited these patients daily. After patients were discharged into veterans' home, the case managers also visited them 6 times. The health care plan was set up by managers and the medical team of these patients. Upon discharge, the case managers contacted the medical team in the veterans' home to achieve sustainable health care. The control group received health care from the ward's case manager. The instrument included Geriatric Depression Scale (GDS), Barthel Index Scale (BIS), and service satisfaction. Demographic data were collected by the transition case manager. The unplanned reentry emergency rate, within 3-day, and 14, 30, 90, 180-day unplanned readmission rate after discharged were also collected. The service satisfactions of two groups were significantly different (t=4.20, p=.000). The study showed the patients' depression level had improved significantly (p=.03) at the second month after discharge and the satisfaction had increased significantly (p=.04) at the first month after discharge in the experimental group. Although there was no significant difference for BIS and unscheduled re-admission (p>.05), the score of BIS in experimental group was higher than the one in the control group. Moreover, the percentage of re-hospitalization in the experimental group was lower than the one in the control group. As those mentioned above, the establishment of a model of transition services not only improved depression level and elevated satisfaction, it also increased patients' daily activity and showed benefit in decreasing rehospitalization.

參考文獻


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胡愈寧、酈欽菁、李佳、林榮輝、胡國琦 (2009).老年人各項日常生活活動功能與 自評健康狀態之調查及相關性探討.臺 灣復健醫誌, 37 (2),107-114。
謝佑珊、廖淑貞、李淑瓊、董育秀、何美 滿、陳梅麗、藍忠孚、汪蘋(2007).應 用MDS-HC 2.0 台灣版評估工具於士林、 北投區獨居榮民之探討.榮總護理, 24 (3),259-269。

被引用紀錄


林淑惠(2016)。腦中風病患轉介急性後期照護後整體功能狀態之成效探討〔碩士論文,義守大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0074-2606201617344000

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