- 期刊
Appropriateness of Hospital Admissions of Gastroenteric Patients via Emergency Services
急診腸胃疾病患者住院適當性之評估
摘要
目的：使用修訂之台灣版住院適當性評估表(T-Appropriateness Evaluation Protocol, T-AEP)，檢定其信度、效度，以了解其做為篩檢急診腸胃疾病病患住院適當性工具之可用性。方法：以中部某醫學中心341接受急診照護病患（171男性；170女性）為研究對象，由二位專科醫師及二位護理師以「台灣版住院適當性評估表」判定其住院適當性，以估算急診不適當住院率，並檢測本研究工具之信度、效度及實用性。結果：不適當住院率為8.2%，其中63.2%之不適當住院原因，來自其病情可在門診接受治療；T-AEP在效度方面，k係數=0.86，95%信賴區間：0.77-0.95；信度方面，k係數=0.8；95%，信賴區間：0.69-0.92，二者均達到良好之水準。結論：證實T-AEP在篩選不適當急診住院上，為一有效且可信之工具，而分析病患不適當住院原因，可做為未來醫院品質改進的依據；本研究亦證實，原版AEP經修訂符合當地國情後，可適用於不同國家。
並列摘要
Background and Purpose: To adapt and test the reliability and validity of the United States- Appropriateness Evaluation Protocol (US-AEP) instrument for screening emergency department admissions of gastroenteric patients in the context of a Taiwan hospital. Methods: A total of 341 patients (171 males; 170 females) receiving ED care in a 1,500-bed Christian Hospital located in central Taiwan were randomly selected. An appropriateness admission review of emergency department patients' medical records was reviewed by 2 physicians and 2 senior nurses based on Taiwanese version of the AEP (T-AEP). The percentage of inappropriate admission was calculated, the reliability, validity and practicality of T-AEP were evaluated, too. Results: 8.2% of hospital admissions were inappropriate. 63.2% of inappropriate admissions were related to diagnostic procedures and/or treatment that could have been done on an outpatient basis. The T-AEP proved to be valid [k=0.86; 95% confidence interval (CI), 0.77-0.95) and reliable (k=0.8; 95% CI, 0.69-0.92]. Conclusions: The T-AEP proved to be both a valid and reliable screening instrument for monitoring the appropriateness of hospital admissions. Understanding the reasons for inappropriate admissions provides important data for follow up quality improvement actions. Our experience shows that the US-AEP can be adapted to local conditions in other countries.
延伸閱讀
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