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題 名 | 臺灣東部某醫學中心復健科病患長期住院因素之探討=Factors Associated with a Long Stay in the Rehabilitation Department of a Medical Center in the Eastern Taiwan |
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作 者 | 梁忠詔; 簡世霖; 宋英聖; 范文光; 王舜光; 楊士賢; | 書刊名 | 慈濟醫學 |
卷 期 | 16:2 2004.04[民93.04] |
頁 次 | 頁99-109 |
分類號 | 419.44 |
關鍵詞 | 住院天數; 復健; 腦中風; 創傷性腦傷; 脊髓損傷; Length of stay; Rehabilitation; Cerebrovascular accident; Traumatic brain injury; Spinal cord injury; |
語 文 | 中文(Chinese) |
中文摘要 | 目的:在探花東地區某醫學中心復健科一般住院和延長住院病患之現況與差異性,以及長期住院的原因。病人與方法:本研究為回溯性的調查研究。研究對象為花東地區某醫學中心復健科三年(1999至2001年)住院患者共計568名,主要疾病類別為腦中風、創傷性腦傷、脊髓損傷,排除死亡、失聯、病歷記錄不全、住院天數小於等於7天的患者,共計335名為有效樣本。本研究方法主要包括復健科住院病患調查表,其內容包括病患及住院基本資料、日常生活活動量表等病患人口學、病情醫療及家庭家屬因素資料。結果:進行卡方檢定分析,呈現住院長短差異的變項依統計順序包括年齡、住院期間主要照顧者、入院途徑(p<0.05);出院後看護花費、其他醫療保、住過加護病房(p<0.01);復健科照會次數、其他科別住院天數、轉診住院、接受手術、功能障礙數、治療項目數,入、出院日常生活活動評估得分與出院日常生活活動進步分數(p<0.001)。以複迴歸分析,影響長期住院天數變項包括功能障礙數、復健科照會次數、運動機能障礙程度、其他醫療保險、病患診斷類別、入院時日常生活活動評估得分以及治療項目數等七項,可解釋變異量為59.2%。結論:以本研究結果建立長期住院病患高危險群之篩選工具,及早介入出院準備計畫,合理管控病患住院天數,使有限病床能做有效利用,亦可做為全民健保在規劃復健科住院照護給付標準的參考。 |
英文摘要 | Objective: To investigate the current status and vaiability of general inpatients and those requiring longer stays. The reasons for extended hospitalization are explored to identify risk factors for this patient group so as to establish a screening reference for medical service providers. Patients and Methods: The research target of this retrospective design was the rehabilitation departemtn of medical center in the Hualien-Taitung region of Taiwan. In total, there were 568 inpatients during 1999 to 2001. After excluding the deceased, the unreachable, those with an incomplete history in their medical charts, and those with a length of stay (LOS) of less than 7 ays, 335 patients were recruited as the sample. The main disease/condition category types included cerebrovascular accident, traumatic brain injury, and spinal cord injury. Patient data were collected and analyzed through a questionnaire inquiring about demographic data and admission data as well a daily activity index. Results: Los differed by categories of age, the statistically significant sequence, the presence of caregivers during the hospital stay, and the admission route (p<0.05); by the post-discharge attendant expense, supplemental medical insurance, and the length of intensive care unit stay (p<0.01); and by LOS in other departments, the referral source, the type of surgery, the number of impaired functions, the number of treatment items, the activity of daily living (ADL) score at demission/discharge, and the ADL progress during the hospital stay (p<0.001). Multiple regression analysis detected 7 important factors affecting the length of extended hospitalization, including the number of impaired functions, the frequency of consultation by the rehabilitation department, the level of motor function disability, supplemental medical insurance, the diagnosis, the ADL score at admission, and treatment items, these variables accounted for 59.2% of the variance in LOS. Conclusions: Based on these results, a screening mechanism can be established to identify high-risk patients who may be more likely to experience a long hospital stay. Such a mechanism, together with discharge planning interventions and reasonable control of hospital days, could improve the efficiency of hospital bed utilization. It can also provide a reference standard for the national health insurance policy in planning case payment schemes for rehabilitation care. |
本系統中英文摘要資訊取自各篇刊載內容。