中風病人具身體功能障礙者出院準備服務之執行評估：病人的角度

Evaluation of Discharge Planning Services for Stroke Patients with Disabilities: Patient Perspectives

10.6288/TJPH2004-23-03-07

蔡宗學(Tsung-Hsueh Tsai)；莊坤洋(Kun-Yang Chuang)；戴玉慈(Yu-Tzu Dai)；曾淑芬(Su-Fen Tzeng)；吳淑瓊(Shwu-Chong Wu)

出院準備服務 ； 連續性照護 ； 病人角度 ； discharge planning ； continuum care ； patient perspective

台灣公共衛生雜誌

23卷3期（2004 / 06 / 01）

235 - 248

繁體中文

目標：針對醫院為有長期照護需要病人安排的出院準備服務，詢問病人對醫院提供出院準備服務的感受，分析接受出院準備服務狀況及其影響因子。方法：調查 489位由臺北縣市七家醫院中風出院有後續照護需要病患，了解病人對出院準備服務包括告知出院時間、出院時機、討論如何照護、提供衛生教育、協助後續長期照護安排、出院後持續追蹤等六項指標之感受，並以迴歸分析探討影響因子。結果：病人感受醫院人員大部分或很詳細討論如何照護與提供衛生教育皆有七成以上，但有77.3％的病患認為醫院並無協助後續的長期照護安排，有58.5％的病患在出院前二天以上被通知要出院，有68.1%的病患覺得出院時間剛好，而有94.1％病患認為醫院並無持續追蹤他們。迴歸分析中，醫院別和身體功能障礙是顯著的重要變項，其他醫院相對於乙醫院的勝算比都小於1，中、重度失能相對於輕度失能的勝算比皆大於l。結論：病患感受的出院準備服務品質不佳，且不同醫院的服務有差異，並可能選擇病患，針對功能障礙不同的病患提供不同的出院準備服務。

Objectives: To explore patients ' perception of discharge planning and uncover the factors associated with it. Methods: The study sample were 489 stroke patients discharged from seven different hospitals in Taipei. To survey these patients' perceptions of six important indicators including patients being informed before the discharge date, premature or retardant time being discharged, discussion of post-discharge care with patients or their caregivers, providing health education to patients or their caregivers, referral to post-discharged long-term care services, following discharged patients up. Results: More than 70.0% of patients considered the hospital staff had discussed post-discharge care with them carefully or perceived they had been provided with health education. More than three-fourth of patients believed that hospitals had inadequately handled the referral of post-discharged long-term care services. There were 58.5% patients informed two days before. As to the timing of discharge, 68.l % of patients thought it was suitable. The follow-up aspect of our study was quite uniform 94.1% of patients perceived no follow-up. Analyzed factors associated with perception of each service, hospital and physical function disability were found to be significant factors after controlling for other variables. The odds ratio of hospitals over the B hospital was less than one and reached a significant level that means the service provided by B hospital was more acceptable than for the other hospitals. In the facet of physical function disability, the odds ratios of moderate disability over minor disability and severe disability over minor disability were larger than one and significant. Conclusions: The result showed patients' pessimistic perception concerning the quality of discharge planning. The discharged patients from different hospitals have dissimilar perceptions of discharge planning services provided by hospitals. The more severe the disability, the stronger the perception of having discharge planning services being provide by the hospital. Hospitals may choose patients and provide the different discharge planning service according to the different disability levels.

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