Exploring the Associations between Long-Term Care and Mortality Rates among Stroke Patients

中風病人長期照護與死亡率之相關性探討

莊坤洋(Kun-Yang Chuang)；吳淑瓊(Shwu-Chong Wu)；張媚(Yeh Mei Chang)；陳育慧(Yu-Hui Chen)；吳振龍(Chen-Long Wu)

長期照護 ； 死亡率 ； 中風 ； long-term care ； mortality ； stroke

The Journal of Nursing Research

13卷1期（2005 / 03 / 01）

66 - 74

英文

中風病人出院後使用長期照護服務模式的情形，是規劃長期照護資源政策的重要資訊，比較不同長期照護服務的使用結果，可提供患者選擇服務時作爲參考。本研究之目的在描述中風病人出院後使用長期照護服務的情形，並探討不同服務模式對患者出院後之死亡率的影響，採縱貫式類實驗性研究設計，收集714位中風病人出院後第一個月、第三個月及第六個月期間使用長期照護務等相關資料。結果顯示，出院後第一個月時有4.5%的病患死亡，22.1%的患者恢復健康且能獨立從事日常生活活動及工具性日常生活活動，病患使用機構式服務、居家或社區式服務及完全由家庭照顧比例分別爲：10.4%、22.4%、40.7%；第三個月時服務使用的比例分別爲：11.2%、18.7%、38.0%；第六個月時服務使用的比例分別爲：10.3%、19.4%、30.9%。控制年齡、性別、中風疾病史和身體功能，多變項分析結果指出：使用居家或社區式服務的患者比使用機構式服務的患者有較低的死亡率(OR=0.39, 95%; CI=0.15-0.97)。爲何使用居家或社區式服務的患者死亡率較低的原因並不清楚，但不同服務使用者照顧品質與生活品質的差異應該被深入探討，同時需要更多的研究來評估何種原因造成不同服務之間的死亡率的差異。

Information on types of long-term care received by stroke patients after hospital discharge is essential for the formulation of long-term care resource development policy. Comparisons of outcomes resulting from different types of long-term care can provide important considerations in the selection of long-term care services. The purpose of this study is to describe the patterns of long-term care received, and to explore if associations exist between long-term care services and mortality status among stroke patients after hospital discharge. Using a longitudinal quasi-experimental study design, this study collected information on the type of long-term care received at 1, 3, and 6 months after discharge for 714 patients. At one month after discharge, 4.5% had died, and 22.1% had regained all functions in activities of daily living and instrumental activities of daily living. The percentage of patients receiving institutional care, home or community-based care, and family care only were 10.4%, 22.4%, and 40.7% respectively. The respective percentages at 3 months after discharge were 11.2%, 18.7%, and 38.0%, and, at 6 months after discharge, 10.3%, 19.4%, and 30.9%. After adjusting for age, sex, previous incidence of stroke, and physical functions, the odds of dying within 6 months after discharge for stroke patients receiving home or community-based care was significantly lower than those in institutions (OR = 0.39; 95% CI = 0.15 to 0.97). It is not clear why a lower mortality rate was observed among patients receiving home or community-based services. Differences in quality of care and quality of life among users of different types of long-term care services should be investigated. More research is needed to assess the causes of the disparity in mortality rates among users of different types of long-term care services.

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