Identifying Factors Associated with Hospital Readmissions among Stroke Patients in Taipei

臺北市中風病人再住院之相關因素探討

莊坤洋(Kun-Yang Chuang)；吳淑瓊(Shwu-Chong Wu)；馬靄萱(Ai-Hsuan Sandra Ma)；陳育慧(Yu-Hui Chen)；吳振龍(Chen-Long Wu)

再住院 ； 中風病人 ； 出院準備服務 ； readmission ； stroke patients ； discharge planning

The Journal of Nursing Research

13卷2期（2005 / 06 / 01）

117 - 128

英文

再住院在醫療照顧成本中佔有重要的一環，且除了反映在出院時並未妥善解決患者的健康問題外，也突顯出後續醫療照護資源的缺乏。本研究的目的主要是探討中風病人再住院之影響因素，包括：患者住院時之人口學特性、護理服務需求、出院準備服務計畫、後續醫療照護安排、及照顧者特性。研究對象來自台北地區七家醫療機構中神經科的住院病患，在患者住院期間以及出院後一個月時持續追蹤，並進行問卷調查。研究樣本共489位，其中24.3%的患者在出院一個月內曾經再住院。控制其他變項後，邏輯式迴歸分析之結果顯示：ADL功能障礙項目、第一次中風、傷口護理需求、接受出院安排以及出院後接受照護的地點，與再住院有達到統計上顯著相關；與預期結果不同的是年齡、住院天數、出院衛教及照顧者負荷等變項，並未與再住院有達到統計上顯著相關。本研究結果指出ADL功能障礙是中風病人再住院之一有效預測因子，增加居家護理服務資源來滿足病人對傷口護理的需求，則能有效降低再住院的情形；病人出院後在護理之家接受短期的照顧能減少再住院機會，或許是較具有經濟效益的照護方式。

Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADI), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.

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