某精神專科醫院住院病人2015～2019職能治療五階分佈之描述世代研究

A descriptive cohort study of progression across the five-stage occupational rehabilitation among the inpatients of a psychiatric hospital in 2015~2019

10.29827/YBYJZZ.202112_5(1).0004

廖子瑞(Tzu-Jui Liao)；李慧玲(Hui-Ling Lee)

慢性精神病友 ； 職能治療 ； 復健服務 ； chronic psychiatric patients ； occupational therapy ； rehabilitation service

醫保研究雜誌

5卷1期（2021 / 12 / 01）

32 - 50

繁體中文

目的：分析2015年至2019年期間進階率、維持率、退階率、有進有退率及其細部比率與花費時間之分佈，以做為調整各階段職能治療服務準則之參考。方法：本研究屬回溯之描述世代研究；資料來源為職能治療服務品質系統，收案條件為接受某精神專科醫院職能治療服務之病人（共3,238人；累積筆數為1,071,591人次）且保留每年皆有至少3個月階段記綠的資料，共得樣本739人。結果：五年期間739人，平均年齡為50.1±9.8歲，最小為20歲，最大為76歲，以51歲以上居多（51.6%）。進階率為21.1%，維持階段率16.1%、退階率34.9%、有進有退率27.8%。在1,225人次數中，進階佔41.9%，平均花費時間20.6±16.8月，中位數16月；維持階佔9.7%，平均維持時間59.7±1.3月，中位數60月；退階佔58.1%，平均花費時間21.1±17.5月，中位數18月。結論：研究結果之各項數值皆可成為樣本醫院職能治療服務品質指標之閾值；建議樣本醫院每年均可計算該等指標並進行比較與檢討原因，以實證並建立各階段職能治療之服務準則。

Objective. The study investigated the outcome of the Five-stage Occupational Rehabilitation Service (FsORS) for the inpatients of a psychiatric hospital in central Taiwan during 2015and 2019. The results of patients' progression, retention, and regression across the five stages were reported and analyzed for clinical application. Methods. This retrospective descriptive cohort study examined the FsORS records of 3,238 inpatients (with 1,071,591 person-time entries) from the hospital's occupational therapy service data system. A sample of 739 participants who met the inclusion criterion (FsORS records available for three or more consecutive months per year) were selected. Data analysis for progression, retention, regression and mixed (progression + regression) conditions among the participants across the five FsORS stages consisted of the total, percentage (rate), person-time, and the mean, standard deviation, maximum, minimum, and median of the length of time for each condition. Results. Participants' ages ranged from 20 to 76 with a mean of 50.1 and a standard deviation of 9.8. The majority of participants aged 51 or older (51.6%). The rates of progression, retention, regression, and mixed conditions among 739 participants were 21.1%, 16.1%, 34.9%, and 27.8%, respectively. Among 1,225 person-time entries, the progression rate was 41.9% with an average progression time 20.6 ± 16.8 months (median = 16); the retention rate was 9.7% with an average retention time 59.7 months (median = 60); and the regression rate was 58.1% with an average regression time 21.1 ±17.5 months (median = 18). Conclusion. These findings serve as clinical estimation for predicting clients' progression and timeframe along the FsORS stages through occupational therapy service. Such clinical data should be collected and analyzed annually for establishing and refining service guidelines for the client population.

1. Llorens, L. A. (1986). Activity analysis: Agreement among factors in a sensory processing model. American Journal of Occupational Therapy, 40(2), 103-110. doi: 10.5014/ajot.40.2.103
   連結：
2. 林育璿, & 李慧玲. (2020). 某精神專科醫院住院病人2010~2014職能治療五階分佈之描述世代研究. 醫保研究雜誌, 4(1),1-13.doi:10.29827/YBYJZZ.202001_4(1).0001
   連結：
3. 陳淑美, 劉璧華, 簡美瑤, & 李慧玲. (2018). 一公立精神專科醫院病友職能工作訓練情形之十年追蹤分析. 職能治療學會雜誌, 36(1), 56-71. doi: 10.6594/JTOTA.2018.36(1).03
   連結：
4. 程秀娥, 陳姿聿, & 李慧玲. (2019). 某精神專科醫院慢性精神病人工作訓練產值之世代研究. 臺灣職能治療研究與實務雜誌, 15(2), 131-141. doi: 10.6534/jtotrp.201912_15(2).0004
   連結：
5. 蔡佳瑜, & 曾瓊瑤. (2019). 中部某精神專科醫院工作復健服務探討~ 職能復健模式五階層之第三階與第四階工作訓練分析. 臺灣職能治療研究與實務雜誌, 15(1), 15-27. doi: 10.6534/jtotrp.201906_15(1).0002
   連結：
6. 吳培君, 林育璿, 許容凰, 莊雯芳, 簡松練, 李慧玲, . . . 陳俊鶯. (2013). 某精神專科醫院職能治療服務品質系統之建立. 醫學與健康期刊, 2(2), 63-79.