缺血性腦中風病人復健強度與非計畫性再入院之關係—以某醫學中心為例

Abstract

研究背景：腦中風造成全球失能及死亡人數居高不下，過去研究大多探討腦中風病人急性期的照護結果，對於分析復健照護密集程度等因素對於缺血性腦中風病患照護結果之影響的研究並不多。 研究目的：探討醫院復健照護強度與缺血性腦中風病患30日及90日非計畫性再入院之相關性。 研究方法：本研究資料取自臺大醫療體系整合資料庫、P4P中風指標登錄表及臺大醫院腦中風個案管理檔進行本研究的資料分析。以2015年10月至2017年7月出院之缺血性腦中風為研究母體，研究樣本共有987人，利用複邏輯斯迴歸模型，探討缺血性腦中風病患復健照護強度與30日或90日內非計畫性再入院之相關性。 研究結果：住院復健強度與30日內非計畫性再入院及90日內非計畫性再入院均達統計上顯著相關，且復健強度越高，30日內非計畫性再入院及90日內非計畫性再入院的風險越低。 結論與建議：在控制病患特性下，缺血性腦中風病患的復健強度與30日內及90日內非計畫性再入院達統計上顯著差異，因此，對於缺血性腦中風的病患，在急性期過後給予病患更積極的復健治療，確實能改善病患的再入院風險。本研究也發現ADL分數、腦中風病史、以及吸菸為缺血性腦中風病患再入院之預測因子。

Background: The global disability and deaths caused by stroke have remained high. In the past, most of the studies focused on the outcomes of acute stroke patients, and there were few studies on the effects of rehabilitation intensity on the outcomes of ischemic stroke patients. Objectives: To explore the correlation between hospital rehabilitation intensity and unplanned 30- and 90-day hospital readmissions of patients with ischemic stroke. Methods: The data from this study were collected from the National Taiwan University Hospital Healthcare system, pay-for-performance documents, and case management files of stroke patients. The subject of this study was ischemic stroke that was discharged from October 2015 to July 2017 (N=987). A multiple logistic regression model was used to investigate the correlation between the rehabilitation intensity in ischemic stroke patients and unplanned readmissions within 30 days and 90 days. Results: The intensity of hospital rehabilitation was statistically significantly related to unplanned readmission within 30 days and 90 days. The higher the rehabilitation intensity, the lower the risk of unplanned readmission within 30 days and 90 days. Conclusions: After controlling for covariates, the statistically significant differences in the rehabilitation intensity of ischemic stroke patients and unplanned readmissions within 30 days and 90 days. Therefore, for patients with ischemic stroke, more active rehabilitation after the acute stage can reduce the risk of readmission. The study also found that ADL, Previous CVA, and smoking were predictors of readmission for ischemic stroke patients.