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  1. NTU Theses and Dissertations Repository
  2. 公共衛生學院
  3. 健康政策與管理研究所
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69162
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dc.contributor.advisor董鈺琪
dc.contributor.authorMing-Ju Leeen
dc.contributor.author李明儒zh_TW
dc.date.accessioned2021-06-17T03:09:54Z-
dc.date.available2023-08-01
dc.date.copyright2018-08-01
dc.date.issued2018
dc.date.submitted2018-07-20
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38. Chen LK, Chen YM, Hwang SJ, et al. Effectiveness of community hospital-based post-acute care on functional recovery and 12-month mortality in older patients: a prospective cohort study. Ann Med 2010; 42:630-6.
39. Wang H, Sandel ME, Terdiman J, et al. Postacute care and ischemic stroke mortality: findings from an integrated health care system in northern California. PM R 2011; 3:686-94.
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42. Peng LN, Lu WH, Liang CK, et al. Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan: A Nationwide Propensity Score-matched Study. J Am Med Dir Assoc 2017.
43. Hou WH, Ni CH, Li CY, Tsai PS, Lin LF, Shen HN. Stroke rehabilitation and risk of mortality: a population-based cohort study stratified by age and gender. J Stroke Cerebrovasc Dis 2015; 24:1414-22.
44. 胡名霞, 許書旋, 李建志, 王顏和, 鄭建興, 葉炳強. 腦中風患者復健治療時程與出院及長期功能結果之關聯性. 台灣醫學 2006:248-55.
45. Hsieh CY, Huang HC, Wu DP, Li CY, Chiu MJ, Sung SF. Effect of Rehabilitation Intensity on Mortality Risk After Stroke. Arch Phys Med Rehabil 2017.
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48. 冼鴻曦, 劉文欽, 楊儀華. 有效提升中風患者的日常生活功能-急性後期照護之成效分析. 臺灣老年醫學暨老年學雜誌 2015; 10(3).
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50. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (AVERT): phase II safety and feasibility. Stroke 2008; 39:390-6.
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52. Slot KB, Berge E, Dorman P, et al. Impact of functional status at six months on long term survival in patients with ischaemic stroke: prospective cohort studies. BMJ 2008; 336:376-9.
53. Toschke AM, Tilling K, Cox AM, Rudd AG, Heuschmann PU, Wolfe CD. Patient-specific recovery patterns over time measured by dependence in activities of daily living after stroke and post-stroke care: the South London Stroke Register (SLSR). Eur J Neurol 2010; 17:219-25.
54. Andrews AW, Li D, Freburger JK. Association of Rehabilitation Intensity for Stroke and Risk of Hospital Readmission. Phys Ther 2015; 95:1660-7.
55. 許擇良. 探討影響長期照護機構腦中風住民復健治療與成效相關因素之研究. 高雄醫學大學醫務管理學研究所在職專班學位論文2010.
56. 吳英黛, 劉千綺, 鄭建興. 慢性中風病人的物理治療需求. 台灣腦中風學會會刊 2008; 15(4).
57. European Stroke Organisation Executive C, Committee ESOW. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008; 25:457-507.
58. Duncan PW, Zorowitz R, Bates B, et al. Management of Adult Stroke Rehabilitation Care: a clinical practice guideline. Stroke 2005; 36:e100-43.
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60. Ingeman A, Pedersen L, Hundborg HH, et al. Quality of Care and Mortality Among Patients With Stroke A Nationwide Follow-up Study. Medical Care 2008; 46:63-9.
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67. Claesson L, Gosman-Hedstrom G, Fagerberg B, Blomstrand C. Hospital re-admissions in relation to acute stroke unit care versus conventional care in elderly patients the first year after stroke: the Goteborg 70+ Stroke study. Age Ageing 2003; 32:109-13.
68. Ottenbacher KJ, Graham JE, Ottenbacher AJ, et al. Hospital readmission in persons with stroke following postacute inpatient rehabilitation. J Gerontol A Biol Sci Med Sci 2012; 67:875-81.
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dc.identifier.urihttp://tdr.lib.ntu.edu.tw/jspui/handle/123456789/69162-
dc.description.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。
zh_TW
dc.description.abstractBackground: 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.
en
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Previous issue date: 2018
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dc.description.tableofcontents誌謝 i
中文摘要 ii
英文摘要 iii
目錄 v
表目錄 vii
圖目錄 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 腦中風之介紹 3
第二節 中風之復健治療與復健強度 13
第三節 中風之再入院情形及危險因子 18
第四節 相關實證研究 23
第三章 研究方法 32
第一節 研究設計與架構 32
第二節 研究假說 34
第三節 資料來源與研究對象 34
第四節 研究變項定義 35
第五節 資料處理流程 38
第六節 統計分析方法 39
第四章 研究結果 40
第一節 描述性統計 40
第二節 雙變項分析 44
第三節 多變項分析 52
第五章 討論 56
第一節 研究方法討論 56
第二節 研究結果討論 58
第三節 研究限制 62
第六章 結論與建議 63
第一節 結論 63
第二節 建議 64
參考文獻 66
dc.language.isozh-TW
dc.title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zh_TW
dc.titleRelationship Between Rehabilitation Intensity and Unplanned Readmission for Patients with Ischemic Stroke in a Medical Centeren
dc.typeThesis
dc.date.schoolyear106-2
dc.description.degree碩士
dc.contributor.oralexamcommittee鍾國彪,鄭建興
dc.subject.keyword缺血性腦中風,復健治療強度,非計畫性再入院,zh_TW
dc.subject.keywordischemic stroke,rehabilitation intensity,unplanned readmission,en
dc.relation.page70
dc.identifier.doi10.6342/NTU201801687
dc.rights.note有償授權
dc.date.accepted2018-07-20
dc.contributor.author-college公共衛生學院zh_TW
dc.contributor.author-dept健康政策與管理研究所zh_TW
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