類別:

黃金自立給付包服務之成效初探－以新北市為例

2020-01-01T00:00:00Z

標題: 黃金自立給付包服務之成效初探－以新北市為例; A Preliminary Analysis of the Effects of the Golden Reablement Package in the New Taipei City. 作者: Hsin-Mei Chang; 張欣湄摘要: 研究目的：新北市政府對於腦中風病患施行黃金自立給付包（包含居家職能治療、居家物理治療、居家護理及居家營養）服務，此研究之目的是檢驗黃金自立給付包計畫之先驅性研究對腦中風病患之身體活動功能介入前後之差異，並探討各項服務介入次數和服務類型之不同是否會影響身體活動功能恢復不同之成效。研究方法：本研究以新北市政府的10家醫院參與此先驅性研究，並提供居家急性後期照顧服務，其中包括居家物理治療及居家職能治療各12次、居家護理服務6次及居家營養服務5次。在服務介入前及介入後分別進行個案之基本日常生活功能量表、工具性日常生活功能量表及改良式Rankin量表之評估。後續採用SPSS 22.0針對個案身體功能狀態之改變情形進行資料統計分析。研究結果：從105年10月20日至106年12月31日共100位病患接受居家急性後期照顧，而其中67位病患完成事後之評估。在使用黃金自立給付包服務（居家急性後期照顧服務）前及使用後，以年齡層50歲至84歲個案之成效在ADL、IADL及mRS皆呈現顯著差異；以失能程度來看，極重度失能個案之成效一樣在ADL、IADL及mRS呈現顯著差異；而使用兩項服務及四項服務之個案其服務介入後在ADL、IADL及mRS皆有顯著改善。討論與結論：黃金自立給付包的個案中成效較佳的特質為年紀輕，失能程度重，使用多重服務，使用物理治療與職能治療的次數多。雖然居家護理與居家營養因為使用次數較少，無法呈現單獨的效益，不過居家急性後期照顧總服務項數與次數的使用對個案功能回復亦有相當的助益，代表多重服務的使用仍舊比單一服務使用更有成效。; Background and objective: The New Taipei City Government’s implementation of the Golden Reablement Package (including home occupational therapy, home physical therapy, home care and home nutrition) on the stroke patients. The purpose of this study was to examine the effects of the pilot study of the Golden Reablement Package on stroke patients’ physical function changes before and after intervention, and to explore whether the number of services and type of services resulted in different physical outcomes. Methods: In this study, 10 hospitals in the New Taipei City participate in the pilot study are participated in this pilot project and provided post-acute care reablement home services, which included 12 times of physical therapy and occupational therapy, 6 time of home visiting nursing care, 5 time of nutritional consultation. ,Pre-post evaluation on Activity Daily Living (ADL), Instrumental Activity of Daily Living (IADL), modified Rankin Scale (mRS) were evaluated before and after the intervention. SPSS 22.0 is used to conduct statistical analysis of the changes in the physical function status of the case. Results: From 105/10/20 to 106/12/31, a total of 100 cases received post-acute reablement home care services, and 67 of them completed pre-post evaluation. After receiving the Golden Reablement Package service (home post-acute care service), the cases aged 50 to 84 years showed significant different improvements in ADL, IADL and mRS. The severely disabled cases also showed significant differences in ADL, IADL, and mRS than less severe cases. Cases received two types and four types of services showed significant improvement in ADL, IADL and mRS. Conclusion: Cases who were younger , with more severe disability, and used multiple types of services and higher frequencies of physical therapy and occupational therapy showed better improvement in physical function. Although home nursing care and home nutrition are less frequently used and these services didnot show significant benefits, using higher total number and frequencies of post-acute home care services also showed benefits physical function improvement. It means that the use of multiple services is more effectively than a single service.

麻醉方式對於醫療利用與照護結果之影響:以髖骨手術為例

2014-01-01T00:00:00Z

標題: 麻醉方式對於醫療利用與照護結果之影響:以髖骨手術為例; The effect of anesthetic type on medical utilization and outcomes for hip surgery 作者: Ya-Hui Hsu; 許雅惠摘要: Background: Most surgery has to be performed under anesthesia, and, with an aging population, hip surgery is a common procedure in orthopedics; the number of patients undergoing hip surgery has been increasing and health care costs continue to rise. There are few current studies on the effect of anesthesia type for hip surgery and the results are not consistent, therefore this study investigates hospital data of patients undergoing hip surgery in a medical center in Taiwan in order to explore the effect of different types of anesthesia on medical utilization and outcomes. Methods: For this retrospective study, the database includes hospitalization and discharge records for all inpatients from January 1, 2012, to December 31, 2012. Patients who underwent hip surgery were identified and divided into groups by anesthesia type: general or regional, and surgery type: hip replacement, and internal fixation of the hip. Patient demographics, inpatient costs, length of stay and postoperative outcomes were analyzed and compared. The statistical analyses contained Pearson chi-square tests, linear regression, and logistic regression. Results: Overall, 1,306 patients undergoing hip surgery were enrolled in the study; a total of 300 patients received internal fixation of the hip and 1,006 patients underwent hip replacement; of these, 10.1% were performed under regional and 89.9% under general anesthesia. Inpatient costs for patients who received regional anesthesia were lower than for general anesthesia in the all-patient groups, hip replacement surgery group and internal fixation of hip group. When we controlled for other variables, the inpatient costs were significantly lower in regional anesthesia groups; in addition, anesthesia type was not found to be significant for length of stay, and was not associated with In-hospital mortality. Conclusions: Anesthesia type does not affect length of stay and In-hospital mortality for hip surgery, but hip surgery patients who received regional anesthesia had lower inpatient costs than those who received general anesthesia.

高齡者參與活躍老化方案之成效探討

2016-01-01T00:00:00Z

標題: 高齡者參與活躍老化方案之成效探討; The Effectiveness of An Active Aging Program for the Elderly 作者: Wei-Ting Su; 蘇暐婷摘要: 研究背景與目的：全世界人口老化日趨嚴重，我國自1993年正式成為高齡化國家，行政院經建會更推估台灣將在2018年邁入「高齡社會」。為落實活躍老化觀念及實踐理念，中華民國老人福利推動聯盟於102年協助督導辦理「樂齡健康活力中心」計畫。本研究即是以102年7月至104年6月參與「台南樂齡健康活力中心」之會員為研究對象，有效樣本159人；主要探討高齡者參與樂齡方案的特質，其次評估高齡者參與樂齡方案後，在健康層面及參與層面之前、後差異，最後分析影響樂齡方案成效之相關因素。研究方法：以描述性統計、相依樣本T檢定、卡方檢定以及分層分析進行探討。研究結果： 1.參與樂齡方案高齡者之特質：平均年齡71.14歲、女性、有偶、與其他人同住、初中(職)或高中(職)畢業、對於經濟狀況感到滿意、自評健康佳、平均罹患疾病數2.08項、無衰弱、認知功能正常、無憂鬱狀況、過去一週做運動的時間達90分鐘以上、體能測試正常、每週1-2次的社會互動頻率、課程參與狀況以低介入程度為主。2.在參與樂齡方案後，身體狀況(老年衰弱、體能測試、運動時間)進步、憂鬱狀況改善、認知功能改善以及社會互動頻率增加，其中30秒椅子坐立與運動時間達到顯著差異(p<0.05)。3.課程介入程度與身體狀況(老年衰弱、體能測試、運動時間)、憂鬱狀況、認知功能及社會互動頻率有顯著相關(p<0.05)，此外，老年衰弱與原始老年衰弱狀況有顯著相關(p<0.05)，憂鬱狀況、認知功能及社會互動頻率則與原始憂鬱狀況達顯著相關(p<0.05)。控制原始老年衰弱狀況、原始憂鬱狀況後，課程介入程度越高，身體狀況(老年衰弱、體能測試、運動時間)、憂鬱狀況、認知功能、社會互動頻率進步程度越高，且達顯著差異(p<0.05)。結論與建議：樂齡方案為我國活躍老化方案之推動典範，而初步的分析結果亦顯現此方案之正面成效，若能藉由課程的介入，持續維持高齡者健康並延緩失能時間與程度，可大幅降低老化對我國經濟、社會帶來的負擔。而本計畫由於開辦初期資料收集缺乏系統化以及評估品質尚未完善建立，導致多筆資料建立不完整，可納入之樣本數流失，進而影響實證研究可涉及內容之廣泛性，若可於各面向(軟體、硬體)皆有完善及穩定的基礎後，再進行會員招募，無論於方案成效或是資料庫的建立等，勢必可發揮本計畫的最大效益。建議本研究結果可作為實務實習單位、政府以及民間團體未來制定相關方案與政策時的參考。; The population of elderly increased rapidly around the world. Taiwan has become an aging society in 1993. Council for Economic Planning and Development estimates that Taiwan will become an aged society in 2018. In order to practice the concept of active aging, Federation for the Welfare of the Elderly started a program called “Aging and Healthy Center” since 2013. The study collected participants’ data who attended the program on July 2013 to June 2015 in this program. There were 159 people included in the analysis. Data analysis methods included descriptive statistics, pair t test, Chi-square test and stratified analysis. The purposes of this study are to describe participant’s characteristics, to examine the effectiveness of this active aging intervention program, and to explore related factors that influence the effects of active aging program. The results showed that the characteristics of the participants, including average age 71.14, female, currently married, living with others, junior or high school graduate, satisfied with their economic status, well self-rated health status, suffered from one to several kinds of diseases (average=2.08), non-frail, normal cognitive function, no depression, exercise more than ninety minutes in the past week, normal in physical fitness test, one to two times social interactive per week, and lower degree of class involvement. After attending active aging program, all of the physical conditions (frailty, physical fitness test, frequency of exercise), depressive symptoms, cognitive function and social interactive frequency were improved. There was a significant improvement for chair stand test and frequency of exercise. The result showed a significant difference between class involvement degree and physical conditions (frailty, physical fitness test, frequency of exercise), depressive symptoms, cognitive function, and frequency of social interactive. In addition, there was significant difference between frailty and original frailty status. Depression, cognitive function and social interactive frequency were significant difference with original depression status. After controlling the original frailty status or original depression status, the higher class involvement degree, the more improvement of physical conditions (frailty, physical fitness test, frequency of exercise), depressive symptoms and social interactive frequency. The result of the program showed a positive effectiveness of active aging program. We believe that we can maintain the health of the elderly and delay the time or the degree of disability by using this active aging program. It is a significant way to reduce the burden of aging in our country. Some concrete suggestions are proposed based on the above conclusions as a reference for internships, government, and future researches of making active aging programs and health policies. Multiple data were incomplete and the number of samples were decreased due to the systematic data collection and the quality control of assessment had not well-established at the beginning of the program which affects the quality of research. We should implement the program with a stable and complete foundation to build a complete database to maximize the benefits of this plan.

骨質疏鬆症是否接受中醫治療療效分析-長庚醫院病例對照研究

2020-01-01T00:00:00Z

標題: 骨質疏鬆症是否接受中醫治療療效分析-長庚醫院病例對照研究; An analysis of treatment effect of whether osteoporosis received traditional Chinese medicine or not – A case-control study of Chang Gung Memorial Hospital 作者: Chu-Yao Tseng; 曾珠堯摘要: 目的世界衛生組織認定骨質疏鬆症是現代人第二大慢性疾病，骨質疏鬆症常造成脊椎壓迫性骨折、股骨頸骨折與腕部骨折，進而增加患者死亡率與急性照護的費用，尤其髖部骨折後患者容易長期臥床，增加照護的費用與人力，進而造成勞動力減退，形成經濟上的損失，如何預防與治療骨質疏鬆症在人口老化的國家是急需面對的問題，而中醫治療對骨質疏鬆症有何臨床助益或協助降低醫療費用，來提供另一種治療方法是本研究所要探討的目的。方法使用長庚醫學資料庫做為資料來源，選取在2004年至2018年期間，患者有兩次以上骨質密度檢查(DXA)，兩次時間在半年至四年間納入收案條件，分為開立中藥超過14天以上共有83人做為實驗組，以及利用傾向分數配對出未使用中藥組332人，蒐集基本資料、骨質密度T值(T-score)、各項醫療費用、住院發生率、骨折發生率等作兩組間的比較，並利用Cox proportional hazard model 做相關風險因子分析。結果結果發現有使用中藥組可以降低住院的機率(P=0.03)，在整體醫療費用兩組沒有顯著差異，但在急門診費用上有使用中藥組費用較高且有顯著差異，在骨質密度第一次T值(T-score)與第二次T值(T-score)兩組間沒有差異，在未使用中藥組內之前未骨折的在追蹤期間發生率高於曾經骨折過的患者(P<0.001)，住院風險有使用中藥住院的風險較未使用中藥HR: 0.23(95% CI: 0.07-0.74)，70歲以上住院的風險較未滿70歲HR: 4.43 (95% CI: 2.22-8.55)。骨折的風險因子具有顯著差異有年齡70歲以上HR: 1.93 (95% CI: 1.26-2.97)、之前有骨折HR:0.27 (95% CI: 0.15-0.51)，最常使用的中藥單味藥為杜仲，方劑為龜鹿二仙膠。結論合併中藥治療骨質疏鬆症可以降低患者住院的機率，且不會增加整體的醫療費用，但骨質疏鬆症中醫治療在門急診費用上與非中醫治療有替代的效果，有使用中藥組的骨質密度T值(T-score)與未使用中藥組結果沒有差異；減少住院風險的因子為使用中藥，增加住院風險的因子為年齡大於70歲，增加骨折的風險因子為年齡大於70歲，減少骨折的風險因子為之前有過骨折經驗。 ; Background The World Health Organization recognizes osteoporosis as the second most chronic disease of people. Osteoporosis often causes spine compression fractures, femoral neck fractures and wrist fractures, which increases patient mortality and the cost of acute care, especially after hip fractures. It is easy for patients become bedridden for a long time, which increases the cost of care and manpower, which leads to labor decline and economic losses. How to prevent and treat osteoporosis is an urgent problem in an aging population. Traditional Chinese medicine (TCM) has potentiality to treat osteoporosis. It is the purpose of this study to provide clinical treatment of clinical benefits or to reduce medical expenses to provide another treatment method. Methods Using Chang Gung Research Database as the data source, selected from 2004 to 2018, the patient had more than two bone density examinations (DXA), two times and between half a year and four years were included, and were divided into prescribing TCM group and non-TCM group. A total of 83 people were used in TCM group for prescribing herbs more than 14 days, and 332 people in the non-TCM group were matched using the propensity scores. Basic data, T value, various medical expenses, and fracture incidence were collected for comparison between the two groups, and Cox proportional hazard model to do relevant risk factor analysis. Results It was found that the use of TCM group can reduce the probability of hospitalization (P = 0.03). There is no significant difference in the overall medical cost between the two groups, but the cost of emergency medicine in the TCM group is higher and there is a significant difference. The first T-score and the second T-score value have no difference between two group. The incidence without previous fractures in the non-TCM group during the follow-up period was higher than that of patients who had fractured before (P <0.001). Admission rate TCM group has low HR: 0.23(95% CI: 0.07-0.74) and age older 70 years has high HR: 4.43 (95% CI: 2.22-8.55). There are significant differences in risk factors for follow-up fractures: age older 70 years HR: 1.93 (95% CI: 1.26-2.97), previous fracture HR:0.27 (95% CI: 0.15-0.51). Conclusion Combined treatment of osteoporosis with traditional Chinese medicine can reduce the patient ’s chance of being hospitalized without increasing the overall medical cost, but osteoporosis traditional Chinese medicine treatment has an alternative effect on outpatient and emergency costs compared with non-Chinese traditional medicine treatment. There was no difference in the results about T-score between the non-Chinese medicine group and Chinese medicine group. The factors that reduced the risk of hospitalization were TCM group and the increased the risk of hospitalization were age, the factors that increased the risk of fractures were age, and the factors that reduced the risk of fractures were previous fractures.