內科病人14天內非計畫性再住院相關因素之回溯性研究

Ya-Hsiu Chang; 張雅琇

請用此 Handle URI 來引用此文件： http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/50196

完整後設資料紀錄

DC 欄位	值	語言
dc.contributor.advisor	黃璉華
dc.contributor.author	Ya-Hsiu Chang	en
dc.contributor.author	張雅琇	zh_TW
dc.date.accessioned	2021-06-15T12:32:14Z	-
dc.date.available	2021-08-26
dc.date.copyright	2016-08-26
dc.date.issued	2016
dc.date.submitted	2016-08-03
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dc.identifier.uri	http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/50196	-
dc.description.abstract	本研究目的主要以人口學特性、共病因素、前次出院狀況及出院後照護情形、對醫療團隊、護理師提供前次出院準備服務及對前次出院後入住機構之滿意度，探討內科病人14天內非計畫性再住院情形、相關影響因素及預測因子。本研究於北部某醫學中心進行，連續收集2014年1月1日至同年12月31日期間出院之內科病人為研究對象，透過品管中心提供14天內非計畫性再住院病人資料、病歷查閱方式及出院後電話追蹤之｢出院準備服務評值表｣進行資料收集及分析，研究對象分為病例組與對照組各135人。結果發現：（1）內科病人14天內非計畫性再住院之影響因素包括，再住院者其平均年齡高於未再住院者（t = 2.199, p < .05）且已婚者再住院比率較少（χ2 = 8.690, p < .05），Charlson Comorbidity Index加權總分越高者越容易再住院（χ2 = 7.368, p < .05）且再住院者平均加權總分較高於未再住院者（t = 2.005, p < .05），再住院者之前次平均住院天數多於未再住院者（t = 2.097, p < .05），而前次出院後主要照顧者為外傭者較易發生再住院（χ2 = 16.476, p < .001）。（2）多變量邏輯式分析結果顯示，內科病人14天內非計畫性再住院之獨立預測因子包括「前次住院主診斷」為惡性腫瘤（OR = 2.903, 95% CI = 1.136-7.419, p <.05）、「前次住院天數」越多（OR = 1.028, 95% CI = 1.000-1.056, p <.05）以及「主要照顧者關係」為外傭者（OR = 4.260, 95% CI = 1.725-10.51, p < .05）較傾向發生非計畫性再住院，反之｢已婚｣者較｢未婚/喪偶/離婚｣不易傾向發生非計畫性再住院（OR = 0.422, 95% CI = 0.179-0.996, p < .05）。本研究顯示應將年齡、婚姻狀況、Charlson Comorbidity Index加權總分、住院天數及出院後主要照顧者，做為出院準備時篩檢非計畫性再住院高危險群的重要項目，針對未婚、喪偶、離婚者及老年者，應於住院期間儘早規劃提供出院準備服務，可採「及早主動式」及運用｢出院評估單｣的評估與介入，對於「前次住院主診斷」為惡性腫瘤及前次住院天數較多者，應有專任疾病個管師，針對疾病個別性給予特殊衛教及後續出院追蹤，此外「主要照顧者關係」為外傭者，護理師應每日執行日常照顧技巧之護理指導及讓照顧者不斷回覆示教，並提供多國語言之衛教單張及多媒體教學，護理師於出院後電訪追蹤，瞭解病人出院後之照護情形，必要時提供協助及轉介，以降低內科病人14天內非計畫性再住院發生。	zh_TW
dc.description.abstract	The purpose of this study was to investigate the relevant factors and independent predictors for unplanned readmission within 14 days of previous hospital discharge in medical patients by exploring the demographic characteristics, comorbid medical conditions, discharge status and care following previous hospital discharge, satisfaction toward care of the medical team, the previous discharge planning and the length of stay of previous hospitalization of study patients. This retrospective, case-control study was undertaken in a medical center in northern Taiwan. This study enrolled 135 unplanned readmission patients who were discharged from medical ward of the study hospital between January 1, 2014 and December 31, 2014. Data were collected through the Quality Control Center, inspection records after discharge and telephone follow-up of 'discharge planning services evaluation scale' data and were compared to the data of 135 control patients who did not have readmission in 14 days of hospital discharge. The results showed that: (1) medical patients of unplanned readmission within 14 days were older (t = 2.199, p <.05), more single or widowed marital status (χ2 = 8.690, p <.05), higher Charlson comorbidity Index score (χ2 = 7.368, p <.05; t = 2.005, p <.05), longer length of stay of previous hospitalization (t = 2.097, p <.05), higher percentage of foreign domestic helper (FDH) as primary caregivers (χ2 = 16.476, p < .001). (2) Independent predictors for unplanned readmission within 14 days of hospital discharge included malignant disease (OR = 2.903, 95% CI = 1.136-7.419, p < .05), the length of stay of previous hospitalization (OR = 1.028 , 95% CI = 1.000-1.056, p < .05) and FDHs as primary caregiver (OR = 4.260, 95% CI = 1.725-10.51, p < .05). On the contrary, married status was negative predictor for unplanned readmission in multivariate logistic regression analysis (OR = 0.422, 95% CI = 0.179-0.996, p < .05). This study showed that age, marital status, Charlson Comorbidity Index weighted score, hospital length of stay and the primary caregivers after discharge were important items for discharge planning in screening high risk patients for readmission after discharge. Discharge planning services should be provided as early as possible to the patient who is elderly, single or widowed marital status, cancer patients, known FDHs as primary caregivers, or has longer hospital length of stay. An integrated strategies including the use of Discharge Assessment Checklist, special health education, case management services, guidance of care skills, providing health education leaflets in multiple languages, subsequent discharge follow-up and when necessary, assistance and referral information, are crucial in an effort to reduce unplanned readmission within 14 days of hospital discharge in medical patients.	en
dc.description.provenance	Made available in DSpace on 2021-06-15T12:32:14Z (GMT). No. of bitstreams: 1 ntu-105-R99426030-1.pdf: 1580479 bytes, checksum: 66988be2b54aec7d5635b671fa92944d (MD5) Previous issue date: 2016	en
dc.description.tableofcontents	第一章緒論……………………………………………………………..…………. 1 第一節研究動機及重要性……………...…………….…….………………… 1 第二節研究目的……………….…………...…………….……..…………… 3 第三節研究假設……………….………….……………..…...……………… 4 第四節名詞界定…………………….....…………………..………………… 5 第二章文獻查證………………………………………………………..…………. 6 第一節醫療照護品質對非計畫性再住院之影響……….…………..……… 6 第二節非計畫性再住院之相關影響因素……………………...…………… 8 第三節出院準備服務..……………………………...…………..……..…… 12 第四節出院準備服務對非計畫性再住院的影響…...…….…………....… 14 第三章研究方法……………………..……….………………...………………. 17 第一節研究工具…………….….………………….………………..……… 17 第二節研究架構………………….……………………...…….…………… 19 第三節研究對象………………….……………….……………..….....…… 20 第四節資料處理與分析………….………….……………………...……… 21 第五節倫理考量……………………….………….………………..…….… 22 第四章研究結果…………………………………………………….…………… 23 第一節研究對象之基本屬性………………………………………….…… 24 第二節內科病人之人口學特性與其14天內非計畫性再住院之相關性… 29 第三節內科病人之共病因素與其14天內非計畫性再住院之相關性....… 31 第四節內科病人之前次出院狀況及出院後照護情形與其14天內非計畫性再住院之相關性………………………………..………………...…… 33 第五節出院準備滿意度與其14天內非計畫性再住院之相關性..……… 35 第六節內科病人14天內非計畫性再住院的重要預測因子….………..… 36 第五章討論……………………......……………………………………………. 39 第一節內科病人14天內非計畫性再住院情形及相關影響因素…...…… 39 第二節內科病人14天內非計畫性再住院之重要預測因子……..……..… 43 第六章結論與建議………………………………………………………………. 45 第一節結論……….….………………………………………………...…… 45 第二節研究限制與建議…..…………………………………………...…… 46 參考文獻……………………………………………………….....……………… 48 中文文獻……………………………………..…………………………………… 48 英文文獻…………………………………………………………………….…… 50 圖目錄圖1 研究架構圖…………………………………………………………….…… 19 表目錄表1人口學特性………………...…………………………………………….…… 24 表2共病因素分佈情形………………………………….………………….…… 25 表3前次出院狀況及出院後照護情形………………………….………….…… 27 表4研究對象對醫療團隊、護理師提供前次出院準備服務及對前次出院後入住機構之滿意度……………………………………………………………………… 28 表5人口學特性與內科病人14天內非計畫性再住院之關係…………….…… 30 表6平均年齡與內科病人14天內非計畫性再住院之關係…….……………….. 30表7共病因素與內科病人14天內非計畫性再住院之關係…………………… 32表8加權總分及前次住院天數之平均值與內科病人14天內非計畫性再住院之關係…….……………………………………………………………………….…… 32 表9前次出院狀況及出院後照護情形與內科病人14天內非計畫性再住院之關係34 表10日常生活活動功能ADL分數(巴氏量表)及留置管路數目之平均值與內科病人14天內非計畫性再住院之關係………………………………………………… 34 表11出院準備滿意度與內科病人14天內非計畫性再住院之關係………...… 35 表12影響內科病人14天內非計畫性再住院之迴歸分析……….……………… 38
dc.language.iso	zh-TW
dc.subject	非計畫性再住院	zh_TW
dc.subject	回溯性研究	zh_TW
dc.subject	主要照顧者	zh_TW
dc.subject	內科病人	zh_TW
dc.subject	危險因子	zh_TW
dc.subject	主要照顧者	zh_TW
dc.subject	回溯性研究	zh_TW
dc.subject	內科病人	zh_TW
dc.subject	危險因子	zh_TW
dc.subject	非計畫性再住院	zh_TW
dc.subject	risk factors	en
dc.subject	retrospective study	en
dc.subject	primary caregivers	en
dc.subject	medical patients	en
dc.subject	risk factors	en
dc.subject	unplanned readmission	en
dc.subject	retrospective study	en
dc.subject	primary caregivers	en
dc.subject	medical patients	en
dc.subject	unplanned readmission	en
dc.title	內科病人14天內非計畫性再住院相關因素之回溯性研究	zh_TW
dc.title	Risk Factors for Unplanned Readmission within 14 Days in Medical Patients: A Retrospective Study	en
dc.type	Thesis
dc.date.schoolyear	104-2
dc.description.degree	碩士
dc.contributor.oralexamcommittee	戴玉慈,張晉豪
dc.subject.keyword	非計畫性再住院,危險因子,內科病人,主要照顧者,回溯性研究,	zh_TW
dc.subject.keyword	unplanned readmission,risk factors,medical patients,primary caregivers,retrospective study,	en
dc.relation.page	54
dc.identifier.doi	10.6342/NTU201601284
dc.rights.note	有償授權
dc.date.accepted	2016-08-03
dc.contributor.author-college	醫學院	zh_TW
dc.contributor.author-dept	護理學研究所	zh_TW
顯示於系所單位：	護理學系所

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