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识别台北中风患者再次入院的相关因素。

Identifying factors associated with hospital readmissions among stroke patients in Taipei.

作者信息

Chuang Kun-Yang, Wu Shwu-Chong, Ma Ai-Hsuan Sandra, Chen Yu-Hui, Wu Chen-Long

机构信息

School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taiwan, ROC.

出版信息

J Nurs Res. 2005 Jun;13(2):117-28. doi: 10.1097/01.jnr.0000387533.07395.42.

Abstract

Hospital readmissions contribute significantly to the cost of medical care, and may reflect unresolved problems at discharge or a lack of resources in post-hospital care. The purpose of this paper is to assess the effects of patient characteristics at discharge, the need for nursing care, discharge planning program, post-hospital care arrangements, and caregiver characteristics on readmissions of stroke patients. Patients discharged from neurological wards in seven hospitals in the Taipei area were recruited into the study. Surveys were conducted before their discharge, and at one month after discharge. Of the 489 patients included in the study, 24.3% were readmitted. After controlling for other variables, factors associated with readmissions were number of limitations in activities of daily living (ADL), first incidence of stroke, the need for wound nursing care, the adoption of a care plan, and the discharge locations. Contrary to expectation, age, length of stay, counseling before discharge, and caregiver burden were not associated with readmissions. The findings of this study indicate that ADL limitation is an effective predictor of readmissions. Increasing home nursing resources to meet the demand for wound nursing care may also be effective in reducing readmissions. Discharging patients into institutions for a short period of time may also prove to be more economically viable due to the reduction in readmissions.

摘要

医院再入院对医疗成本有重大影响,可能反映出出院时未解决的问题或出院后护理资源的不足。本文旨在评估出院时患者特征、护理需求、出院计划项目、出院后护理安排以及照顾者特征对中风患者再入院的影响。台北地区七家医院神经科病房出院的患者被纳入本研究。在出院前和出院后一个月进行调查。在纳入研究的489名患者中,24.3%再次入院。在控制其他变量后,与再入院相关的因素包括日常生活活动(ADL)受限数量、首次中风发作、伤口护理需求、护理计划的采用以及出院地点。与预期相反,年龄、住院时间、出院前咨询以及照顾者负担与再入院无关。本研究结果表明,ADL受限是再入院的有效预测指标。增加家庭护理资源以满足伤口护理需求也可能有效减少再入院。由于再入院率降低,将患者短期安置在机构中可能在经济上更可行。

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