Young E C, Durant-Jones L
Department of Audiology and Speech Pathology, University of Rochester Medical Center, Strong Memorial Hospital, New York 14642.
Dysphagia. 1990;5(3):159-65. doi: 10.1007/BF02412640.
A needs assessment for a hospital-based dysphagia program was conducted to determine incidence, management procedures, and outcome for stroke patients with swallowing disorders. Using a chart review of 225 patients, it was found that 28% had documented evidence of dysphagia. When dysphagia co-occurred with stroke, significantly more functional problems and medical complications were reported, as well as increased need for dietary modifications and alternative feeding methods. The dysphagic patients were more often aphasic and dysarthric and less able to communicate. Mental status was more likely to be reduced and the need for staff supervision during mealtime was increased. Dysphagic patients had significantly longer hospital stays, thus increasing the cost of their care. At discharge, almost half of them continued to need feeding modifications, which may have delayed rehabilitation or transfer to facilities with other levels of care. The dysphagia group clearly displayed a wide range of clinical symptoms that would alert staff to their risk for medical complications because of swallowing problems. We believe that this needs assessment clearly showed that a multidisciplinary dysphagia management program has the potential to enhance patient care while decreasing the cost of health care delivery for the hospital.
为确定吞咽障碍的中风患者的发病率、管理程序和预后，开展了一项针对医院吞咽困难项目的需求评估。通过对225名患者的病历回顾发现，28%的患者有吞咽困难的记录证据。当吞咽困难与中风同时出现时，报告的功能问题和医疗并发症明显更多，对饮食调整和替代喂养方法的需求也增加。吞咽困难的患者更常出现失语和构音障碍，沟通能力较差。精神状态更可能下降，进餐时对工作人员监督的需求增加。吞咽困难的患者住院时间明显更长，从而增加了护理成本。出院时，几乎一半的患者仍需要饮食调整，这可能会延迟康复或转至其他护理级别的机构。吞咽困难组明显表现出广泛的临床症状，这会提醒工作人员注意他们因吞咽问题而出现医疗并发症的风险。我们认为，这项需求评估清楚地表明，多学科吞咽困难管理项目有潜力提高患者护理质量，同时降低医院的医疗保健提供成本。
