慢性阻塞性肺疾病臨床路徑之成效

Effectiveness of the Clinical Pathway for Patients with Chronic Obstructive Pulmonary Disease

本研究旨在發展慢性阻塞性肺疾病病人臨床路徑，並測試該路徑在住院天數、醫療費用、病患呼吸困難、運動耐力、病人滿意度、醫護人員工作滿意度之影響與變異情形。研究分兩階段進行，首先經由病歷回溯以行動研究法發展慢性阻塞性肺疾病病人臨床路徑，再測試該路徑之成效。研究採類實驗設計，針對慢性阻塞性肺疾病病人及醫護人員分別測試。於北區某區域教學醫院內科病房進行收案，先收集對照組30名，再依慢性阻塞性肺疾病病人之疾病嚴重度配對方式收集實驗組30名，醫護人員則以26人為樣本。研究工具包括：病患基本資料表、視覺類比量表、六分鐘走路距離、臨床路徑變異記錄表、病患對護理照護滿意度量表，醫護人員工作滿意度量表。對照組採醫院一般照護，實驗組以所發展之臨床路徑進行。資料以SPSS 10.0套裝軟體進行統計分析。統計方法包括：平均值、標準差、百分比、t-檢定及共變數分析。研究結果發現:實施慢性阻塞性肺疾病臨床路徑可縮短住院天數；可降低醫療費用；對病患呼吸困難及運動耐力之改善則無顯著差異；可提升病患滿意度；亦可增加醫護人員滿意度。

The purposes of this research were to develop a clinical pathway for patients with chronic obstructive pulmonary disease, and to test the effects of the pathway on length of stay, medical cost, dyspnea levels, endurance of exercises, satisfaction of the patients and medical personnel. The research was carry out in two stages: The first stage was to develop a clinical pathway for chronic obstructive pulmonary disease patients. Retrospective chart review method was used. The second stage was to test the effectiveness of the COPD clinical pathway. The study is a quasi-experimental design. Subjects include COPD patients, medical and nursing staffs. The study was carried out in a medical ward of a hospital in the northern Taiwan. Data were collected from the control group of 30 patients first, then the experimental group of 30 patients. Both groups of patients were matched with the disease severity. The research instruments included basic medical record charts, Visual Analogue Scale of dyspnea, 6-minute walking test, Clinical Pathway Variance Record List, Patient Satisfaction with Nursing Care Questionnaire, and Six-Dimension Scal of Nursing Performance. Control group patients were cared with unit routine. Experimental group patients received care as indicated within COPD clinical pathway. The software SPSS 10.0 was used for data analysis. The statistical methods included: mean, standard deviation, percentile, independent sample t-test, and ANCOVA. The results indicated that clinical pathway for chronic obstructive pulmonary disease patients can effectively shorten length of stay (LOS), and decreased medical cost significantly (p<.05). There was no significant difference on patients dyspnea levels and endurance of exercises. The pathway also improved the satisfaction of patients and the job satisfaction of medical and nursing staffs.