缺血性腦中風臨床路徑之成效

Outcome of the Clinical Pathway for Ischemic Stroke Patients

本研究旨在發展缺血性腦中風病人臨床路徑並測試其對住院天數、身體功能狀態、醫療費用、病患滿意度、醫護人員工作滿意度之影響。首先經由病歷回溯及以行動研究法發展缺血性腦中風病人之臨床路徑，並測試此臨床路徑之成效。研究採類實驗設計，針對缺血性腦中風之病患及醫護人員分別進行測試。於北區某醫學中心神經內科病房進行收案，先收集控制組50名，再以中風嚴重度配對方式收集實驗組50名；醫護人員樣本為30人。研究工具包括：美國國家衛生院中風量表；巴氏量表；病患護理品質滿意度量表及醫護人員工作滿意量表。控制組採醫院常規照護；實驗組依據所發展的臨床路徑進行照護。資料以SPSS 10.0套裝軟體進行建檔和統計分析。統計方法包括：平均值、標準差、百分比、t-檢定及共變數分析。研究結果顯示：實施缺血性腦中風之臨床路徑可縮短住院天數；節省醫療費用；改進身體活動功能；增加病患及家屬之滿意度及提升醫護人員之滿意度。

The purpose of this study is to develop a clinical pathway for ischemic stroke patients and to test the effectiveness of the pathway to length of stay (LOS), functional status, medical cost, patient satisfaction, and staff satisfaction. The first stage was to develop a clinical pathway for ischemic stroke patients. Retrospective chart review method was used. The second stage was to test the effectiveness of the isehemic stroke pathway. The study was a quasi-experimental design. Subjects included ischemic stroke patients, medical and nursing staffs. The study was carried out in a neurological unit of a medical center in the northern Taiwan. Data were collected from the control group of 50 patients first, then followed with a matched stroke severity of experimental group of 50 patients. The research instruments included the U.S. National Institute of Health Stroke Scale (NIHSS), Barthel Index, Patient Satisfaction with Nursing Care Questionnaire, and McCloskey/ Mueller Job Satisfaction Scale. Control group patients only received unit routine care, and experimental group patients received specific care as indicated within ischemic stroke pathway. The SPSS10.0 software was used for coding and data analysis. Statistic methods included mean, standard deviation, percentile, independent sample t-test, and ANCOVA. Results showed that clinical pathway can effectively shorten length of stay and decreased medical cost for ischemic stroke patients. Implimentation of the clinical pathway had demonstrated significant improvement in the patients’satisfaction and job satisfaction of medical and nursing staffs as well.