經出院準備服務病人於14天非計畫性再住院之相關因素

Study on 14-day Unplanned Readmission of Patients in Discharge Planning (DP) and their Related Factors

目的：探討南部某醫學中心經出院準備服務收案之病人，於出院後14天內非計畫性再住院的相關因素。方法：本研究為回溯性相關研究。研究樣本為自2007年1月至2009年12月執行出院準備服務，於出院後14天非計畫性再住院者共289人次。結果：研究結果顯示再住院病人平均年齡約63.4歲，以65歲以上高齡，國中以下學歷、和家人同住、疾病診斷為惡性腫瘤者最多。大部分病人的意識清楚，有63%身上留置管路，自我照顧能力（ADL）需旁人協助或完全依賴者高達75%以上；平均住院天數為24.6（±22.8）天，返家後9成以上的病人由家人和看護照顧。比較有疾病復發與發生併發症兩組病人特性及出院準備服務項目，在年齡、疾病診斷、意識狀態、自我照顧能力、管路留置、照顧者、出院後安置等變項，皆有統計顯著差異，進一步以邏輯斯迴歸分析，發現自我照顧能力完全依賴、呼吸系統疾病及由看護照顧者，為影響出院後14天內非計劃再住院者之預測因子。結論：醫療團隊執行出院準備服務過程，除應加強對病人的評估，盡早發現其潛在問題，亦需增強衛教病人及照顧者的照護技巧，以降低併發症及非計畫再住院。

Objective: This study aimed to investigate the factors related to the 14-day unplanned readmission of patients in discharge planning (DP) in a Medical Center in Southern Taiwan.Methods: The study was a retrospective related research. 289 DP patients unplanned readmitted within 14-day from 2007 to 2009.Results: The findings showed that the average age of patients was 63.4 years old, among them most were above 65 years old, with below high school education, living with family and diagnosed to have malignant tumor. Majority of patients were conscious clear. 63% of them had insertion tubes, and more than 75% required assistance for their activities of daily living (ADL). The average length of hospitalization was 24.6 (+22.8) days and most of the patients were taken care of by there families and caregivers. Comparing the patient characteristics and DP contents between the groups of complications and recrudescence, there were significant differences in ages, diagnoses, levels of consciousness, ADLs, insertion tubes, caregivers, and the discharge replacements. In addition, regression analyses found total required assistance for ADL, respiratory disease, and caregiver were predict factors of the 14-day unplanned readmission.Conclusion: To reduce complication and unplanned readmission, the medical professionals should enhance the DP service and promote the caring skills of patients and caregivers.