接受居家護理老人住院情形及其相關因素探討

Risk Factors Associated with Hospitalization in Elderly Patients Receiving Home Care Nursing

1995年起居家護理正式納入全民健康保險給付，居家護理提供已由125家增加至491家，居家護理服務個案多為高齡、慢性退化疾病所致身體活動功能障礙人口，服務對象以腦中風居多，由於老人生理結構上的老化，再加上慢性疾病失能比例高及留置管路的加成，出院後常需仰賴他人照顧等因素，而較容易造成反覆住院，衍生後續照護問題，增加家庭及醫療資源負擔。由於國內文獻大多探討長期照護機構個案住院危險因子，但對居家護理老人住院相關少有研究，故引發作者動機。本研究採橫斷式研究設計，使用結構式問卷調查表進行病歷回溯，以北部某醫學中心附設居家護理所年滿65歲以上服務個案為調查對象，依Andersen行為理論影響醫療服務利用行為模式，探討居家護理老人發生住院之相關。皮爾森積差相關係數檢定顯示居家護理老人診斷總數與住院次數有關，居家護理老人留置管路數、進食途徑與住院天數有關。迴歸分析顯示住院天數的預測因子為疾病診斷總數、留置管路數。本研究僅以北部某一醫學中心附設居家護理所其服務的居家護理老人為對象，研究發現其屬性及疾病相似度高，或許對發生住院情形及相關的影響有偏差，無法對住院次數行為做整體趨勢推論，建議未來可進行縱貫性研究，擴大範圍並分區隨機抽樣加以深入探討分析，有助於確認住院的相關，並提供相關單位做為尋求改善住院的參考，讓高齡長者有更好的生活品質。

The past decade has seen a great deal of growth in home nursing care services, increasing from 125 to 491 facilities, thanks to its coverage by the National Health Insurance in 1995. The majority of its users pertained to the aged, physically disabled due to chronic diseases, particularly those suffered from cerebral vascular diseases. A combination of aging syndromes, physical disabilities, and in some cases, the intubations has led to patients' recurrent hospitalizations, putting a great burden on both their family and medical resources. Despite of its importance, research on the subject regarding factors associated with hospitalization of patients using nursing services at home was conspicuously scanty. This study attempted to fill the void in the literature. Through employing cross-sectional case review study design with structured questionnaire, this study surveyed cases age 65 and above who used services from a home care unit of an anonymous hospital in northern Taiwan to investigate the occurrence of hospitalization among home care elderly based on Andersen Behavioral Model on Health Services Use. The Pearson's correlation analysis found that the number of diagnosis was related to the frequency of hospitalization while the number of tube indwelling and dietary route were related to length of hospitalization. Result from regression analysis indicating total diagnosis, and number of tube indwelling to be the predicting factors of the length of hospitalization. In this study, sampling was conducted only in one home care unit from a hospital in northern Taiwan, which their high similarity in both characteristics and disease properties might cause deviation on hospitalization. It is suggested a broadened and randomized sampling longitudinal study could be carried out in future to identify the related risk factors to ameliorate the hospitalization among elderly and improve their quality of life.