某高齡醫學中心長者病人90天內非計畫性再住院之相關因素

Factors Related to the Unplanned 90-Day Readmission Rate Among Elderly at a Geriatric Medicine Center

背景：非計劃性再住院造成醫療使用率增加及健保財務的負擔，台灣醫療照護品質指標系列（Taiwan healthcare indicator series）將再住院率視為醫療照護品質的重要指標。長者因健康與疾病的特殊性，在急性疾病治療後，可能因身體功能退化及合併症，而造成非計劃性再住院的風險較高。目的：探討某高齡醫學中心長者出院後90天內，非計畫性再住院之相關因素。方法　以病歷回溯法收集2013年1月至2014年12月期間，某高齡醫學中心65歲以上住院長者資料，利用卡方檢定及邏輯斯迴歸，分析90天內非計畫性再住院相關因素。結果　研究結果顯示，長者病人90天內非計畫性再住院率為20.3%。再住院之相關因素為：經由急診入院者（佔88.7%）、無規則門診追蹤者（60.4%）、罹患腦中風（43.4%）、骨質疏鬆症（32.1%）、消化道疾病（45.3%）及血紅素值低於10.0mg/dl者（35.8%）。結論／實務應用　此研究結果有助於瞭解長者非計畫性再住院的影響因素，建議適時提供長者病人衛教指導、慢性疾病的整合醫療照護、營養補充，以期減少長者病人非計畫性再住院。

Background: Unplanned readmissions increase healthcare utilization rates and healthcare costs. The Taiwan Healthcare Indicator Series regards the rate of hospital readmission as an important indicator of inpatient-care quality. The elderly face a higher risk of unplanned readmission due to elderly-specific health and disease characteristics such as deteriorating body functions and the relatively high incidence of complications after the treatment of acute diseases. Purpose: To explore the factors that relate to the unplanned readmission of elderly within 90 days of discharge at a geriatric medical center. Methods: We retrospectively reviewed the medical records of inpatients aged ≥65 years who had been admitted between January 2013 and December 2014. Related factors that affected the rate of unplanned readmission within 90 days of discharge were screened and analyzed using the chi-squared test and logistic regression analysis. Results: The 90-day unplanned readmission rate was 20.3%. Factors that were found to relate to unplanned readmissions were: emergency room admission (88.7%), lack of regular outpatient follow-up (60.4%), cerebrovascular incidents (43.4%), osteoporosis (32.1%), gastrointestinal diseases (45.3%), and a hemoglobin level ＜ 10.0 mg/dL (35.8%). Conclusions / Implications for Practice: The results of the present study may help the healthcare team better understand the factors that affect unplanned readmission in the elderly. We suggest that these teams provide timely health education for elderly, integrative healthcare for chronic diseases, and appropriate nutritional supplements in order to reduce unplanned readmissions.