影響出院準備服務病人使用居家服務之因素探討

Factors Influencing the use of home care Services by Patients who Received Discharge Planning

目的：出院準備服務是病人回歸社區的重要轉銜服務，住院期間銜接長照2.0的服務項目中又以申請居家服務之使用人數居多。因此，本文以出院準備服務的角度瞭解銜接長照2.0之病人特性及探討出院準備服務病人使用居家服務之預測因素。方法：採用病歷回顧，收集2017年11月至2018年10月接受花蓮縣南區某醫院之出院準備服務病人，首次銜接長照2.0且經由衛生福利部照顧服務管理資訊平臺通過核定者，資料內容包括病人特性及照顧者特質（含照顧者負荷）二大部份進行收集。共有120位病人納入本研究分析，運用SPSS for windows 21.0進行統計分析，採用描述性統計、t檢定、單因子變異數分析及線性迴歸分析。結果：研究發現，逾五成（50.8％）病人有居家服務需求。在病人特性方面，影響出院準備服務病人使用居家服務預測因子為住院診斷之呼吸系統疾病者（p＝0.005）與服務需求數目（項）（p＜0.001）；然而，照顧者特質對使用居家服務則未達統計上之顯著。結論：居家服務在長期照護中是普遍使用的社區資源，也是病人回歸家庭、實踐在地老化之重要推手，落實出院準備服務更能增加長照資源之使用效能。冀望藉由本文提升醫療院所執行出院準備服務銜接長照2.0的敏銳度，有效推廣本國居家服務之利用。

Purposes Discharge planning is a key transition service that facilitates the return of patients to the community. Statistically speaking, most applications submitted during hospitalization for transition to the Long-Term Care 2.0 Program (LTC 2.0) were for home care services. Therefore, in the present study, we determined the characteristics of patients who transitioned to LTC 2.0 from the perspective of discharge planning and investigated the predictive factors for the use of home care services by patients who received discharge planning. Methods By adopting a medical record review method, data on patients who received discharge planning at a hospital in southern Hualien County from November 2017 to October 2018 and were approved for first-time transition to LTC 2.0 on the Ministry and Health and Welfare's Care Service Management Information Platform were collected. The collected data comprised two major sections, namely patient characteristics and caregiver characteristics (including caregiver burden). A total of 120 patients were included in this study, and the data of these patients were statistically analyzed using descriptive statistics, the t-test, one-way ANOVA, and linear regression analysis in SPSS 21.0. Results Results showed that more than half (50.8%) of the included patients had demands for home care services. Among the various patient characteristics, an inpatient diagnosis of respiratory diseases (p=0.005) and the number of service items demanded (p<0.001) were predictive factors of the use of home care services by patients who received discharge planning. In addition, the influence of caregiver characteristics on the use of home care services was not found to be statistically significant. Conclusions Home care services are commonly used community resources in long-term care and a key promoter for the homecoming of patients and for those aging in place; the enhanced implementation of discharge planning can increase the effectiveness of long-term care. It is hoped that the present study can improve the responsiveness of hospitals in the transition from discharge planning to LTC 2.0 and effectively promote the use of home care services in Taiwan.