預防老年人非計畫性再入院之臨床照護指引

Guidelines for Prevention of Unplanned Rehospitalization of Elderly Patients

在台灣，出院14天內非計畫性再入院比率隨者年紀增長而上升。出院後再入院對病人的傷害以及政府醫療照護系統的資源耗損具有相當大的影響。本指引透過五個階段建立「預防老年人非計畫性再入院之臨床照護指引」，第一階段成立照護指引發展小組；第二階段進行文獻篩選收納1篇系統性文獻回顧及5篇隨機對照研究文獻；第三階段進行文獻評讀與分析，建置22項臨床照護指引內容及處置建議初稿第四階段進行臨床照護指引初稿之專家效度分析，依據專家建議修改內容及建議強度；第五階段進行臨床照護指引之可行性問卷調查，最後形成22項指引內容。此指引包含4項範圍界定、9項具有高風險非計畫性再入院老年病人之評估方法、6項出院前準備計畫、7項出院後追蹤計畫等四個構面。期許本指引可提早發現高風險非計畫性再入院的老年病人，適時介入一系列的出院組合照護計畫，以提升病人疾病自我管理及強化照護者的能力，並降低因相同疾病或相關因素再入院的機會，減少醫療資源的耗損。

In Taiwan, the rate of unplanned readmission within 14 days of discharge increases with age. Unplanned readmission has a considerable impact on the well-being of the patient and depletes the resources of the government’s medical care system. The Guidelines for the Prevention of Unplanned Rehospitalization of Elderly Patients were established in five phases. Phase I involved convening a team for the project. Phase II involved screening and selecting articles, among which one review article and five randomized controlled trial articles were selected. Phase III involved reviewing the literature and then establishing 22-item preliminary clinical guidelines and recommendations. Phase IV involved assessing the validity of the preliminary clinical guidelines and revising the content on the basis of recommendations by experts. Phase V involved conducting a questionnaire-based survey regarding the feasibility of the clinical guidelines, and the 22 items were finalized. The guidelines comprise four main parts: four definitions of scope, nine high-risk unplanned rehospitalization assessments for elderly patients, six predischarge plans, and seven postdischarge follow-up plans. The guidelines are expected to enable early identification of elderly patients at high risk of unplanned readmission. We can then intervene with a series of discharge bundle plans to enhance patients’ self-management, strengthen the ability of caregivers, and thus reduce readmissions and consumption of medical resources.