腦中風病人住院經驗與以病人為中心照護結果之關係──以某醫學中心為例

Association between inpatient experience and patient-centered care outcomes in patients hospitalized with stroke

目標：過往對於腦中風倖存者傾向功能狀態恢復結果，鮮少以病人需要及實際感受作為照護指標。而以病人為中心概念逐漸受到重視，須同時納入病人觀點之評比指標，促使醫療品質監測及改善更趨完善，本研究係探討哪些住院經驗構面與以病人為中心照護結果有關。方法：本研究針對20歲以上腦中風住院病人，以美國病人住院經驗（Hospital Consumer Assessment ofHealthcare Providers and Systems, HCAHPS）評估問卷於台灣北部某醫學中心住院病房收案，有效樣本數共為142位病人，於患者出院後90天進行電話訪談追蹤。以多變項線性迴歸以及羅吉斯迴歸分析，探討腦中風病人住院經驗構面與日常生活活動功能（activities of daily living,ADL）、健康相關生活品質及再住院之關係。結果：照護轉銜分數較高，與出院後90天ADL、歐洲生活品質5構面5層級（European Quality of Life-5 Dimensions-5 Levels, EQ-5D-5L）及歐洲生活品質視覺類比量表（EuroQol Visual Analogue Scale, EQ-VAS）較好、再住院勝算較低相關；出院資訊分數與出院後90天ADL及EQ-VAS呈正相關。結論：出院資訊、照護轉銜與出院後90天病人報告結果測量以及再住院相關，透過了解腦中風病人住院經驗各構面評比，可找出影響病人照護結果之重要因素，提供各項數據與以當前指標相互輔助。

Objectives: Previous studies have not considered the subjective needs of patients when evaluating care outcomes, opting to use functional outcomes instead. This runs counter to the concept of patient-centeredness, which has gradually garnered attention in the medical community. Thus, in this study, we investigated the association between inpatient experience and patientcentered care outcomes in patients hospitalized with stroke. Methods: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) survey was conducted among 142 patients (age≤20 years) with stroke who were hospitalized in a medical center in northern Taiwan. Telephonic follow-up was conducted 90 days after discharge. Multivariable linear and logistic regression analyses were performed to investigate the associations between HCHAPS dimensions and patients’activities of daily living (ADL), quality of life, and readmission status. Results: Higher scores in the care transition dimension were associated with better ADL, higher European Quality of Life-5 Dimension-5 (EQ-5D-5L) Level scores, and higher EuroQol Visual Analogue Scale (EQ-VAS) scores but lower odds of readmission at follow-up. The discharge information dimension was positively associated with patients’90-day ADL and EQ-VAS scores. Conclusions: Discharge information and care transition are associated with 90-day patientreported outcomes and readmission. By assessing inpatient experience, we identified the factors influencing care outcomes in our cohort. Thus, inpatient experience may serve as a supplementary indicator of care outcomes in patients hospitalized with stroke.