非計畫性再住院之概念分析

A Concept Analysis of Unplanned Hospital Readmission

非計畫性再住院是醫療照護品質中重要的監測指標，其影響不僅涉及健保資源支出和負擔，還會對病人、家庭、醫療機構和社會產生負面影響。然而，各國對非計畫性再住院的定義並不完全一致，這影響了台灣醫療機構與國際間相關議題之比較，以及針對非計畫再住院改善方案的規劃。本文以Walker和Avant(2019)概念分析步驟，統整字典和文獻中的定義，歸納非計畫性再住院的概念為（1）病人出院後14天內再度入住同一醫療機構、（2）住院原因為前次住院相同或相關疾病診斷、（3）此次住院非上次住院計畫安排好的；並以典型、邊緣與相反案例來做非計畫性再住院的概念說明。最後，確認影響非計畫性再住院前因後果與常用實證性評估工具。期望藉此概念分析，增進護理人員瞭解非計畫性再住院的概念，並在臨床照護或研究中加以應用。

Unplanned hospital readmissions constitute a significant metric for evaluating the quality of healthcare delivery, affecting not just the expenditure of health insurance resources but also imposing burdens on patients, families, and medical institutions, while adversely impacting societal resources. However, the lack of a consistent definition for unplanned hospital readmissions internationally complicates the comparison of such incidents between healthcare facilities in Taiwan and those abroad, as well as the development of targeted improvement strategies for reducing these readmissions. This article employed the concept analysis methodology outlined by Walker and Avant (2019) to integrate definitions from dictionaries and the literature, summarizing the concept of unplanned hospital readmission as: (1) the readmission of a patient to the same medical facility within 14 days of discharge, (2) readmission due to the same or a related diagnosis as the initial admission, and (3) the readmission was not planned at the time of the previous discharge. To delineate the concept of unplanned hospital readmission, we presented the model case, contrary, and borderline cases. Finally, this paper identified factors influencing unplanned hospital readmissions and commonly used empirical assessment tools. Through this concept analysis, it is anticipated that nurses can enhance their understanding of unplanned hospital readmissions and apply this knowledge in clinical care or research.