居家照護病人一年內住院或急診之危險因子探討

Risk Factors of One-Year Readmission or Emergency Room Revisit in Patients Receiving Home Health Care

目的：台灣老年人口逐年攀升，因身體狀況而有居家醫療及護理需求的患者亦日漸增加。本研究的目的為探討接受居家照護病患病人住院或急診之影響因子，並進一步思考如何降低此類病人住院與急診就診率。

 

方法：本研究為回溯性病例分析，針對北部某醫學中心自2015年8月至2016年7月間居家護理病人，回顧其歷次訪視時之健康狀況評估表、身體功能評估表、醫師出診紀錄醫囑、營養評估表與歷次住院紀錄。根據病歷紀錄將性別、年齡、居家照護時間、巴氏量表、老年症候群各相關變項、共病情形、近一年內住院、急診就診次數等資訊，進行單變項與多變項邏輯斯迴歸分析探討居家醫療病患住院或急診之影響因子。

 

結果：本研究共計131人，其平均年齡為84.1歲，其中女性占54.2%，長照機構病人占10.0%，平均居家照護時間為35.4個月。居家護理起始照護年度曾住院的比率為85.5%、巴氏量表平均為5.1分、迷你營養評估平均為15.4分。近一年評估的巴氏量表平均為3.8分、迷你營養評估平均為19.4分、近一年住院或急診的患者比例為60.3%，其中平均住院次數為1.7次。以單變項邏輯斯迴歸分析發現只有起始照護年度的迷你營養評估分數(OR=0.86, p<0.05)和接受居家照護時間(OR=0.98, p<0.05)與住院或急診呈現負相關。多變項邏輯斯迴歸分析調整年齡與性別後發現起始照護年度的迷你營養評估分數低，共病症多、到院急診就診次數越多與住院或急診呈正相關。

 

結論：接受居家醫療之病人，其於居家護理起始照護年度之營養狀態越差、共病症越多、急診就診次數越多，則後續有較高的機率再次住院或急診。

 

Background: The steady rise in the elderly population has triggered a corresponding growth in the demand for home health care. Our study aims at exploring the risk factors of readmission or emergency room (ER) visit among recipients of home health care so as to help reduce readmission and ER visit rates.

 

Methods: This is a retrospective cohort study based on chart review. Patients receiving home health care from a medical center in Taipei from August 1, 2015 to July 31, 2016 were included in the study. Charts related to each patient’s health status assessment, physical function assessment, diagnosis records of visiting physician, nutritional status assessment, and hospitalization records were reviewed and covariates, notably sex, age, home care duration, Barthel index, geriatric syndromes, Carlson Comorbidity Index (CCI), and previous admission and/or emergency room visit in the most recent year were examined in the univariate and multiple logistic regression analysis to help identify the risk factors of readmission or emergency room visit.

 

Results: A total of 131 patients with a mean age of 84.1 years old were included in this study. Women and residents at long-term care homes accounted respectively for 54.2% and 10% of the patients. The average duration of home health care read 35.4 months. Prior to receiving home health care, 85.5% of the patients showed records of hospitalization or ER visit. Their mean Barthel index score was 5.1 and mean Mini-Nutritional Assessment (MNA) score 15.4. In the most recent year, the two scores read respectively 3.8 and 19.4; 60.3% of the patients experienced hospital readmission or ER visit. Univariate analysis indicated that only the initial MNA score (OR=0.86, p<0.05) and the duration of home health care (OR=0.98, p<0.05) were associated with recent readmission or ER visit. Multiple logistic regression showed that a lower MNA score, a higher CCI score, and a higher number of previous ER visit were related to recent readmission or ER visit rate.

 

Conclusion: For patients receiving home health care, poor nutritional status, higher comorbidities, and multiple previous ER visits appear to be the risk factors of readmission or ER visit.