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研究生:王蓉敏
研究生(外文):Wang Rong_Min
論文名稱:中風病患實施「出院準備計畫」服務之成效探討──以某地區教學醫院為例
論文名稱(外文):Evaluate the Effectiveness on Discharge Planning Service for the CVA Patients──A Study of a Local Teaching Hospital
指導教授:李麗傳李麗傳引用關係劉秀枝劉秀枝引用關係吳聖良吳聖良引用關係陳育忠陳育忠引用關係
指導教授(外文):Lee_Li_ChuangLiu_Chiou_ChiWu_Sheng_LiangChen_Yu_Zhong
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理學研究所
學門:醫藥衛生學門
學類:護理學類
論文種類:學術論文
論文出版年:1998
畢業學年度:87
語文別:中文
論文頁數:76
中文關鍵詞:出院準備計畫腦中風病患平均住院日平均住院醫療費用再入院率門診複查率
外文關鍵詞:Discharge planningCerebral vascular accident patientLength of stayMedical costReadmission rateOPD follow-up rate
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在醫療源緊縮的情形下,配合衛生署推行「出院準備計畫」服務 的政策,提供有長期照顧需求的病患整體性、持續性的照護模式,並探討此服務模式下腦中風病患的平均住院日、住院醫療費用、再入院率、門診複查率、轉介率、自我照顧功能、病患滿意度等指標之成效。
本實驗係採非相當實驗控制組後測設計,來檢驗某地區教學醫院對腦中風病患實施「出院準備計畫」服務之前後,各項指標差異情形。以方便取樣法,從民國86年9月1日至87年3月31日止,取得研究樣本對照組28位,實驗組37位。比較兩組結果,實驗組在平均住院日、門診複查率、病患滿意度方面皆有顯著性正面效果。日常生活活動指數呈部份依賴程度的病患在自我照顧功能方面,實驗組比對照組顯著進步;在平均住院醫療費用、再入院率、轉介率方面兩組無顯著性差異。
由研究結果可知,醫院在經營成本壓力下,整體性的「出院準備計畫」服務是可以促動腦中風病患滿意早期出院,並配合門診追蹤的治療計畫,維持持續性的照護品質。
本次研究實施過程與結果,提出下面建議:在護理實務方面要繼續擴大服務面、制定篩選量表、定訂出院準備計畫的標準、加強與社區資源機構的聯繫;在護理行政方面應增設出院準備規劃員、定期召開討論會;在護理教育方面要加強護理技術標準、全面宣導「出院準備計畫」服務的理念;在護理研究方面可以繼續探討其他研究指標,訪談工作人員、病患及其家屬的感受。
Recent changes in government regulations and hospital reimbursement practices have increased the importance of early effective discharge. In order to promote the "Discharge Planning" Service (The Service) in conjunction with long term care policy, we set a protocol for integrated medical care for patients who need continuous long term care. Then, we also exam the cerebral vascular accident patients (CVA patients) under The Service. We will measure a series of indicators including length of stay, medical cost, readmission rate, OPD follow-up rate, referral rate, self-care function leveland client satisfaction.
Variations of those indicators in CVA patients discharged before and after the implementation were evaluated by employing the nonequivalent control group only design. All subject CVA patients came from a local teaching hospital and were assigned to either the control group from September 1. 1997 to March 31. 1998, a total of 28 patients, or the experimental group, a total of 37 patients, by convenient sampling method. When those indicators for patients discharged before and after the implementation of The Service were compared and studied, significant differences were observed between control and the experimental group. Patients participated in the experimental group performed much better than those in the control group. They have shorter days of stay in hospital, more frequent OPD follow-up visits, and displayed higher client satisfaction rate. As well, partial dependency patients in experimental group have more noticeable improvement in self-care function level than control group in contrast to these, there was not much difference in other areas such as the average medical cost,readmission rate, or referral rate between the two groups.
Under the pressure to be more cost effective, hospital are looking for ways to discharge their patients earlier without compromising the quality of service provided. The results observed from the CVA patients in our experimental group demonstrated that "Discharge Planning" Service could be a better alternative to provide a continuous integrated medical care. A well planned complimentary OPD follow-up treatment project can enhance its efficiency. Despite the reported effectiveness, The Service still leaves several areas for potential improvement. In terms of nursing practice, the number of patients participating in The Service can be gradually
increased. Development of a screen index for selecting appropriate candidates, setting standards for The Service, and reinforcement on communication with community resources and facilities can also be helpful. In terms of nursing administration, recruiting and training of "Discharge Planner" is just as important as having regular meeting to discuss pertinent matters. For nursing education, improvements can be made by reinforcing the standard of nursing techniques, and by both advocating and educating the public about the concepts of "Discharge Planning" Service. Last but not least, further research in this area can better our basic understanding of this matter. For instance, finding other new indicators can provide a broader view of the quality of the service. Interviews with patients and their caregivers can also improve our assessment of The service for the purpose of providing an integrated continuous quality medical care for patient need long term care.
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