臺灣博碩士論文加值系統

本研究主要目的為了解需要後續照護的中風病人出院後的長期照護安排，並進一步探討影響長期照護安排的因子。研究資料來自1999年台大公共衛生學院衛生政策與管理研究所吳淑瓊教授主持之「政策對長期照護的可近性、品質與成本之影響」研究計畫。研究樣本為1999年9月1日起至2000年6月30日止，在台北市立仁愛醫院、台大醫學院附設醫院、衛生署台北醫院、耕莘醫院、台北市立陽明醫院、台北醫學大學附設醫院、台北市立萬芳醫院等七家醫院因中風而住院之病人，且經篩選確定為出院後一個月有後續照護需要者，共491位。
研究結果指出，中風病人出院後一個月間14.1%住進機構，55.4%完全由家庭照顧，佔最大多數，30.5%不但有家人照顧，並使用外來社區式服務，顯示目前仍然是由家庭承擔大多數的照護責任。
利用多類別對數複迴歸(polytomous logistic regression)分析病人之社會人口學特性(包括性別、年齡、籍貫、教育程度、家庭月收入、居住地區都市化程度)、出院後一個月的健康照護需要(包括身體功能障礙程度、認知功能)、照護資源(包括子女人數、是否有社會補助)、出院準備服務、病人與家庭間的資源交換(包括工具性、財務性、知識經驗性)等變項對病人出院後之長期照護安排的影響。在控制相關影響因子之後，得到重要結果如下：(1)年齡較高(OR=1.05)、身體功能障礙程度為3~4項ADLs障礙(OR=4.99)、5項ADLs全部障礙(OR=15.37)、醫院有安排後續照護服務者(OR=6.45)，與完全由家庭照顧比較之下較可能使用機構式照護。(2)子女人數較少(OR=0.82)、工具性資源交換為很少~常常組(OR=0.26)、知識經驗性資源交換為常常組者(OR=0.41)使用機構式照護的機會較低。(3)病人為女性、身體功能障礙程度為3~4項ADLs障礙(OR=3.21)、5項ADLs全部障礙(OR=9.57)、醫院有安排後續照護服務者(OR=3.49)，與完全由家庭照顧比較之下，較可能採用家庭加社區式正式照護資源。
除病人社會人口學特性、健康照護需要等因素之外，照護資源、出院準備服務與病人生病以前和家庭間的資源交換程度亦為出院後長期照護安排的影響因子。其中，出院準備服務的作用更是值得重視。它可以提高出院病人對後續照護服務的可近性，因此在政策發展上應促進出院準備服務的品質，建立完善的轉介機制，並充實社區中的居家支持服務，以落實連續性照顧之理念。

The purpose of this study is to examine the long-term care arrangement of the discharged patients suffered from stroke, and to analyze the factors associated with these different types of post-hospital care arrangement. The study draws on the data from the research project〝The Impact of policies on the accessibility, quality, and cost of long-term care〞. The sample in this study is consecutive stroke patients from 7 hospitals in Taipei at one month post discharge and screened as having need of long-term care.
The results revealed that 14.1% of the discharged patients needing long-term care lived in the long-term care institutions, 30.5% of them were cared by their families and used at least one kind of community-based formal care services, and 55.4% of them were cared by their families completely. It shows that the families bear quite huge responsibility of care.
In this study, the long-term care arrangement of discharged stroke patients is influenced by five domains：the sociodemographic characteristics of the patients, the need for health care, the resource of care, the discharge plan, and the resource exchanges between patients and their families when the patients were still healthy. After controlling for other factors by using the method of polytomous logistic regression, we found that (1) the patients who were older, discharged with 3~4 items of ADLs disabled, all the 5 ADLs disabled, had fewer children, been transferred to some kind of post-hospital care by their hospitals, never gave instrumental assistance to their families, never or seldom gave informational assistance to their families tended to live into the long-term care institutions. (2) the patients who were female, discharged with 3~4 ADLs disabled, all the 5 ADLs disabled, been transferred to some kind of post-hospital care by their hospitals, tended to be cared both by their families and community-based formal services.

目 錄
第一章 緒論
第一節 研究背景與動機………………………………………………………6
第二節 研究重要性與目的……………………………………………………9
第二章 文獻探討
第一節 中風後遺症及照護需求…………………………………………..…11
第二節 出院病人可使用之服務模式……………………………………..…15
第三節 中風病人出院後服務使用情形及其影響因子……………………..19
第三章 研究方法
第一節 研究架構與假設……………………………………………………..23
第二節 研究變項之操作型定義及測量……………………………………..25
第三節 研究材料……………………………………………………………..33
第四節 資料處理與分析…………………………….……………………….34
第四章 研究結果
第一節 樣本回收情形及回收樣本特性……………………………………..37
第二節 長期照護安排影響因子之雙變項分析……………………………..43
第三節 長期照護安排影響因子之多變項分析……………………………..48
第五章 討論
第一節 重要發現與討論……………………………………………………..53
第二節 研究限制……………………………………………………………..62
第三節 未來研究方向………………………………………………………..63
第四節 政策啟示……………………………………………………………..65
參考文獻……………………………………………………………………………..90
圖表目錄
圖3-1 中風病人出院後之長期照護安排影響因子研究架構……..……………24
表3-1 研究變項之操作型定義與測量…….………………………………….…30
表3-2 多類別對數複迴歸分析變項參考組說明……………………………..…36
表4-1 住院樣本回收情形………………………………………………………..67
表4-2 出院後一個月追蹤情形…………………………………………………..67
表4-3 樣本社會人口學特性……………………………………………………..68
表4-4 病人居住安排…………………………………………………………..…69
表4-5 ADLs功能表現分佈狀況…………………………………………………70
表4-6 ADLs功能障礙狀況………………………………………………………70
表4-7 ADLs功能障礙累計………………………………………………………70
表4-8 IADLs功能障礙狀況……………………………………………………..71
表4-9 IADLs功能障礙累計…………………………………………………..…71
表4-10 身體功能障礙程度…………………………………………………….….72
表4-11 認知功能狀況………………………………………………………..……73
表4-12 認知功能障礙程度……………………………………………………..…74
表4-13 子女人數…………………………………………………………………..75
表4-14 各項社會補助情形……………………………………………………..…75
表4-15 社會補助…………………………………………………………………..76
表4-16 出院準備服務內容………………………………………………………..77
表4-17 出院準備服務分組………………………………………………………..77
表4-18 與家庭的工具性資源交換………………………………………………..78
表4-19 工具性資源交換分組分佈……………………………………………..…79
表4-20 與家庭間的財務性資源交換……………………………………………..80
表4-21 財務性資源交換分組分佈………………………………………………..80
表4-22 與家庭間的知識經驗性資源交換……………………………………..…81
表4-23 知識經驗性資源換分組分佈……………………………………………..81
表4-24 出院後各項長期照護服務使用情形…………………………………..…82
表4-25 出院後之長期照護安排…………………………………………………..83
表4-26 長期照護安排與社會人口學特性之關係………………………………..84
表4-27 長期照護安排與健康照護需要之關係…………………………………..85
表4-28 長期照護安排與照顧資源之關係………………………………………..86
表4-29 長期照護安排與出院準備服務之關係……………………………….….87
表4-30 長期照護安排與病人和家庭間資源交換之關係………………………..88
表4-31 中風病人出院後長期照護安排影響因子多類別對數複迴歸分析…..…89

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