探討社區居家醫療患者不預期緊急急診就醫行為之相關因子
探討社區居家醫療患者不預期緊急急診就醫行為之相關因子
衛生福利部中央健康保險署自一０五年起推動「全民健康保險居家醫療照護整合計畫」，已逐漸建立連續的居家醫療照護網絡，但仍有部分患者不定期至急診就醫，造成病患、照顧者及家庭在時間、健康及金錢上沉重的負擔。本研究透過回溯性病歷分析、旨在探討接受社區居家醫療患者其基本屬性、主要照顧者屬性及居家醫療服務影響一年內急診就醫行為之相關危險因子。
共納入108名社區居家醫療病患，平均年齡為80.8歲，以重度居家醫療患者為主佔95.4%，平均接受居家醫療照護期間為24.4個月，於照護年度內曾到急診就醫的患者比例為60.2%，平均次數為2.1次。經由單變量分析初步篩選出鼻胃管灌食、導尿管留置、褥瘡、臥床狀態、查爾森共病指標、多重用藥、主要照顧者性別、專責護理師資歷、過去一年急診就醫次數及接受居家醫療照護期間共10個淺在可能影響因子，再以最佳子集合選取法(best subset selection)進行多變項羅吉斯迴歸，最後發現接受居家醫療照護整合計畫的病患，其較嚴重的共病情形(查爾森共病指標) (odds ratio [OR] = 1.33, 95% CI = 1.05~1.70)與過去一年較頻繁的急診就醫次數(OR = 1.54, 95% CI = 1.14～2.10)會提高不預期急診就醫的可能性；而主要照顧者為男性(OR = 0.18, 95% CI = 0.05～0.66)、接受越長期的居家醫療照護(OR = 0.97, 95% CI = 0.95～1.00)及越豐富的專責護理師資歷(OR = 0.89, 95% CI = 0.79～0.99)降低患者不預期急診就醫行為。
透過本研究建立社區居家醫療患者的一年內急診就醫行為之相關危險因子預測模型，有助於社區長照資源、基層醫療院所及居家護理所等資源的有效分配，能夠在接觸居家醫療照護個案早期預警特定不預期急診就醫高風險族群，進而改善病患的生活品質及降低家屬和照顧者的負擔。
應用與亮點：
1.提供居家醫療整合照護可以有效降低不預期急診就醫行為
2.考量共病情形、主要照顧者性別、專責護理師資歷、過去一年急診就醫次數及接受居家醫療照護期間可預測接受居家醫療整合照護患者不預期急診
就醫行為
【研究團隊】
團隊成員：楊家琪、邱玟逸
代表單位：長期照顧研究中心
團隊簡介：楊家琪助理教授帶領的研究團隊長期致力於銀髮族群之長期照護相關研究，主要方向包括銀髮健康促進策略、肌少症社區篩檢與預防及高齡福祉科技研發。
研究聯繫Email：chiachiyang@kmu.edu.tw
【論文資訊】
論文出處：International Journal of Health Policy and Management. 2023,10; 12: 7377.
全文下載：https://www.ijhpm.com/article_4511.html
Factors Associated With Unplanned Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services
Factors Associated With Unplanned Emergency Department Visits Among Patients Receiving Publicly-Funded Homecare Services
The public health strategy of increasing access to comprehensive home or community-based healthcare services and emergency home visits is intent on reducing the overcrowding of emergency departments (EDs). However, scientific evidence regarding the association between home-based healthcare services and ED uses is surprisingly insufficient and controversial so far. The present retrospective study identified the risk factors for ED visits among patients receiving publicly-funded homecare services.
The personal demographic and medical information, caregiver characteristics, and behaviors related to homecare services and ED visits from the medical records and structured questionnaires of 108 patients who were recipients of integrated homecare services in a regional hospital in southern Taiwan were collected. Best subset selection regression analysis showed Charlson Comorbidity Index (odds ratio [OR]=1.33, 95% CI=1.05~1.70), male caregiver (OR=0.18, 95% CI=0.05~0.66), duration of introducing homecare services (OR=0.97, 95% CI=0.95~1.00), working experience of dedicated nurses (OR=0.89, 95% CI=0.79 to 0.99) and number of ED utilizations within previous past year before enrollment (OR=1.54, 95% CI =1.14~2.10) as significant determinants for unplanned ED visits.
Application and Highlights:
1.Provision of continuous and comprehensive integrated homecare model would reduce unnecessary or avoidable visits to the emergency
department.
2.The optimal parsimonious five-determinant model, comprising of Charlson Comorbidity Index, caregiver’s sex, duration to introduce
homecare services,working experience of dedicated nurses and number of ED visits within previous past year before enrollment could
predict unplanned ED utilizations among patients receiving publicly-funded integrated homecare services.
Research Team Members: Chia-Chi Yang, Wen-Yi Chiu
Representative Department: Center for Long-term Care Research
Introduction of Research Team:The research team lead by Assistant Professor Chia-Chi Yang has long been focusing on researches for long-term care among elderly. The research topics emphasize on health promotion programs for elderly, screening and preventive strategies for sarcopenia and gerontechnology developments and designs.
Contact Email:
chiachiyang@kmu.edu.tw
Publication:International Journal of Health Policy and Management. 2023,10; 12: 7377.
Full-Text Article: https://www.ijhpm.com/article_4511.html
