[[alternative]]The Relationship Between Discharge Planning and Unexpected Hospital Admissions in Elderly Patients at Chest Medical Department in a Regional Teaching Hospital in New Taipei City

[[abstract]]隨著醫療技術的發展與進步，台灣地區高齡人口急速增加，倍化速度、慢性病和失能盛行率的上升，使得健康照護費用提升，其中住院花費最高；在出院準備服務計畫的推動及醫策會將非計畫性再入院納入出院後照護品質指標，期能改善照護品質與降低醫療資源耗用。過去國內文獻大多研究以探討再入院率、出院準備服務滿意度等主題，鮮少對胸腔內科老人病患出院準備服務與非計畫性再住院相關的研究，故引發研究動機。 本研究採橫斷式研究設計，使用結構式問卷調查表進行病歷回溯，以新北市某區域教學醫院65歲以上之胸腔內科老人為對象，依安德森行為模式，探討胸腔內科老人病患提供出院準備服務與非計畫性再住院之相關性。 研究結果病人14天非計畫性再住院與婚姻、居住型態、腦中風及氣切管存留有關。而年齡、居住型態、照顧身分別、慢性病種類為腦中風及肺炎、慢性病數量、存留鼻胃管、導尿管及氣切管、管路存放數、意識狀況、返家照護模式與出院準備服務有關。以迴歸分析顯示，婚姻為無偶狀況及出院後入住機構是14天非計畫性再住院的預測因子；而是否提供出院準備服務與14天非計畫性再住院是無關的。 本研究僅以新北市某區域教學醫院胸腔內科老人病患為對象，研究發現其屬性及疾病相似度高，且出院準備服務個案量較少，或許對14天非計畫性再住院情形及相關的影響有所偏差，建議未來可進行實驗對照研究，將研究對象分為實驗組及對照組並進行護理人員對出院準備服務認知的前後測，有助於確認出院準備服務與非計畫性再住院的相關性，並提供相關單位做為尋求改善非計畫性再住院的參考，讓高齡長者有更好的生活品質。[[abstract]]The senior population in Taiwan is growing rapidly, and the highest percentage of health care costs are spent on the elderly. Among the various kinds of the health costs for the elderly, hospitalization remarks the highest. In order to decrease the unplanned readmission and reduce the cost of the health resource, Taiwan Joint Commission on Hospital accreditation has been promoting the discharge planning services. In literature reviews, the correlation between the discharge planning services and the unplanned readmission in the elder patients of the thoracic medicine department is lacking. Therefore, the purpose of this study is to reexamine the correlation.This study pertained to a cross-sectional design with secondary analysis. The study subjects were the patients at the age of 65 and above from the thoracic medicine department in the regional teaching hospital in New Taipei City, Taiwan. Data were extracted from medical charts which were collected by trained case managers. Andersens Behavior Model of medical service utilization was applied to analyze the relationships between the unplanned readmission and the discharge planning service. The result of our study demonstrated that the incidence of unplanned readmission within 14 days was associated with the marital status, living status, stroke and the remaining of tracheostomy tube. The age, living status, care providers, the number of comorbidities, chronic illness with stroke and pneumonia, remaining of nasogastric tube, Foley catheter or tracheostomy tube, the number of catheters, conscious status, the home care supporting system influence the opportunities for the patients to receive discharge preparation service. The logistic regression demonstrated that the uncoupled status and the care instituition were the predictors of unplanned readmission within 14 days after discharge. Providing discharge planning service was not associated with the unplanned readmission within 14 days after discharge. Our study took the elderly patients from the thoracic medicine department in single regional hospital in the New Taipei City, therefore caution was required when generalizing our research findings to other settings. Our findings were still applicable given that the patient characteristics were similar in many medical settings. One of the limitations lied in the number of elderly patients receiving discharge planning that were relatively fewer. In the future, rigorous research designs such as randomized control tests may be employed to explore the relationship between the discharge planning service and unexpected readmission. The finding of this study also pointed to the way in which discharge planning services need to be carried out more systematically to assure their outcomes