[[alternative]]The effects of case management for improvement of symptoms distress and readmission in order patients with heart failure

[[abstract]]心臟衰竭是65歲以上老年人最常見的住院診斷。在台灣，因心臟疾病死亡人數佔全國總死亡人數17.48%，也是老年人口死亡原因第二名。 本研究為類實驗性研究，採方便取樣，於 2010年03月01日至2010年10月31日完成資料收集。收案對象為北區某醫學中心心臟衰竭住院之中老年病患，收案總人數為67人，分實驗組及對照組；其中實驗組34人接受個案管理照護，控制組33人接受常規照護。每位個案皆依研究階段進行隨時序採前測、後測及後後測，測其心臟衰竭症狀困擾及心臟衰竭疲憊程度。研究資料分析採用SPSS 15.0 版軟體資料進行統計分析，探討個案管理對心臟衰竭病患症狀困擾程度、疲憊程度控制、及再入院之成效。研究結果為（一）、心臟衰竭中老年住院病患分期以第Ⅱ、Ⅲ期居多，三十天內非計畫性再入院率為16.7%。（二）、在症狀困擾方面，心臟衰竭中老年病患症狀困擾程度為中度，個案管理措施介入結束後第一週，症狀困擾程度即呈現顯著之成效，直到個案管理措施介入結束後第三週仍可觀察得到顯著之差異。（三）、在疲憊程度方面，心臟衰竭病患疲憊程度為中至重度，個案管理措施結束後一週，疲憊程度即有顯著差異，並延宕至第三週。（四）、個案管理措施介入對於心衰竭中老年患者非計畫性再入院無顯著效果。本研究為縱貫性研究設計，限於時間、人力與物力限制，僅在單一場所收案，且只評估並追蹤三個時間點，研究結果的推論性受到限制。[[abstract]]The purpose of this study was to examine the effectiveness of case management in improving symptom distress and reamission in older patients with heart failure. The quasi-experimental study design was used. The period of study was from Mary 2010 to Octuber 2010. Convenience sampling was adopted to select two groups’ subjects separately from two cardiac general wards of one teaching hospital in northern Taiwan, thirty-three patients in control group who received routine care, thirty-four patients in intervention group who received both routine care and intervention program which included home follow-up protocol. Data were collected at index admission and one and three weeks after discharge. The study results demonstrated that the intervention group had significant improvements in symptom distress. However, there were no significant differences in improved readmission. Study findings can be concluded that heart failure case management is effective in improving symptom distress and fatigue. This program is worthy of applying in clinical practice and derive benefits to increasing heart failure patients and those population with high risk developing to heart failure