[[alternative]]Factors Associated with Hospitalization ofElderly People Receiving Home Care Nursing

[[abstract]]民國84年起居家護理正式納入全民健康保險給付，居家護理提供已由125家增加至491家，居家護理服務個案多為高齡、慢性退化疾病所致身體活動功能障礙人口，服務對象以腦中風居多，由於老人生理結構上的老化再加上慢性疾病失能比例高及留置管路的加成，出院後常需仰賴他人照顧等因素，而較容易造成反覆住院，衍生後續照護問題，增加家庭及醫療資源負擔。由於國內文獻大多探討長期照護機構個案住院危險因子，但對居家護理老人住院相關少有研究，故引發作者動機。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，以北部某醫學中心附設居家護理所年滿65歲以上老人為調查對象，依Andersen行為理論影響醫療服務利用行為模式，探討居家護理老人發生住院之相關。研究結果顯示經濟來源、進食途徑、留置管路數與住院天數有顯著差異。皮爾森積差相關係數係數檢定顯示居家護理老人診斷總數與住院次數有關，居家護理老人留置管路數、進食途徑與住院天數有關。迴歸分析顯示住院天數的預測因子為家屬教育程度、疾病診斷總數、留置管路數。本研究僅以北部某一醫學中心附設居家護理所其服務的居家護理老人為對象，研究發現其屬性及疾病相似度高，或許對發生住院情形及相關的影響有偏差，無法對住院次數行為做整體趨勢推論，建議未來可進行縱貫性研究，擴大範圍並分區隨機抽樣加以深入探討分析，有助於確認住院的相關，並提供相關單位做為尋求改善住院的參考，讓高齡長者有更好的生活品質。[[abstract]]The past decade has seen a great deal of growth in home nursing care services, increasing from 125 to 491 providers, thanks to its coverage by the National Health Insurance in 1995. The majority of its users pertained to the aged, physically disabled due to chronic diseases, particularly those suffered from cerebral vascular diseases. A combination of age syndromes, physical disabilities, and in some cases the intubations has led to patients’ repeated hospitalizations, putting a great burden on both their family and medical resources. Despite of its importance, research on the subject regarding factors associated with hospitalization of patients using nursing services at home was conspiculously scanty. This study attempted to fill the void in the literature.This study pertained to a cross-sectional and correlational design. Data collected from patients using nursing services at home were collected by face-to-face interviews, using structured questionnaire constructed for this study. A portion of data were extracted from medical charts. Those elders age 65 and over who used nursing care services provided by a home care unit of a teaching hospital in northern Taiwan This study used the Andersen’s behavioral Model of medical service utilization. Logistical Regression was used for the model with its dependent variable measured dichotomously, while Ordinaly Least Squares method was used for the model with its dependent variable measured continuously. SPSS-20.1 was used for statistical analyses. The result from mutilple regression analyses showed that financial resources, dietary route, and the number of intubations were significantly correlated with the length of hospital stay. The result from logistic regression analysis indicating patients’ educational level and financial supports from daughters vs from other resources were significantly associated with the probability for hospitalization. The findings from this study pointed to the need to target those users of nursing care at home who were at risk of being hospitalized