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• Main Authors: Chung-Chao Liang, 梁忠詔
• Other Authors: Sheau-hwa Chen
• Format: Others
• Language: zh-TW
• Published: 2002
• Online Access: http://ndltd.ncl.edu.tw/handle/65792970330567467850

碩士 === 國立東華大學 === 企業管理學系 === 90 === The rate of long-term hospitalization has been escalating alarmingly with the coming of aging society, the prevalence of chronic illnesses, allure of public health insurance policy, and the incompleteness of the medical care system. The situation is even more obvious for rehabilitation departments. It will inevitably be the goal for all rehabilitation medicine providers to shorten the length of stay (LOS) following the implementation of case payment and the global budget policies to be in practice soon. The main purpose of this study is to investigate the present phenomena and variability of the normal inpatients and those requiring longer stay. The reasons for extended hospitalization are explored to identify risk factors for this patient group so as to establish screening reference for the medical service providers. The research target of this retrospective design was the rehabilitation department of a medical center in the Hualien-Taitong region. There were 568 inpatients during 1999 to 2001. After excluding the deceased, the unreachable, those with incomplete history in medical chart, and those with LOS less than seven days, 335 cases were included in the sample. The main disease types were cerebrovascular accident, traumatic brain injury, and spinal cord injury. Patient data were collected through a questionnaire inquiring patient demographic data, admission data, and information for delayed discharge as well as a daily activity index. Results of one-way analysis of variance revealed that LOS differed in categories of age, frequency of consultation by rehabilitation/other departments, caregivers during/after hospital stay, post-discharge attendant expense, supplemental medical insurance, diagnosis, LOS at other departments, referral source, in-hospital transfer, intensive care unit stay, operation, number of impaired functions, motor function disability, number of treatment items, activity of daily living (ADL) score at admission/discharge and ADL progress during hospital stay. Multiple regression analysis detected seven important factors affecting the length of extended hospitalization, including number of impaired functions, frequency of consultation by rehabilitation department, motor function disability, supplemental medical insurance, diagnosis, ADL score at admission, and treatment items. These variables accounted for 59.2% of variance in LOS. Based on the results, to establish a screening mechanism is suggested to identify high-risk patients inclined for long hospital stay. Such a mechanism, together with discharge planning interventions and reasonable control of hospital days, could improve the efficiency of hospital bed utilization. It also provides a reference standard for national health insurance policy in planning case payment scheme of the rehabilitation medicine.