Research of Functional Status among Patient’s with Stroke Receiving Post-Acute Care

• Main Authors: Li-Ying Hung, 洪麗瀅
• Other Authors: Hon-Yi Shi
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/95185091191316302705

碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 105 === Objects： Post-Acute Care (PAC) provides aggressive, high-intensity integrated inpatient rehabilitation during the first three months of golden period for treatment. This study is aimed to investigate functional outcomes of patients with stroke after PAC program and to identify important factors that could be referenced by the ongoing policies. Method： A total of 121 stroke patients who received PAC program were enrolled from a local community hospital between March 1, 2014 and December 31, 2016. In descriptive statistics, categorical variables were described by the number and percentage of the study participants, and continuous variables were demonstrated by the mean, standard deviation, median, and interquartile range (IQR) to measure the statistical dispersion. In inferential statistics, the Cochran-Armitage test for trend was used to estimate the trend of categorical data over time. Furthermore, generalized estimating equation (GEE) was used to analyze longitudinal measurements of functional status of the study participants, and thus to identify the important risk factors. Cox regression was used to determine the risks of readmission and mortality. All analyses were performed using the SPSS Statistics (version 20.0) and STATA (version 11). Results： In all, there were 121 patients with stroke were recruited. Most of them were male, having ischemic stroke, without any catheterization and without handicap certificates. The average length of stay in hospital was 21.5 days. Trend analysis showed an increasing trend of male, without handicap certificates and without readmission. Among the continuous variables, we found the most significant increase in education level (0.043) and the most decline in Charlson comorbidity index (CCI) scores (-0.043). The greatest increase in Barthel index scores was observed between the date of admission and the third week of PAC, and between the twelfth week and the third week of PAC (p <.001). Although factors varied in the different evaluating scales, PAC beyond three weeks and the baseline scores remained statistically significant. After adjusting covariates, education level (HR = 1.6, p=.022) and body mass index (BMI) (HR=0.5, p =.006) were significant factors in survival analysis. Conclusion： PAC rehabilitation program could be an ideal measure to implement the hierarchical medical system and to distribute medical resources more efficiently. Keyword： Post-Acute Care, Stroke, Functional Status