個案管理對心臟衰竭患者生活型態及再住院率之成效

南華大學機構典藏系統 > 科技學院 > 自然生物科技學系(自然療癒碩士班) > 博碩士論文-自然療癒碩士班 > Item 987654321/17880

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題名:	個案管理對心臟衰竭患者生活型態及再住院率之成效
其他題名:	The Effects of Case Management on Lifestyle and Readmission Rate in Patients with Heart Failure
作者:	蕭伊祐 Hsiao, I-yu
貢獻者:	自然醫學研究所陳嘉民 Chia-min Chen
關鍵詞:	生活品質;再住院率;心臟衰竭;個案管理;自我照顧 quality of life;case management;re-hospitalization rate;self-care;heart failure
日期:	2012
上傳時間:	2015-01-06 17:02:10 (UTC+8)
摘要:	背景：個案管理是落實整合性照護的策略之一，除了成功拓展護理的角色之外，協助患者運用現有的資源，藉由整合與協調各種醫療照護服務，除了讓醫療品質提高，並兼顧照護品質與成本效益，創造醫療、患者、護理三贏的局面。　　　目的：探討個案管理對心臟衰竭患者生活型態及再住院率成效。　　　方法：採前、後測問卷調查法，以立意取樣於2011年6月1日至2012 年3月31日在嘉義縣某區域教學醫院心臟科門診進行收案，共收集100名年滿30歲經診斷為心臟衰竭患者為研究對象。所使用的研究工具包括基本屬性表、醫療相關紀錄、生活品質量表及自我照顧行為量表。個案管理師介入滿六個月後施予後測，評估個案6個月內之非計畫再住院率；所得資料以SPSS18.0進行統計分析。　　　結果：個案管理介入後在生活品質的八大層面中照護成效最好的是因生理功能角色受限制，其次是生理功能，成效最少的是活力狀況；在自我照顧行為方面，以主動聯絡醫療行為最佳，其次是居家生活照顧行為，主動就醫行為進步最少；再住院的照護成效為平均住院天數減少10天，平均住院次數減少為0.17次，平均住院費用減少約13萬；在醫療相關資料相關情形，在生活型態中抽菸史、飲酒史、運動習慣這三方面有顯著差異，在NYHA功能分級、住院次數、住院天數、住院費用、心室射出率與生化血液檢查上都有明顯進步。　　　結論：可提供醫療相關單位設計適合患者的照護模式，不僅可增加患者的疾病相關知識，並改善生活品質與自我照護行為。　　Background: Case management is an integrated care strategy for patients with heart failure. The case management also implies a diversified care model. The benefits of case management include the improvements of medical quality and health care, and cost-effectiveness by integrating and coordinating the health care services. In other words, the patients with heart failure can utilize the limited resources to obtain higher benefits.　　　Objective: The objective is to investigate the effects of case management on lifestyle and re-hospitalization rate of patients with heart failure.　　　Methods: This study used a pretest and posttest questionnaire design. By the purposive sampling, one hundred patients aged 30 to 90 and diagnosed of heart failure were recruited from June 2011 to March 2012 at a regional teaching hospital in Chiayi County. The medical records, quality of life scale (QOLS) and the European heart failure self-care behavior scale (EHFScBS) were used to evaluate before and the differences between what six months after case management. The collected data were analysed with SPSS 18.0.　　　Results: In comparison with pre-case management, the QOLS and EHFScBS were shown to have a significant improvement after case management. In QOLS, the changes of role-physical (RP) is the best, the next is physical component summary (PCS) and the last is vitality (VT). In EHFScBS, the changes of the best was to visit the heart failure clinic as scheduled arrangement, the next was life care behavior and the last one was the capability of seeking for medical assistance. In re-hospitalization, the length of hospitalization is reduced from 11.06 to 1.02 days, the rehospitalization rate is reduced from 1.48 to 0.17 and the cost of hospitalizations is reduced from NT 141912 to NT 8364. In medical records, the smoking, drinking, and exercise habits, NYHA functional classification, left ventricular ejection fraction (LVEF) and biochemical blood tests were shown to have a significant improvement. 　　　Conclusion: The benefits of the case management have been confirmed in improving the disease knowledge, quality of life and self-care behavior. The results can help the medical institutions to design a complete case management model.
顯示於類別:	[自然生物科技學系(自然療癒碩士班)] 博碩士論文-自然療癒碩士班

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