老年患者出院6个月内非计划性再入院影响因素研究

发布时间：2018-03-18 09:13

本文选题：老年患者　切入点：出院6个月内　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的了解出院后6个月内非计划性再入院老年患者的临床特征,并分析导致老年患者非计划性再入院的影响因素,为老年患者的出院指导及延续性护理干预提供理论依据。方法采用描述性研究方法,对2014年7月1日-2015年6月31日由宁夏医科大学总医院出院后6个月内非计划性再入该院的60岁及以上老年患者1206例进行一般资料、临床特征等描述性分析。在此基础上,采用病例对照研究方法从1206例患者中随机抽取90例为病例组;并按照年龄(±5岁)、性别、病种配对选取同时期内未再入院老年患者90例为对照组,采用日常生活活动能力量表(ADL)、家庭照护能力量表(FCCS)、健康促进生活形态量表Ⅱ(HPLP-Ⅱ)、社会支持评定量表(SSRS)、健康自评量表进行问卷调查。使用SPSS17.0统计软件进行统计分析,计量资料懫用均数、标准差描述,计数资料采用频数、百分比描述,采用单因素分析、多因素条件logistic回归分析老年患者出院后6个月内非计划性再入院的影响因素。结果1.非计划性再入院老年患者的人口学特征:本次调查的1206例患者中,年龄为60~90(70.02±7.58)岁,其中,60-69岁者627例,占51.99%;70-79岁者411例,占34.08%;80岁以上者168例,占13.93%。男性771例,女性435例,男女比为1.8:1。有配偶者1179例,占97.76%;无配偶者27例,占2.24%。汉族989例,占82.01%;回族191例,占15.84%;其他26例,占2.15%。2.非计划性再入院老年患者的临床特征:主要诊断排前3位的是冠心病255例,占21.14%;肝硬化153例,占12.69%;胆囊胆管炎138例,占11.44%。出院后非计划性再入院的平均时间为(52.49±47.77)天,其中,出院后0-30天再入院者543例,占45.02%;31-60天再入院者255例,占21.14%;61-90天再入院者144例,占11.94%;其他时间再入院者264例,占21.90%。3.老年患者非计划性再入院的影响因素:单因素分析结果显示,老年患者的文化程度、职业、居住情况、居住地区、经济来源、医疗保障、对疾病的了解程度、出院指导、出院带药、生活自理能力、健康自评、健康饮食、人际关系、健康职责、体育运动、照护者健康、照护者时间、疾病认知、家庭关系、替代能力、周边支援、客观支持、主观支持各项差异有统计学意义(P0.05)。多因素条件logistic回归分析结果显示:患者的生活自理能力、健康饮食、人际关系、照护者健康、替代能力、家庭关系是老年患者非计划性再入院的独立影响因素。患者的生活自理能力越好(OR=0.047,95CI=0.003-0.775)、健康饮食意识越强(OR=0.660,95CI=0.462-0.942,)、人际关系越好(OR=0.426,95CI=0.228-0.796)、照护者健康(OR=0.224,95CI=0.056-0.899)、有辅助照护者(OR=0.195,95CI=0.043-0.877)、家庭关系越和睦(OR=0.204,95CI=0.046-0.899),老年患者发生非计划性再入院的风险越小。结论1.老年患者出院后非计划性再入院的时间以2个月内再入院者最多,主要诊断以心血管系统、消化系统疾病所占比例最多。2.患者的生活自理能力、健康饮食、人际关系、照护者健康、替代能力、家庭关系是老年患者非计划性再入院的独立影响因素。提示临床护士在出院指导以及延续性护理服务时,应重点关注这些影响因素,针对不同的个体特征制定相应的护理应对策略,从而减少老年患者非计划性再入院的发生。
[Abstract]:Objective to understand the 6 months after discharge and unplanned clinical features at admission in senile patients, and analyze the causes of non factors affecting the planned readmission of elderly patients, and provide a theoretical basis for the intervention of elderly patients with discharge guidance and continuity of care. Methods descriptive research methods, on the July 1, 2014 -2015 year in June 31st by the General Hospital of Ningxia Medical University after 6 months the unplanned reentry of the hospital elderly patients aged 60 years and over 1206 cases of general data, descriptive analysis of clinical features. On this basis, a case-control study from 1206 patients randomly selected 90 cases; and according to age (+ 5 years), sex, disease at the same time were chosen period before the re admission of 90 cases of elderly patients as the control group, the activities of daily living scale (ADL), family care ability scale (FCCS), Health Promoting Lifestyle Scale II (HPLP- II), social support rating scale (SSRS), health self rating scale questionnaire. Statistical analysis was performed using the SPSS17.0 statistical software was used for measurement data Zhi, standard deviation, count data using frequency, percentage, single factor analysis, multivariate logistic regression analysis of factors in 6 months of unplanned readmission of elderly patients after discharge. Results 1. of unplanned readmission of elderly patients with demographic characteristics: 1206 cases of the patients, age of 60~90 (70.02 + 7.58) years old, among them, 60-69 years old in 627 cases, accounting for 51.99%; 70-79 in 411 cases, accounting for 34.08%; 168 patients over the age of 80, accounting for 13.93%. male 771 cases, female 435 cases, male and female ratio of 1.8:1. has a spouse in 1179 cases, accounting for 97.76%; 27 cases without a spouse, accounted for 2.24%. of 989 cases of Han, Hui accounted for 82.01%; 191 cases, accounting for 15.84%; other 26 cases, accounting for 2.15%.2. of unplanned re hospitalized elderly patients The main clinical features: diagnosis ranked the first 3 of 255 cases of coronary heart disease, accounted for 21.14%; 153 cases of cirrhosis, 12.69%; gallbladder cholangitis in 138 cases, accounting for 11.44%. after discharge of unplanned readmission for an average of (52.49 + 47.77) days, including 0-30 days after discharge and readmission in 543 cases. Accounted for 45.02%; 31-60 day readmission in 255 cases, accounting for 21.14%; 61-90 day readmission in 144 cases, accounting for 11.94%; 264 cases of other time readmission, accounting for non planned factors affecting readmission of elderly patients with 21.90%.3.: single factor analysis showed that the degree of culture, elderly patients with occupation, living conditions, living area, economic source, medical security, discharge guidance to the degree of the disease, discharge medication, self-care ability, self-rated health, healthy diet, interpersonal relationship, health responsibility, sports, health care, caregiver time, disease awareness, family relationships, the ability to replace, peripheral support, Objective support, subjective support and the difference was statistically significant (P0.05). Multivariate logistic regression analysis showed that patients with self-care ability, healthy diet, interpersonal relationship, ability to substitute health, caregivers, family relations are the factors in elderly patients with unplanned readmission. The independent effect of patient self-care ability is better (OR=0.047,95CI=0.003-0.775), the stronger consciousness of health diet (OR=0.660,95CI=0.462-0.942), better interpersonal relationship (OR=0.426,95CI=0.228-0.796), health care (OR=0.224,95CI=0.056-0.899), secondary caregivers (OR=0.195,95CI=0.043-0.877), more harmonious family relations (OR=0.204,95CI=0.046-0.899) in elderly patients, the risk of unplanned readmission was smaller. Conclusion 1. elderly patients after non planning the time of readmission within 2 months readmission most, mainly in diagnosis of cardiovascular system, digestive system The disease accounted for the largest proportion of.2. patients' self-care ability, healthy diet, interpersonal relationship, ability to substitute health, caregivers, family relations are the factors in elderly patients with unplanned readmission. The independent effect of the clinical nurses in discharge guidance and continuity of care services, should focus on these factors, nursing strategy to deal with the corresponding different individual characteristics, so as to reduce unplanned readmission occurred in elderly patients.

【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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