目的：
由於國內醫療水準進步，國民平均壽命延長及生育率下降，使得高齡化社會快速來臨，長期照護機構的需求也大為增加。如何維護住民的健康以減少轉住院的發生，是長期照護機構服務品質的重要指標。本研究擬探討護理之家住民入住急性病房的情形，並分析可能發生轉住院事件的危險因子，進而針對原因預先防範，期望因此而能降低住民入住急性病房的次數，才能避免醫療資源的浪費和提高長期照護的品質。
方法：
本研究收錄南部某區域教學醫院附設護理之家，於2011年3月31日之前入住的住民且居住期間超過90天者共329人為研究對象，以病歷回顧法收集整理機構內的病歷資料進行統計分析。
結果：
男女性住民各佔42.9% 與57.1%，住民的平均年齡為78.06歲，居住期間死亡者佔33.7%，個別住民發生轉住院的次數最少為0次，最多為18次，平均每90天的住院頻率為0.42次。住院的主要診斷以感染症為數最多，佔76.3%。個別疾病則以肺炎佔45.5%、泌尿道感染佔20.0 % 、上腸胃道出血佔10.3%，為排名前三位最常見的住院診斷。
轉住院的頻率與各個自變項的相關分析發現，住院頻率與年齡呈現正相關，與血紅素值、血清白蛋白數值、血清膽固醇數值、身體質量指數、迷你營養評估分數、巴氏量表分數、迷你智能狀態測驗分數等變項呈現負相關。以單因子變異數分析檢驗各個自變項當中，發現性別、年齡、依賴程度與長期臥床、有氣切管、有鼻胃管、意識程度、失智程度、營養不良、貧血、血清白蛋白數值、血清膽固醇數值、是否罹患肺部疾病、腎臟病、失智症、骨折疾病等，以及病房類型等變項與轉住院的發生頻率均有顯著的差異。多變量線性迴歸分析得知對住院頻率具有顯著預測力的變項如下: 男性、年齡、有肺部疾病者、長期臥床者以及迷你營養評估分數。從標準化迴歸係數來看，男性住民、年齡越大者、有肺部疾病者以及長期臥床者有比較高的轉住院傾向，迷你營養評估分數較高的住民有比較低的轉住院傾向。
結論：
若護理之家的醫護人員能充分瞭解住民的特性和轉住院的危險因子，而針對住民中的高危險群採取適當的防範措施，應可降低住民入住急性病房的頻率，才能提高護理之家的照護品質。減少護理之家住民的轉住院事件，是長期照護機構服務品質的重要指標，在上述的結論中所發現相關的危險因子可以提供照護機構參考，以減少轉住院事件。

Background
The demand of long-term care facilities has increased because of the geriatric population growing up rapidly. How to reduce the frequency of the nursing home residents’ being hospitalized is one of the most important indicators for the quality of long-term care.
Objective
To understand the characteristics of facilities and nursing home residents.
To test the effect of the characteristics on the probability of hospitalization of nursing home residents and to analyze the predictors of readmission in order to improve the quality of nursing care and the life quality of their residents.
Methods
We collected 329 residents of a hospital-based nursing home in southern Taiwan before March 31, 2011 and who stayed more than 90 days at the facility. The medical records were reviewed retrospectively. Data were analyzed using descriptive statistics (correlation and one way ANOVA) to test the effect of the resident’s and facility’s characteristics on the probability of hospitalization. Multiple linear regression was used to study the risk factors and the predictors of readmission frequency.
Results
Of the 29 residents, 141(42.9%) were male. The average age was 78.06. 33.7% of the residents died in the facility. The total individual admissions were from 0 to 18. The hospitalized frequency was 0.42 in each 90-day period. Infectious disease was the majority diagnosis of admission. The three leading causes of admission were pneumonia(45.5%), urinary tract infection (20.0%) and upper gastrointestinal bleeding(10.3%). Correlation analysis showed the age had a positive correlation with the frequency of readmission. The hemoglobin level, serum albumin level, serum cholesterol level, body mass index, mini-nutritional assessment score and mini-mental status evaluation score disclosed a negative correlation with the frequency of readmission. Multiple linear regression showed the male gender, age, lung diseases, complete bed-ridden and mini-nutritional assessment score were significant predictors of readmission frequency.
Conclusion
The evaluation of the risk factors and predictors might help to identify the
nursing home residents who are likely to be readmitted. It is hoped that the hospitalizations from nursing home may be prevented and the results of this study might contribute to the quality of long-term care facilities.

論文審定書 i
誌謝 ii
中文摘要 iii
英文摘要 v
目錄 vii
表目錄 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 護理之家的住民特性對轉住院之影響 5
第二節 護理之家的機構特性對轉住院之影響 11
第三節 其他因素對轉住院之影響 13
第四節 文獻總結 14
第三章 研究方法 16
第一節 研究設計 16
第二節 研究架構 17
第三節 研究問題 18
第四節 研究假設 19
第五節 名詞界定 20
第六節 研究變項 21
第七節 資料來源與研究對象 23
第八節 研究工具 24
第九節 資料處理與統計分析 26
第四章 研究結果 27
第一節 研究樣本基本資料 27
第二節 護理之家轉住院與各變項的相關性研究 34
第三節 護理之家轉住院與各變項的單因子變異數分析 35
第四節 性別與健康狀況及住院頻率的差異性研究 38
第五節 護理之家轉住院相關變項的多變量線性迴歸分析 40
第六節 研究結果總結 42
第七節 假設驗證 43
第五章 討論 44
第一節 護理之家轉住民的特性 44
第二節 護理之家住民轉住院常見的疾病 45
第三節 護理之家住民轉住院的相關因素 47

第六章 總結 51
第一節 研究結論與建議 51
第二節 研究限制 53
第三節 研究成果對於提昇長期照護機構品質的意涵與建議 54
參考文獻 56
附錄一 巴氏量表 63
附錄二 柯氏量表 64
附錄三 迷你智能狀態測驗 65
附錄四 迷你營養評估量表 66
附錄五 護理機構設置標準表 68

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