指導教授：簡國龍臺灣大學：流行病學與預防醫學研究所謝曉芙Hsieh, Shiau-FuShiau-FuHsieh2014-11-272018-06-292014-11-272018-06-292014http://ntur.lib.ntu.edu.tw//handle/246246/262393背景： 出院安置對急性期後住院復健之腦中風病患是一重要健康問題。台灣目前無相關資料，亦不清楚病患女兒數目是否影響病患返家安置之成功率。 方法：於2011年7月至2013年9月間台灣一都會區醫院進行回溯性臨床研究，追蹤所有於接受急性期後住院復健治療之腦中風病患。研究收集病人基本性質、家屬狀況、疾病影響及功能狀況。主要結果為病患是否無法返家安置，資料來源為病歷記錄。 結果：297位病患，平均年齡63歲，37%為女性，其中118位無法返家安置，包括109名入住其他醫院復健科及9名至養護機構安置。女兒數目較多的病患，相較於沒有或僅一個女兒者，其年齡較高，女性較多，已婚比例較高，梗塞性中風較多，接受正式教育年數較短，無工作比例較高，居家有樓梯比例較高，同時兒子數目較多，小孩數目也較多。 女兒數目較多的病患，無法返家安置的機會較低：有三個女兒以上的病患，相較於沒有女兒者，無法返家安置的風險降低77% (勝算比0.23，95%信賴區間0.07-0.72)。年齡較高與自理功能較佳者，無法返家安置之風險亦較低（前者勝算比0.97，95%信賴區間0.95-0.99，後者勝算比0.97，95%信賴區間0.95-0.98）。 結論：在台灣目前接受急性期後住院復健之腦中風病患中，有很高比例無法返家安置。而其中如病患女兒數目較多，無法返家安置之風險顯著下降。Background: Discharge disposition has been important for stroke patients after post-acute inpatient rehabilitation. The rate of failure of home discharge in Taiwan was still unknown. In addition, whether the number of daughters affected patients’ home discharge needs investigation. Methods: We conducted a retrospective case-control study in a tertiary hospital between July 2011 and Sep 2013, investigating stroke patients consecutively discharged from post-acute rehabilitation. Factors regarding patient demographics, family information, as well as disease and function information were collected. We defined the outcome, failure of home discharge or home discharge, from the discharge chart. Results: One hundred and eighteen of 297 stroke patients (mean age 63 years, 37% women) failed to discharge to home after post-acute inpatient rehabilitation, including 109 admitting to other rehabilitation hospitals and 9 to long-term care facilities. Patients with more daughters tended to be older, female, married, to have ischemic stroke, to receive fewer years of formal education, to have no job, to have homes without stairs, and to have more sons and children. A trend existed between having more daughters and a lower risk of failure of home discharge: having three or more daughters reduced 77 percent of the risk (odds ratio [OR] 0.23, 95% confidence interval [CI] 0.07-0.72), compared with those without daughters (test for trend, p=0.002). Other protective factors included a higher age (OR 0.97, 95%CI 0.95-0.99) and a better function at discharge (OR 0.97, 95%CI 0.95-0.98). Conclusion: The rate of failure of home discharge after post-acute inpatient rehabilitation was high in Taiwan and having more daughters lowered the risk.口試委員會審定書 i 致謝 ii 英文摘要 iii 中文摘要 v Abbreviations vi 1. Introduction and literature review 1 1.1. Discharge disposition at the participation level of new health model 1 1.2. Failure of home discharge is the poor outcome for discharge disposition 2 1.3. Stroke and rehabilitation in the acute, post-acute, chronic stages 2 1.4. Post-acute inpatient stage, an important stage of stroke 4 1.5. The rate of failure of home discharge after post-acute stroke inpatient rehabilitation 5 1.6. Predictors for failure of home discharge after post-acute stroke inpatient rehabilitation 6 1.7. Social and environmental factors as predictors 6 1.8. Will number of daughters influence failure of home discharge? 7 1.9. Research gaps 7 2. Hypotheses and study aims 9 3. Materials and methods 10 3.1. Study design 10 3.2. Study participants 10 3.2.1. Inclusion criteria 10 3.2.2. Exclusion criteria 10 3.3. Study setting 11 3.4. Outcome variables 12 3.5. Predictors 12 3.5.1. Patient factors 13 3.5.2. Disease factors 13 3.5.3. Functional status 14 3.5.4. Social and environmental factors 15 3.6. Statistical analyses 16 3.6.1. Descriptive analyses 16 3.6.2. Correlations 16 3.6.3. Tests for trend 17 3.6.4. Simple logistic regressions 17 3.6.5. Multiple logistic regressions 17 3.7. Power calculation and sample size estimation 18 4. Results 19 5. Discussion 21 5.1. Main findings 21 5.2. Studies on the rate of failure of home discharge after post-acute inpatient rehabilitation 21 5.3. Previous findings on social factors 23 5.4. Number of daughters as a protecting factor for failure of home discharge 24 5.5. The different roles of daughters, sons, daughters-in-law and spouses 25 5.6. Other predictors for failure of home discharge after post-acute inpatient rehabilitation 27 5.7. The importance of a comprehensive framework for predictors 30 5.8. Strengths and limitations 31 5.9. Future implications 33 Conclusion 35 References 36 Tables and figures 40 Table 1. Literature review: the rate of home discharge from previous studies 41 Table 2. Literature review: important determinants from previous studies 42 Table 3. Literature review: systemic reviews and framework of predictors of discharge destination 43 Table 4. Characteristics of patients: based on number of daughters 45 Table 5. Distributions of patients’ daughters, sons, and children 46 Table 6. Correlations between continuous independent variables 47 Table 7. Correlations between binary independent variables 48 Table 8. Simple logistic regressions for predictors of failure of home discharge 50 Table 9. Multiple logistic regressions for predictors of failure of home discharge 60 Figure 1. Discharge disposition in the health model of World Health Organization 61 Figure 2. Stages of stroke rehabilitation 62 Figure 3. Structure of predictors for discharge disposition 63 Figure 4. Diagram of study setting 64 Figure 5. Diagram of data collection 65 Figure 6. Flowchart of patients 66 Figure 7. Trend test for number of daughters and rate of failure of home discharge 67 Figure 8. Trend test for number of sons and rate of failure of home discharge 68 Appendix 69 Appendix 1. The National Institute of Health Stroke Severity (NIHSS) Scale 69 Appendix 2. The Cog-4 Scale 74 Appendix 3. The Barthel Index 755836585 bytesapplication/pdf論文使用權限：同意無償授權腦中風出院安置家庭支持社會因素女兒thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/262393/1/ntu-103-R01849018-1.pdf