腦中風病患照護質量及成本效益控制

英文摘要
The purpose of this study was to investigate the application
ofcase management in the frequency of complication, cognition of
self-care, satisfaction on health care, length of stays, medical
cost, and related factors on the length of stays and medical
cost in hospitalization for the cerebrovascular accident(CVA)
patients. The Quasi-experimental design was used in this
study. Based on the hospitalization order and the study
inclusion criterion, the total sample consisted of 114 CVA
patients. The subjects were divided into two groups, 57 subjects
in each group. The subjects in the experimental group received
case management method and the subjects in the control received
the routine care method.

Content validity, Cronbach''s alpha, and Kappa were performed to
examine the validity and reliability of the instruments used i
this study. Using Cronbach''s alpha method, the reliability
coefficients were 0.75 for the evaluation tool of self-
cognition, and 0.88 for the satisfactory questionnaire. Kappa
method was used for the agreement among the researchers and
coefficient was 0.86. Data collection was done by using the
demographic data sheet, the evaluation tool of self-cognition,
the satisfactory questionnaire, and the patient''s chart. Data
also were collected from the center of research institutuions.
The pre-test was done by researcher within 24 hours after
patient''s hospitalization, and the post-test was done on the day
of patient''s discharge.Data were analyzed by using the chi-
square test, t-test, pair t-test, Mc Nemar''s test, ANOVA and
multiple regression test. The results indicated that the
frequency of urinary tract infection on experimental group was
significantly less. The experimental group was significantly
higher in the cognition of self-care and patient''s satisfaction
on medical health care.The experimental group was significantly
less in the average length of stays and medical cost. There was
no significant difference on Activities of Daily Living
Dependent Index, Coma Scale and the types of placement on the
patient''s dischargeday. The study results also showed that Case
management and variance causes, pnumonia, coma scale index, and
diagnosis could predict the length of stays.The toatl explained
sources of variation was 61%. Case management and
variancecauses, pneumonia and coma scale index could predict the
medical cost. Base on the study results, it was concluded that
the implication of casemanagement method can effectively control
quality of care, length of stays andmedical cost in CVA
patients. In addition, during the change of insurance
paymentpolicy, the findings would provide to nursing
administrators as on managing quality and cost.