個案管理之效益評估--以全膝關節置換術為例
Evaluating the effectiveness of case management：An Example of total knee replacement
中文摘要
論文摘要
論文名稱：個案管理之效益評估─以全膝關節置換術為例 台北醫學大學護理學研究所
研究生姓名：杜素珍
畢業時間：九十一學年度第二學期 指導教授：張文英助理教授
本研究目的在於探討應用個案管理於全膝關節置換術病患之效益評估─包括再入院率、合併症發 生率、住院天數、醫療費用、病患自我照顧認知、服務滿意度、膝關節功能、生活品質。採類實 驗研究法，於某醫學中心收案60 位全膝關節置換術病患分派至個案管理組及對照組各 30 人，
個案管理組接受個案管理方案，對照組接受常規照護方案。研究資料來源包括病患基本資料調查 表、全膝關節置換術自我照顧認知量表、服務滿意度調查表、膝關節功能評估量表、生活品質量
表測得，及從病歷、研究機構醫療費用處理中心取得醫療費用。前測資料於病患住院24 小時後
進行問卷調查及從病歷收集資料，後測資料於出院當天收集、住院醫療費用、服務滿意度、自我 照顧認知後測；出院後三個月再測量合併症發生率、再入院率、膝關節功能及生活品質。以 chi-square test、t-test、pair-t 進行統計分析。
研究結果顯示，實施個案管理（1）兩組病患平均住院天數，個案管理組 4.77 天，對照組 7.50 天，個案管理組較對照組少2.73 天，達顯著差異（p<.001）。（2）比較兩組個案合併症發生 率，個案管理組個案無發生合併症，對照組有一病患發生急性感染合併症，但兩組間未達顯著差 異（p=0.31）。（3）比較兩組病患再入院發生率，個案管理組無個案再入院情形，對照組有一 病患有1 次再入院，但未達顯著差異（p=0.31）。（4）兩組病患自我照顧認知前測無顯著差異；
後測平均得分個案管理組14.67 分（總分=16 分），對照組 12.6 分，個案管理組得分較控制組 高，且達顯著之差異（p<.001）。（5）兩組病患對醫療服務滿意度得分，個案管理組 4.55 分
（滿分5 分），對照組 4.01 分，個案管理組得分較控制組高，達顯著之差異（p<.001）。（6）
比較兩組個案膝關節復健功能，術前膝關節功能無顯著差異；術後三個月個案管理組平均得分 86.57 分（總分=100 分），對照組平均得分 79.13 分，個案管理組得分較控制組高，達顯著 之差異（p<.001）；兩組病患單組前後測比較，後測得分皆較前測高，且有顯著差異，（p<.001）， 顯示手術能改善膝關關節功能。（7）兩組病患生活品質前測無顯著差異；後測平均得分個案管 理組15.26 分（總分=20 分），對照組 15.20 分，個案管理組得分較控制組高，但未達顯著之 差異；單組前後測比較，兩組病患後測生活品質皆較前測有明顯改善，且皆有顯著差異，
（p<.001）顯示手術能改善病患生活品質。
本研究結論：個案管理應用於全膝關節置換術病患之照護，可以縮短平均住院天數，提升病患自 我照顧認知、住院服務滿意度及身體功能恢復狀況，此研究結果對病患、醫療提供者、第三付費 者而言，達到三贏的目標。
關鍵詞：個案管理、全膝關節置換術、效益評估
英文摘要
ABSTRACT
Title of Thesis：Evaluating the Effectiveness of Case Management: An Example of Total Knee Replacement Institution：Graduate Institute of Nursing, Taipei Medical University
Author：Su-jene Dou
Thesis directed by：Wen-yin Chang, Assistant Professor
The purpose of this study was to Evaluate effectiveness of case management on total knee replacement (TKR) patients. The effectiveness outcome indicators include the frequency of readmission, frequency of complication, length of stays, cognition of self-care, satisfaction of health care, function of knee, and quality of life.
The quasi-experimental design was used in this study. The total sample consisted of 60 TKR patients in a northern teaching hospital. The subjects were divided in two groups, 30 subjects in each group. The subjects in the experimental group received case management method and the subjects in the control group received the routine care method. Data was collected from the demographic data sheet, the assessment tool of self-cognition, the satisfactory questionnaire of health care, rating functional scale of knee, questionnaire of WHO quality life, the chart of patient, and the cost of medical data. The pre-test was done by researcher within 24 hours after patient’s hospitalization, and the post-test was done on the day of patients discharge and after patient＇s discharge 3 months. Data were analyzed by using the chi-square test, t-test, and paired t-test。
The results indicated that (1) subjects in the experimental group and the control group were respectively average 4.77 and 7.50. The experimental group had significantly higher average length of stays 2.73 (p<.001). (2) the frequency of complication in the two groups was no significance (p=.31). The experimental group was no frequency of complication and the control group had one with acute infection.
(3) the frequency of readmission in the two groups was no significance (p=.31). The experimental group was no frequency of complication and the control group had one readmission. (4) the cognition of self-care in the two groups with pretest was no significance. The average score of posttest in the experimental group was 14.67 (total score was 16) and the control group was 12.60. There were significantly on experimental group in higher score with posttest (p<.001). (5) the satisfactory scores of health care in the experimental group and the control group were
respectively average 4.55 and 4.01 (total score was 5). There were significantly on
experimental group in higher score (p<.001). (6) the function of knee rehabilitation was no significance in the two groups with pre-operation. The rating functional scores of knee rehabilitation after patient’s discharge 3 months in the experimental group and the control group were respectively average 86.57 and 79.13 (total score was 100). There were significantly on experimental group in higher score (p <.001).
In addition, the two groups had significantly higher score in the function of knee rehabilitation with posttest (p<.001) that indicated the operation could improve the function of knee. (7) the quality of life in the two groups was not significant with pretest. The scores of quality life in the experimental group and the control group were respectively average 15.26 and 15.20 (total score was 20) with posttest. The experimental group in higher scores with posttest, but there were no significance.
On the other hand, the scores of quality life in the two groups were significantly better in posttest (p<.001) that indicated the operation could improve the quality of life.
According to the study results, application of case management on TKR patient care, which could effectively control length of stays and medical cost, increase the cognition of self-care and satisfaction of health care, and improve the recovery of the health. The findings can offer a reference on patients, medical provider, and medical payer.
Key words：case management, total knee replacement, evaluating effectiveness.
