急性期病院と回復期リハビリテーション病棟間の脳卒中地域連携パスと転帰に影響する因子の検討

A Study of the Liaison Critical Pathway for Stroke between an Acute Hospital and a Convalescent Rehabilitation Ward and the Effect of Clinical Factors on Outcome

要旨：当圏域における2007～2008年の2年間の脳卒中地域連携クリティカルパス（パス）を検討した．急性期病院（AH）で十分に全身状態を検討し，回復期リハビリテーション病院（CRW）へ詳細な情報提供を行うパスを考案し活用した．その結果AH脳卒中804例の在院日数が2006年よりも5.7日短縮した．AHからCRWに転院したのは155例であった．このうち最終的にCRWを退院した148例中，死亡は1例（0.7％），AHへの再入院は6例（4.1％）と少なかった．CRWから自宅退院（97例）か，施設や療養型病院に転出（44例）かに影響する因子を検討した．性別，年齢，在院日数，転院時modified Rankin Scale（mRS），FIM全・運動・認知項目，CRW退院時FIM全項目，FIM利得のうち，転院時mRS，CRW退院時FIM全項目が影響した．配偶者に加え子（ないし子夫婦）同居は自宅退院率が高かった．

Abstract : We examined the effect of the liaison critical pathway for stroke among the inpatients in an acute hospital (AH) from 2007 to 2008. The average length of hospital stay in the AH was reduced by 5.7 days compared with 2006 by means of the critical pathway. Among 155 patients who had been transferred from the AH to a convalescent rehabilitation ward (CRW), 148 were discharged from the CRW. Ninety-seven patients returned home and 44 patients were transferred from the CRW to a nursing home type unit or an institution. One patient died in the CRW, six were returned to the AH. From among the clinical factors, that included sex, age, modified Rankin Scale (mRS), total, motor and cognitive scores of Functional independence measure (FIM) at discharge from the AH, total FIM scores and FIM gain at discharge from the CRW, mRS at discharge from the AH and total FIM scores at discharge from the CRW exerted an influence on outcome. Patients living with their spouses and / or children before the onset of stroke were more inclined to return home.