リハビリテーション後の転帰と在院日数に影響を与える社会的要因の検討

Social Factors influenced the Discharge Destination and Length of Hospital Stay of Stroke Patients after Rehabilitation

要旨：脳卒中患者83名を対象に，退院先と在院日数に影響を与える社会的要因を調査した．退院先は，自宅群と転院群の2群とした．退院先に影響を与える因子として年齢，性別，発病から転院までの日数，退院時全FIM値，の他に，社会的要因として，「独居」「高齢世帯」「生活保護受給」「要介護家族あり」の有無を診療録から後方視的に収集した．更にこれらの社会的要因が在院日数に与える影響を調査した．対象患者の平均年齢は68.1±8.9歳，自宅退院率は83.1％，平均在院日数は86.1±25.2日であった．多変量解析の結果では，退院時全FIM値が高いと自宅退院を促進し，「独居」「要介護家族あり」は自宅退院を阻害した．また，生活保護受給者は在院日数が長期化していた．独居のみならず，要介護者が同居する家庭への在宅復帰率は低下し，また，生活保護受給者の在院日数は長期化する可能性が示唆された．

Abstract : The purpose of this study was to analyze the socioeconomic factors influencing patient discharge destination and the length of their hospital stay. We investigated 83 consecutive stroke patients admitted to our rehabilitation ward between January 1 and December 31, 2008. The mean age was 68.1 years old, the mean length of stay was 86.1 days, and 57％ were men. The outcome for this study was the patient discharge destination, defined as home or a nursing home type of facility. To examine the predictors of the discharge destination, we collected data including patient age, sex, total Functional Independence Measure (FIM) scores at discharge, ‘living alone’, ‘over 65 years old’, ‘requiring public assistance’, and ‘having a family member at home who requires nursing care’. In all, 69 patients were able to return home, and 14 patients were discharged to a nursing home type of facility. The home group showed a higher total FIM score (p＜0.001). Logistic regression analysis showed that two factors, ‘living alone’ and ‘having a family member at home who requires nursing care’, adversely affected patient discharge to home. Also, the length of stay was longer among those patients who required public assistance (p＜0.01). This study suggests that it is harder for patients to be discharged back to their homes who have these factors : ‘having a family member at home who requires nursing care’ and ‘living alone’. Additionally, having the patient characteristic of ‘requiring public assistance’ could prolong the length of hospital stay.