地域連携クリニカルパスを適用した脳卒中患者群における自宅復帰率向上とADL改善に関する課題の検討

Problems affecting improvement of home return rates and activities of daily living (ADL) in stroke patients adopting the community cooperation clinical pathway

要旨：急性期と回復期の連携において地域連携パスを用いた脳卒中患者の現状を確認し，成果向上のための課題を検討した．対象は脳卒中患者180名とした．現状の確認前に自宅復帰率と年齢，後遺症重症度の関係を分析し有意な相関が認められた．そのため自宅復帰率を評価する際は年齢や重症度の違いを考慮する必要があると考えた．当地域の自宅復帰率は全対象者群52.8％と過去の複数の報告と比べ最も低かったが，平均年齢は75.3歳と最も高かった．ADLの分析では急性期に既に自立水準が高かった軽度群を除き全群，重度群，中等度群は5項目で改善が認められたが変化の程度は項目によって異なり，今後も改善に影響する要因を検討したいと考えた．

　This study confirms the prevailing status and examines problems in the improvement of outcomes of patients with stroke using the community cooperation clinical pathway in collaboration with acute and recovery care hospitals. 180 stroke patients participated in the pathway. Before confirmation of their status, correlations between the home return rates and mean age, or severity of sequela were analyzed;significant correlations were observed between these factors. Therefore, it was necessary to take into account differences of mean age and severity of sequela between groups in the comparison. The home return rate in the local area was 52.8% among all subjects. This result was the lowest reported;however, the mean age of the subjects was the highest, at 75.3 years. Analysis of the change in levels of independence in performing activities of daily living (ADL) revealed significant improvements on all five ADL items among subjects : those in the subgroups with severe and moderate sequela, but not the mild group, which was already at high independence levels during their acute treatment period. However, the degree of change in independence levels for each of the ADL items varied greatly, suggesting that examination of individual factors influencing their improvement is warranted in the future.