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研究生: 依文達
Eriska, Winda
論文名稱: 探討住院高齡病人接受周全老年評估完整性與照護結果之相關性研究:以印尼某院為例
EXPLORING THE COMPLETENESS OF COMPREHENSIVE GERIATRIC ASSESSMENT IN RELATION TO CARE OUTCOMES IN HOSPITALIZED OLDER PATIENTS IN ONE INDONESIAN HOSPITAL
指導教授: 陳靜敏
Chen, Ching-Min
學位類別: 碩士
Master
系所名稱: 醫學院 - 護理學系
Department of Nursing
論文出版年: 2020
畢業學年度: 108
語文別: 英文
論文頁數: 83
外文關鍵詞: Comprehensive Geriatric Assessment, hospitalized older patients, health care outcomes, in-hospital death, length of stay, readmission
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  • Background: Comprehensive Geriatric Assessment (CGA) as an early assessment is a key and a starting point to provide an effective care plan. The completeness of the CGA assessment tools is vital to fulfilling the comprehensive diagnoses and appropriate intervention for an older patient to obtain the best care outcome. Some of the common care outcomes related to older patients are readmission, length of stay, and in-hospital death. Several studies have been conducted to look at CGA applications for the results of treatment, and they turned out to have inconsistent conclusions.
    Aim: Evaluate the completeness of CGA in relation to care outcomes (readmission, length of stay, and in-hospital death) in hospitalized older patients.
    Methods: The retrospective design with the stratified random sampling method was utilized to evaluate 222 older patients’ medical records of one hospital in Jakarta, Indonesia who discharge from 1st January to 31st December 2018. The self-developed observational checklist had been tested for validity and reliability by the content validity index, internal consistency, and interrater reliability tests. Independent t-test, Mann-Whitney U-test, correlation Pearson r, Spearman, and Chi-square were utilized to analyze the data based on the scale of the data. Linear and logistic regression has also been utilized for the multivariate analysis.
    Results: The average completeness rate of CGA was 68.19%, range 52.38-85.71, where the rate was significantly higher in the geriatric ward than in the non-geriatric ward (71.99% vs. 64.52%). The highest completeness was in the socio-environmental domain, and the lowest was psychological health. There were 6.3% older patients who had 30-day readmission, 8% in the non-geriatric ward, and 4.6% from the geriatric ward. The relationship between the completeness of CGA in the physical health domain and 30-day readmission was positive statistically significant in the geriatric ward. There was an 8.1% incidence of death, where 13.8% has happened in the geriatric ward, and 2.7% happened in the non-geriatric ward. The relationship between the completeness of CGA and in-hospital death was not statistically significant. However, multiple logistic regression results showed that older patients in the geriatric ward had the odds seven times to die in hospital. The median length of stay was eight days range between 2-62 days, where patient in the geriatric ward significantly stay longer in the geriatric ward than in the non-geriatric ward. The completeness of CGA had a significant impact on the length of stay in the geriatric ward, which means every one-unit increase in the completeness of CGA score will increase the length of stay for about two days.
    Conclusions: Data about the completeness of CGA have significant impact on the length of stay of hospitalized older patients in the geriatric ward. There was no significant relationship between the completeness of CGA and 30-day readmission or in-hospital death. However, the result showed that the tendency to have higher completeness of CGA performed in patients would avoid readmission or dying in the hospital.

    The Passing Certificate (Chinese) ii Abstract iii Acknowledgments v Table of Contents vii List of Tables ix List of Figures x Chapter 1 Introduction 1 1.1 Background 1 1.2 Purpose of the Study 5 1.3 Expected Result 5 Chapter 2 Literature Review 7 2.1 Comprehensive Geriatric Assessment 7 2.2 Care Outcomes 9 2.2.1 Readmission 10 2.2.2 In-Hospital Death 12 2.2.3 Length of Stay 12 2.3 Studies Investigating CGA and Care Outcomes 13 2.3.1 Readmission 13 2.3.2 In-Hospital Death 17 2.3.3 Length of Stay 19 2.4 Conceptual Framework 22 Chapter 3 Methods 25 3.1 Design 25 3.2 Sampling 26 3.3 Research Instrument 27 3.4 Data Collection Procedures and Ethical Consideration 29 3.4.1 Data Collection Procedure 29 3.4.2 Ethical Consideration 30 3.5 Data Analysis 31 Chapter 4 Result 35 4.1 Description of Hospitalized Older Patients 35 4.2 Completeness of CGA 36 4.3 Correlation between age, and comorbidity to the completeness of CGA 41 4.4 Care Outcomes 41 4.5 Completeness of CGA in Relation to Care Outcome 43 4.6 The Correlation between the completeness of CGA and Care Outcome after controlled by other variables 46 Chapter 5 Discussion 52 5.1 Hospitalized older patients 52 5.3 Care Outcomes 58 5.3.1 30-day readmission 58 5.3.2 In-hospital death 60 5.3.3 Length of Stay 61 5.4 Predictors of care outcomes based on the type of ward 62 Chapter 6 Conclusion 64 6.1 Conclusion 64 6.2 Recommendation 65 6.2.1 Clinical practice 65 6.2.2 Education 66 6.2.3 Policy 66 6.2.4 Future Research 66 6.3 Limitation 67 References 69 Appendix 1. Ethical Clearance 74 Appendix 2. Letter of Permission 75 Appendix 3. Table of CVI 76 Appendix 4. Instrument of study 82

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