脳梗塞リハビリテーションのクリティカルパス―アウトカム評価とバリアンス分析―

DOI Web Site
  • 塩見 典子
    筑波記念病院リハビリテーション部 社会福祉法人恩賜財団済生会西条病院リハビリテーション科
  • 斉藤 秀之
    筑波記念病院リハビリテーション部
  • 金森 毅繁
    筑波記念病院リハビリテーション部
  • 酒井 芳美
    筑波記念病院リハビリテーション部
  • 井上 喜美子
    筑波記念病院リハビリテーション部
  • 柴田 靖
    筑波記念病院脳神経外科 筑波大学大学院人間総合科学研究科脳神経機能制御医学

書誌事項

タイトル別名
  • Rehabilitation critical pathway for the patients with cerebral infarction
  • ノウ コウソク リハビリテーション ノ クリティカルパス : アウトカム ヒョウカ ト バリアンス ブンセキ
  • アウトカム評価とバリアンス分析

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説明

We created three types of critical pathways; rehabilitation for the patients with mild, moderate and severe cerebral infarction, and introduced them into clinical practice in March 2004. For evaluation and improvement, we compared several clinical indicators for three groups of patients with cerebral infarction; 33 patients hospitalized in same month of one year before introducing critical pathways (group A), 32 patients just before introducing critical pathways (group B), and 43 patients who was managed with critical pathways (group C) among 86 patients hospitalized after the introducing critical pathways. Also we investigated the state of critical pathways usage and variance. Group C showed significantly better modified Rankin Scale (mRS), Glasgow Outcome Scale (GOS), and Functional Independence Measure (FIM), improvement rate, etc. than group A and B (p<0.05).<BR>There were 13 drop-outs from critical pathways in 43 patients who was managed with critical pathways, and the major reason of drop-out was inappropriate recording. Thirty patients (70%) completed critical pathways, and the major variance of these cases was delay of schedule. It also became clear that the content and the method of critical pathways recording varied among each staffs, and the understanding for critical pathways is poor for rehabilitation and nursing staffs. In the future, further analysis of variance and effect of the critical pathways will be needed to improve its form and use. Also, it is important to standardize the usage of critical pathways by making user manuals, and to educate rehabilitation and nursing staffs. Moreover, it is necessary for every staff to work in closer connection and corporation among other sections.

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