長照機構住民接受在宅急症照護服務之觀察性研究

背景與目的: 隨著人口快速高齡化，高齡者罹患急慢性疾病及醫療照護需求遽增，挑戰現有照護體系。政府推動長照2.0與居家醫療整合計畫，並於2024年試辦「在宅急症照護」，以期減少傳統住院並提升照護連續性。本研究旨在觀察長照機構個案接受在宅急症照護後，其生活品質、健康狀況之變化與結案早期再入院率，以期為連續性照護政策提供實證依據。方法: 本研究為觀察性研究，以長照機構個案接受在宅急症照護後，觀察其基準期（T1）、第7天（T2）、第14天（T3）、第30天（T4）之健康生活品質與日常生活功能之變化及結案後3天內與14天內之內轉急診率及住院率之情形。研究期間為2025年11月至2026年6月。使用之測量工具為健康生活品質量表（EQ-5D-5L）、自覺健康視覺類比量表（EQ-VAS）、日常生活功能評估量表（ADL）及在宅醫療成效觀察指標（再轉急診與住院率）。資料分析含描述性統計；個數、百分比、平均值、標準差及推論性統計；單因子重複量數變異數分析（Repeated Measures ANOVA）及廣義估計方程式 (GEE)。結果: 共收案40位（平均84.48 ± 7.29歲；女性80%），高血壓（75%）及心臟、內分泌、泌尿系統疾病（各50%）為主要慢性疾病。健康生活品質量表（EQ-5D-5L）隨著時間變化；自收案後基準期（T1）（16.95 ±0.96）至第30天（T4）（16.63 ±0.95）有顯著改善（p < .01）。自覺健康視覺類比量表（EQ-VAS）隨著時間變化；自收案後基準期（T1）（72.55 ±5.48）至第30天（T4）（74.58 ±4.61）有顯著改善（p < .01）。而日常生活功能評估量表（ADL） 於觀察期間則相對穩定，各階段無顯著變化（p >.05）。「已婚」個案之日常生活功能評估量表（ADL）分數顯著高於未婚或喪偶組（B = .641, p = .036）。結案後3天內，內轉急診率22.50%，內轉住院率達17.50%；而14天內，內轉急診率及住院率分別為2.5%。結論: 本研究顯示，長照機構個案接受在宅急症照護後，其健康生活品質及自覺健康狀況於30天內均有顯著改善。個案結案後14天內再轉急診及住院率均維持低水準，顯示多數個案於完成在宅急症照護後仍能維持穩定健康狀態。研究結果支持在宅急症照護作為長照機構高齡住民急性醫療照護之可行模式，具提升照護連續性及減少不必要住院之潛力，可作為未來相關政策推動與服務模式發展之實證參考。

Background and Objective: With the rapid aging of the population, the increasing prevalence of acute and chronic diseases among older adults has led to a growing demand for healthcare services, which poses significant challenges to existing healthcare systems. In response, the Taiwanese government has implemented the Long-Term Care 2.0 program and the Integrated Home Healthcare Program, and launched the Hospital-at-Home (HaH) Acute Care Program as a pilot initiative in 2024 to reduce unnecessary hospitalization and enhance continuity of care. This study aimed to examine changes in quality of life, health status, and early postdischarge emergency department (ED) visits and hospitalization rates among long-term care facilities receiving Hospital-at-Home acute care in the hospital at home, thus providing evidence to support continuity of care policies.Methods: This observational study enrolled residents of long-term care facilities who received acute care. Participants were evaluated at baseline (T1), day 7 (T2), Day 14 (T3), and Day 30 (T4) to evaluate changes in quality of life and activities of daily living (ADL). Furthermore, the hospitalization and transfer rates to the ED were recorded within 3 and 14 days after case closure. Data were collected between November 2025 and June 2026. Outcome measures included the EuroQol Five-Dimension Five-Level Questionnaire (EQ-5D-5L), the EuroQol Visual Analogue Scale (EQ-VAS), the Barthel Index (BI), and indicators of hospital-at-home outcomes (ED transfer and hospitalization rates). Data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation), repeated-measures analysis of variance (repeated measures ANOVA), and generalized estimating equations (GEE).Results: A total of 40 participants were enrolled (mean age: 84.48 ± 7.29 years; 80% female). Hypertension (75%) was the most common comorbidity, followed by cardiovascular, endocrine, and genitourinary diseases (50% each). The quality of life, measured by EQ-5D-5L, improved significantly over time, with scores changing from 16.95 ± 0.96 at baseline (T1) to 16.63 ± 0.95 on day 30 (T4) (p < .01). The self-rated health status, assessed by the EQ-VAS, also showed a significant improvement from 72.55 ± 5.48 at T1 to 74.58 ± 4.61 at T4 (p < .01). ADL remained relatively stable throughout the observation period, with no significant changes at all time points (p > .05). Married participants had significantly higher ADL scores than unmarried or widowed participants (B = 0.641, p = 0.036). Within 3 days after case closure, the ED transfer rate was 22.5% and the hospitalization rate was 17.5%. Within 14 days, both the ED transfer rate and hospitalization rate decreased to 2.5%.Conclusions: Hospital-at-home acute care significantly improved health-related quality of life and self-perceived health status among residents of long-term care facilities in 30 days while maintaining stable functional status. The low rates of transfer and hospitalization within 14 days after case closure suggest that most of the participants maintained stable health after completion of Hospital-at-Home acute care. These findings support hospital-at-home acute care as a feasible alternative model for managing acute medical conditions among older adults in long-term care facilities, with the potential to improve continuity of care and reduce unnecessary hospitalizations. The results provide empirical evidence to inform future policy development and the expansion of Hospital-at-Home services.