The influence of physiological factors, psychological factors, and informal social support on hospital readmission in discharged patients with chronic obstructive pulmonary disease (COPD) in Taiwan.

摘要

Chronic obstructive pulmonary disease (COPD) is one of the world's most common chronic illnesses with increasing morbidity and mortality, and it continues to be a common primary diagnosis for hospital admission and readmission. In Taiwan, COPD was the eleventh leading cause of death in 2001 and the tenth leading cause of death in males (Department of Health, Republic of China, 2002). However, little research has been conducted on influential factors that contribute to readmission of patients with COPD in Taiwan.;This study used a longitudinal, descriptive correlational design based on Roy's adaptation model. The purpose of this study was to examine the relationships among physiological factors, psychological factors, informal social support and hospital readmission for people with COPD following hospital discharge in Taiwan. Moreover, the effects of variables predicting COPD readmission were also determined at two weeks (14 days) and three months (90 days), following discharge.;A convenience sample of 145 patients with COPD scheduled for discharge from six regional and district hospitals in the Pingtung area in southern Taiwan was consecutively selected. Data collection on readmission status used face-to-face interview and follow-up calls. Daily functioning was the only variable to correlate with readmission at 90 days. It was also a critical predictor for COPD readmission at 90 days in the Taiwan population living in a rural area. Clinically, age and frequency of admissions during the previous year could also be pertinent factors that need to be considered. Post-hoc analyses also revealed that among three ethnic groups, Mainlanders (primarily retired veterans from China) perceived less family support, had higher depressive symptoms and lower daily functioning than the majority culture Fukiens/Hakkas, or the Aborigines.;Roy's Adaptation Model was not effective in explaining the phenomenon of readmission in Taiwan and needs further research incorporating cultural differences. The overall results of the study provide direction to guide future studies of chronic diseases in Taiwan. The study will also help nurses and other healthcare providers reinforce the need for identification of risk for early readmission and discharge planning interventions to improve the functioning of patients with COPD.