長期照護患者簡易全方位評估量表之建立

An Simplified Comprehensive Assessment Tool for Long-term Care Residents in Taiwan

林佩欣(Pay-Shin Lin) ； 林亭妗(Ting-Chin Lin) ； 陳治中(Chih-Chung Chen) ； 紀夙芬(Sun-Fen Chi) ； 陳智光(Chih-Kuang Chen) ； 黃美涓(Alice May-Kuen Wong)

《台灣復健醫學雜誌》 42卷1期 (2014/03) Pp. 41-50

https://doi.org/10.6315/2014.42(1)05

摘要

背景與目的：隨著老年人口的不斷增加以及國民平均壽命的延長，老年人的日常生活活動功能受損的盛行率也愈來愈高，導致老年人的照顧需求也逐年提高，老年人的照顧需求與資源使用度也受到高度的重視。因此，如何簡易有效地評估照顧需求和資源使用度也成了一個重要的課題。本研究目的為建立目前由專家初步完成之長期照護患者全面性簡易照顧等級評量（PRABC）之信效度分析，以期對於長期照護患者提供迅速且全面之評估，了解照護活動項目、照顧所需之程度等個別化資訊。更可提供國內未來長期照護人力配置、督導評估、住民分類及收費標準之參考。方法：本實驗是一個橫斷面研究，採方便取樣，受試者為桃園龜山地區長期照護機構的住民，納入標準為年齡大於等於65歲以上的住民，且入住時間大於等於一個月。總共收取90位受試者，使用立意取樣的方式，依住民巴氏量表分數分成0~20分，21~60分，61~100分三個等級，每個等級各收30位。統計方法將使用組內相關係數（Intra-class correlation coefficient, ICC）估計再測信度以及施測者間信度，另外還會使用斯皮爾曼等級相關係數（Spearman’s rank correlation coefficient）和皮爾森相關係數（Pearson’s correlation coefficient），分析機構照護評估工具（Minimum Data Set, MDS）的子量表（Subscales）和PRABC之相關性以及使用皮爾森相關係數來分析照顧時間分別與住民資源耗用群組（Resource Utilization Group, RUG）等級與PRABC之間的相關性。最後會做PRABC以及MDS施測所需時間的分析。結果：本研究結果顯示，本量表具中度的施測者間信度（ICC = 0.575）以及相當好的再測信度（ICC = 0.969）；量表的內部一致性亦為良好（Cronbach’s Alpha = 0.830）；與MDS子量表的效標關聯效度：PRABC分數與CPS分數具高度相關性（r = 0.765，P ＜ 0.01），PRABC分數與ADL long-form分數也具高度相關性（r = 0.819，P ＜ 0.01）。因所有樣本均無行為問題，ABS分數為零，故無法分析其相關性。PRABC與照顧時間觀察的相關性達顯著相關（r = 0.670、P ＜ 0.01）。RUG與照顧時間觀察的相關性則是不顯著相關（r = -0.193）。施測PRABC所需平均時間為6分03秒；MDS評估時間平均48分02秒。結論：根據目前分析的數據，PRABC是一個簡單、耗時合理且具有良好信效度以及內部一致性的評估量表，可以用來評估長照機構中個案的照護使用量。

關鍵字

長期照護 ； 資源使用度 ； 照護需求評估

並列摘要

Background and purpose: Along with the population and mean age of the older adults increase steadily, the prevalence of ADL impairment is getting higher which would increase the needs for elderly care. Therefore, how to evaluate patients’ care needs and resource utilization has become an important issue recently. The purposes of this study are to test the reliability and validity of a newly developed comprehensive assessment tool for care need-PRABC, hoping that it could be a easy, quick and clinical usable tool to assess the level of residents’ long-term care needs. Method: This is a cross-sectional study. Subjects were recruited from long-term care facility (LTCFs) in Kweishan, Taoyuan. Inclusion criteria are aged 65 or older and has lived in the LTCF for more than 1 month. Ninety people were recruited and were classified into 3 groups according to their Barthel Index (BI) scores. Intra-class correlation coefficient was used to verify the test-retest reliability and inter-rater reliability. The concurrent validity with MDS subscales was carried out by using the Spearman’s rank correlation coefficient and Pearson’s correlation coefficient. Investigation of the relationships between PRABC and RUG with care time respectively were also be studied by using Pearson’s correlation coefficient. Administration time for each assessment tool and care time of 15 subjects were recorded and analyzed as well. Result: The results show that PRABC has moderate inter-rater reliability (ICC = 0.575) and perfect test-retest reliability (ICC = 0.969). The internal consistency is good (Cronbach’s Alpha = 0.830). PRABC is highly correlated with CPS (r = 0.765, P ＜ 0.01) and ADL-long form (r = 0.819, P ＜ 0.01). PRABC is also correlated with care time (r = 0.670, P ＜ 0.01), but RUG is not (r = -0.158, p ＞ 0.05). The mean administration time for PRABC is 6min 03sec, MDS 48min02sec. Conclusion: PRABC is a simple, reasonable time-consuming yet comprehensive assessment tool with good reliability, concurrent validity and internal consistency. It provides a good measure of residents’ care needs for LTCFs in Taiwan and is worth for further study.

並列關鍵字

Long-term care ； Resource Utilization ； Assessment of Care Need