居家護理與護理之家照護品質之探討

Quality of Care in Home Care and in Nursing Homes

李愛誠(Ai-Cheng Li) ； 葉玲玲(Ling-Ling Yeh) ； 黃光華(Kuang-Hua Huang) ； 朱僑麗(Chiao-Lee Chu)

《澄清醫護管理雜誌》 8卷3期 (2012/07) Pp. 38-46

https://doi.org/10.30156/CCMJ.201207.0005

摘要

Background and objectiveIn Taiwan, disabled people who require medical treatment but do not require hospital stays can choose either home or institutional care while still enjoying financial assistance from the National Health Insurance (NHI). Understanding the differences in quality between these two types of long-term care services should increase the quality of care. This study investigated differences in the quality of care received by users of home care and nursing homes.MethodsThis study obtained data on 2006 inpatient and outpatient medical claims from the data of one million people in the 2005 National Health Insurance Database. A total of 1241 nursing home residents and 323 home care service recipients were identified. The quality indicators for long term care included falls, pressure ulcers, urinary tract infections, weight loss, depression, dehydration, pain, disorders of sleep and fecal impaction.ResultsDuring the first year, users of nursing homes had higher rates of depression when compared to users of home care services (9.6%vs 4.5%,p＜.001). The rate of urinary tract infections among users of nursing homes was greater in the second year (62.1%vs 49.8%, p=.001). After controlling for factors such as age, gender, and injury, the first-year depression rate for nursing home users was 2.62 times greater than that of users of home care services (95%CI：1.41-3.63, p=.001), and the second-year urinary tract infection rate for nursing home users was 1.54 times greater than that of users of home care services (95%CI：1.13-2.11, p=.007).ConclusionsMedical referral units and providers of services should establish suitable guidelines for nursing homes and providers of home care. Quality management and improvements in the health care process should then provide people receiving long-term care with higher quality service.

關鍵字

居家護理 ； 護理之家 ； 照護品質 ； 健保資料庫

並列摘要

Background and objectiveIn Taiwan, disabled people who require medical treatment but do not require hospital stays can choose either home or institutional care while still enjoying financial assistance from the National Health Insurance (NHI). Understanding the differences in quality between these two types of long-term care services should increase the quality of care. This study investigated differences in the quality of care received by users of home care and nursing homes.MethodsThis study obtained data on 2006 inpatient and outpatient medical claims from the data of one million people in the 2005 National Health Insurance Database. A total of 1241 nursing home residents and 323 home care service recipients were identified. The quality indicators for long term care included falls, pressure ulcers, urinary tract infections, weight loss, depression, dehydration, pain, disorders of sleep and fecal impaction.ResultsDuring the first year, users of nursing homes had higher rates of depression when compared to users of home care services (9.6%vs 4.5%,p＜.001). The rate of urinary tract infections among users of nursing homes was greater in the second year (62.1%vs 49.8%, p=.001). After controlling for factors such as age, gender, and injury, the first-year depression rate for nursing home users was 2.62 times greater than that of users of home care services (95%CI：1.41-3.63, p=.001), and the second-year urinary tract infection rate for nursing home users was 1.54 times greater than that of users of home care services (95%CI：1.13-2.11, p=.007).ConclusionsMedical referral units and providers of services should establish suitable guidelines for nursing homes and providers of home care. Quality management and improvements in the health care process should then provide people receiving long-term care with higher quality service.

並列關鍵字

home care ； nursing home ； quality of care ； National HealthInsurance research database