居家復能服務的結構與過程：文獻回顧

復能強調增進功能性獨立，是長期照護居家服務的趨勢。Donabedian健康照護品質評估模式，強調好的「結構」為基礎與「過程」落實服務是服務具成效的前提，然文獻對於復能服務的架構與執行尚未有系統的討論。本論文透過文獻回顧深入了解復能服務的結構及過程面，於Google搜尋引擎搜尋英國、挪威、澳洲等國政府資料和實證資料庫（例如Pubmed）的復能實證研究。在結構面，我們發現復能多由跨部之公部門合作主導、有跨專業團隊、研究的受試者以新近功能性衰退、障礙程度輕中度和獨居者為主；在過程面（如服務輸送流程、時程、介入內容、團隊溝通和復能典範之宣導），以跨單位方式合作，服務時程介於六至十二周。介入內容之相關研究以質性研究為主，各國的服務提供者多認同「以個案目標為中心」，並關注在支持個案促進在家獨立生活，也討論復能是一個照護典範轉換、產生的問題與可因應的策略，如專業訓練、溝通和宣導，都需要有政府提供即時的資訊和新的行政架構。目前復能仍缺乏相關研究探討復能在組織層級之效益、最優化服務傳遞模式及復能服務的宣導成效。建議未來可以針對組織層級深入探討更有效的服務機制與針對不同族群（如失智和重度失能者）的復能模式，以發展具高品質和效率之復能服務。

關鍵字

復能；照護品質管理模式；健康照護品質

並列摘要

Reablement focuses on functional independence and is the current trend of long-term-care home services. The Donabedian model of health service emphasizes that a good "structure" is the foundation for effective services and implementation "processes" are the prerequisites. This review collated the structure and process of reablement described in literature, which is seldom systematically explored. We used Google search engine to search for data provided by governmental agencies, such as Britain, Norway, and Australia, and evidence-based studies provided by empirical database (such as Pubmed and PEDro). In regard to structure, reablement is mostly provided by multidisciplinary teams driven by inter-departmental collaboration in public sectors. Most participants in empirical studies had recent functional decline, mild to moderate disabilities, or lived alone. In regard to process, reablement is provided for six to twelve weeks with the intention of supporting clients to live independently and achieve their personal goals. Research that informs intervention content were mostly qualitative studies. Difficulties with changes of the care model and corresponding strategies, such as training, communication, and marketing, are described. Timely information and new administrative framework by the government are required. There is still limited research on the propagation of reablement, its benefits at the organizational level, and a high-quality and efficient service model. Future research can explore the organizational characteristics for effective service delivery and reablement models for populations with different disabilities (such as people with dementia and/or with severe disability) to develop high-quality reablement services.

並列關鍵字

Reablement ； Donabedian Model ； Quality of Health Care

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