居家護理與護理之家照護品質之探討

Quality of Care in Home Care and Nursing Home

李愛誠(Ai-Cheng Li)

指導教授 ： 葉玲玲

亞洲大學/健康學院/長期照護研究所/碩士(2011年)

摘要

目的：失能者及人口老化所衍生的長期照護問題逐漸受到各國重視，長期照護品質改善議題更迫切需要關注。因此本論文以全民健保資料庫探討居家護理與護理之家服務使用者照護品質之差異。

方法：由國家衛生研究院全民健保資料庫之「2005年承保抽樣歸人檔」100萬人，擷取2006年門住診就醫申報資料，以居家護理與護理之家服務使用者共1564人為樣本，探討其收案兩年內照護品質指標、藥物使用指標及醫療利用指標之差異。

結果：居家護理服務使用者觀察第一年因為憂鬱疾病就醫者佔4.5%、第二年因為泌尿道感染就醫者佔49.8%、門診平均用藥4.6項、平均每人年門診34次；護理之家服務使用者第一年因憂鬱就醫者佔9.6%、第二年因泌尿道感染就醫者佔62.1%、門診平均用藥4.2項、平均每人年門診49次，居家護理與護理之家服務使用者之差異達統計意義。在控制其他變項後，邏輯斯迴歸分析顯示接受護理之家服務者之憂鬱(第一年)、泌尿道感染(第二年)機率分別是接受居家護理服務者之2.62及1.54倍。

結論：雖然台灣健保給付居家護理與護理之家服務之使用者其失能程度類似，但接受不同服務模式在品質上仍有差異，相關醫療轉介單位、服務提供者應及早規劃衛生指導教育、進行指標管理及照護過程的改善，使照護品質更臻完善。

關鍵字

居家護理 ； 護理之家 ； 照護品質 ； 健保資料庫

並列摘要

Objective: The problem of long-term healthcare for a disabled and aging population has gradually become a point of concern in many countries. Improvement of the quality of long-term healthcare is a topic that requires urgent focus. Thus, this study used the National Health Insurance (NHI) Claim Database to investigate differences in quality of care with regard to home care and nursing home services.

Methods: This study obtained data on 2006 inpatient and outpatient medical claims from the data of one million people in 2005 Health Insurance Database. A sample of 1,564 users of home care and nursing home services was taken. This study then investigated the difference in quality indicators of healthcare, drug use, and healthcare utilization among these users within a two-year period.

Results: Observation of users of home care services showed the following statistics: 4.5 % sought medical care due to depressive illnesses in the first year; 49.8 % sought medical care due to urinary tract infection (UTI) in the second year; 4.6 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 34.Observation of users of nursing home services showed the following statistics: 9.6 % sought medical care due to depressive illnesses in the first year; 62.1 % sought medical care due to urinary tract infection (UTI) in the second year; 4.2 types of drugs were issued on average at each outpatient visit, and the average number of outpatient visits per year was 49. The differences among users of home care services and users of nursing home services reached statistical significance. After other variables had been controlled, logistic regression analysis showed that the probability of depression (first year) and UTI (second year) among users of nursing home services was 2.62 and 1.54 times that of users of home care services, respectively.

Conclusion: Although NHI in Taiwan affords a similar degree of disability benefits to users of home care services and nursing home services, the quality of the two service models differs. Related medical referral units and service providers should plan health education and guidance, and improve index management and care processes as soon as possible, to enhance the quality of healthcare services.

並列關鍵字

Home care ； Nursing care ； Quality of care ； National Health Insurance Research Database

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