- 學位論文
以國際健康功能分類系統(ICF)評量不同長期照護機構腦中風住民之試用性
Application of International Classification of Functioning, Disability and Health (ICF) on stroke clients among different long-term care facilities
摘要
本研究旨在評量不同長照機構腦中風住民使用ICF腦中風核心編碼分類狀況之試用性、探討長照機構腦中風住民一般健康功能狀況與ICF腦中風核心編碼分類狀況之相關性及在不同長照機構腦中風住民的特質、一般健康功能狀況及ICF腦中風核心編碼分類狀況之差異性。應用橫斷式相關性研究設計，以自行發展檢核表(參考長期照顧服務個案評估量表、WHO 2003年之ICF checklist、Geyh等人於2004年所發展之ICF core set for stroke)之工具，以觀察及病歷回顧進行資料收集，依配額抽樣法共收集護理之家54位、安養機構16位及養護機構84位個案資料。 結果顯示，個案平均年齡為78.9歲(SD=11.1)，以男性居多(68.2%)，在不同長照機構腦中風住民的特質及其一般健康狀況大多有顯著差異，其中以居住在護理之家住民平均年齡最高(F=12.02 , p=<.001)；以安養機構腦中風住民之一般健康狀況含ADL (F=52.87, p<.001)、IADL (F=161.49, p<.001)、MMSE (F=31.78, p<.001)平均得分最佳；以ICF腦中風核心編碼分類評估不同機構腦中風住民之狀況有明顯差異，護理之家及養護機構住民之身體功能損傷程度(F=40.15, p<.001)、身體構造損傷程度(F=18.30, p<.001)及活動限制及參與侷限得分(F=76.88, p<.001)顯著較安養機構個案嚴重，而護理之家與養護機構之間差異不大；長期照護機構腦中風住民一般健康功能狀況與ICF腦中風核心編碼分類狀況得分大致上皆有顯著相關性，特別是ICF中的d4行動與ADL(r =-.95, p<.001)；d2一般任務與需求與IADL(r =-.91, p<.001)；b1心智功能及d3溝通與MMSE (r =-.86, p<.001)有高度相關，顯見以ICF腦中風核心編碼評量不同長照機構腦中風住民的問題是適用的，唯部分ICF評量編碼，如s110腦部構造、s410心血管系統構造，因無法由觀察得知其嚴重程度，僅能判斷是否存在該問題。 研究顯示ICF腦中風核心編碼評量不同長期照護機構腦中風住民是具有其適用性。然本研究只在部分台北市長期照護機構收案，未來宜進行更具代表性的樣本收集，以使研究結果更具推論性。此外長期照護機構住民罹患多種慢性疾病，未來應進行不同疾病的核心編碼之評量，使研究結果更具完整及多樣性，提供所需之照護計畫。
並列摘要
This study aimed to evaluate the applicability of ICF core set for stroke coding classification on stroke clients among different long-term care facilities, and further to compare differences in personal characteristics, general health status and ICF coding among clients in different settings. The cross-sectional correlation research design was used, and research instrument using the checklist based on long-term care services client assessment scale, WHO of ICF checklist (2003), and ICF core set for stroke (Geyh, 2004) was self-developed. Observation and chart review were utilized for data collection. A total of 54 cases from nursing homes, 16 cases from senior homes and 84 cases from residential centers were recruited using the quota sampling. The results showed that the majority of cases were male (68.2%) with average age of 78.9 years old (SD=11.1). There were significant differences in personal characteristics and their general health status among stroke clients living in different long-term care facilities. Those living in nursing homes were significantly older (F=12.02, p=<.001) than others. Stroke residents in senior homes had better general health status than other 2 groups, including, ADL (F=52.87, p<.001), IADL (F=161.49, p<.001), and MMSE (F=31.78, p<.001). Based on evaluation of ICF core set for stroke code classification assessment, residents in nursing homes and residential centers had worse results in the impairments of body functions (F=40.15, p < .001), impairments of body structures (F=18.30, p<.001) and activity limitations and participation restriction score (F= 76.88, p <.001) than those from senior homes. However, there was no significant difference between residents from nursing homes and residential centers. There were significant correlations between general health status and results of ICF core set for stroke coding classification among stroke residents, especially the ICF core set for stroke of d4 Mobility and the ADL (r=-.95, p<.001), d2 General tasks and demands and IADL (r=-.91, p<.001), b1 Mental function and d3 Communication and MMSE (r=-.86, p<.001) were highly correlated. Apparently, ICF core set for stroke coding assessment could be applied on stroke residents in long term care facilities except some parts can’t be measured in levels of severity, such as s110 structure of brain, s410 structure of the cardiovascular system, can only be determined whether the presence of the problems. The study had shown that the applicability of ICF core set for stroke assessment of the core coding on stroke residents among different long-term care facilities. However, this study only collected data from long - term care facilities in Taipei, better representative samples should be collected to make the results more generalized in the future. In addition, residents of long-term care facilities suffer from multiple chronic diseases, future research should be conducted to apply various core coding of ICF among clients with different diseases in order to enhance its integrity and diversity and further to provide a better understanding for developing care plan.