臺灣博碩士論文加值系統

社區中有許多的失能者需要他人給予日常生活活動方面的協助，當沒有獲得足夠的協助時，往往會對失能者造成許多影響：如使用機構式服務、增加醫療服務的使用及影響生活品質等。本研究的目的主要是探討未滿足需求對失能者往後住院的影響。
資料來源包含社區調查與全民健康保險資料庫。社區調查資料來自九十年內政部「建構長期照護體系先導計畫」的第一年社區前測調查，研究對象為居住在嘉義市、三鶯地區、新店市、樹林市四個社區的失能者；且利用社區調查個案的身份證字號連結全民健康保險資料庫，追蹤個案於訪視後六個月內住院的情況。在本研究當中依變項除了「自述未滿足需求」以外，也以傾向分數（propensity score）的分析方法計算出每個個案的「未滿足需求傾向」，分別探討兩者對於住院的影響。以T檢定與卡方檢定進行雙變項分析，並使用邏輯斯回歸建立未滿足需求傾向分數和探討未滿足需求對住院的影響。
研究結果顯示社區中有四分之一的失能者有未滿足需求，在控制了其他影響住院的因素，包含失能者的年齡、性別、家庭月收入、訪視前醫療服務使用情形、健康情形（罹患之疾病、健康評價、失能程度），發現未滿足需求傾向較高者，其住院的的可能性也較高。以最高傾向為參考值，中高傾向、中度傾向、最低傾向的OR值分別為0.66（95％CI:0.48~0.93）、0.56（95％CI:0.32~0.97）與0.36（95％CI:0.15~0.86）；且深入分析發現，未滿足需求傾向與住院的關係只在自述沒有未滿足者有達到統計上顯著意義。
由本研究的結果證實長期照護不足會增加急性醫療服務的使用，且自述沒有未滿足需求但屬於高未滿足需求傾向者更是住院的高危險群，因此建議在擬定失能者的介入方案時，應特別考量到這些潛在個案，避免因為他們自述沒有未滿足需求而忽略了他們。

Many disabled living in the community need assistance in Activities of Daily Living. Unmet need occurs when they do not receive enough assistance. As a result, their independence and quality of life are greatly affected. Furthermore, unmet need may lead to institutionalization, or an increase in health care services. Thus, this research intends to explore the effects of unmet need on hospitalization among the disabled in the community.
Data used in this research came from the “Pilot Program for the Development of Long-term Care System in Taiwan”. Information was collected through face-to-face interviews from the disabled residing in Chia-Yi City ,San-Yin area, Hsin-Tien City, Shu-Lin Townships from June to September, 2001. Hospitalization data was collected from the National Health Insurance Bureau, In this research, both self-reported unmet needs and propensity for unmet needs were assessed. T-test and Chi-Square Test were used to compare difference between groups. Logistic regression was used to calculate the propensity score, and to identify correlates of unmet need and hospitalization.
The result show that one-fourth of disabled in the communities had unmet needs. After controlling for age, gender, household income, prior use of medical care service, and health status, those with higher propensity for unmet needs were more likely to be hospitalized within 6 months. Using the quartile 4 to be the reference, the odds ratio for quartile 3,2, and 1 are 0.66（95％CI:0.48~0.93）, 0.56（95％CI:0.32~0.97）, and 0.36（95％CI:0.15~0.86）. Further examination revealed that the finding was significant only among those reported no unmet needs.
Unmet needs in activity of daily living are likely to lead to increased hospitalization, particularly among those with high propensity but reported no unmet needs. Therefore, they should be included in programs aimed to reduce unmet needs and hospitalization.

第一章 研究緣起 6
第一節 研究背景 6
第二節 研究目的 8
第二章 文獻探討 9
第一節 未滿足需求的定義 9
第二節 未滿足需求的盛行率 10
第三節 影響未滿足需求的相關因素 13
第四節 未滿足需求的影響 19
第五節 研究者對於未滿足需求研究的建議 21
第六節 影響住院的因素 21
第三章 研究設計與方法 23
第一節 研究架構與研究假設 23
第二節 研究設計 26
第三節 研究變項的操作型定義 29
第四節 統計分析方法 37
第四章 研究結果 38
第一節 樣本特性描述 38
第二節 雙變項分析 45
第三節 多變項分析 47
第五章 討論與建議 61
第一節 重要發現與討論 61
第二節 建議 66
第三節 研究限制與優點 68
參考文獻 70
圖表目錄
圖3-1研究架構 25
圖3-2 ADL未滿足需求狀況之判定過程 30
圖4-1個案條件說明 39
圖4-2 未滿足需求傾向分數分佈情形 43
圖4-3未滿足需求傾向分數四分位中自述有未滿足需求的分佈情形 43
表3-1 各變項之操作型定義與測量 34
表4-1 個案基本特性以及研究個案與遺漏個案的差異比較 50
表4-2 失能者需要協助與自述未滿足需求情形 53
表4-3 失能者自述未滿足需求分佈情形 53
表4-4未滿足需求傾向分數的建立模式 54
表4-5 有無住院個案之基本特性分佈比較 55
表4-6 控制變項與住院之邏輯斯回歸分析 57
表4-7 自述未滿足需求與住院之邏輯斯回歸分析 58
表4-8 未滿足需求傾向與住院之邏輯斯回歸分析 59
表4-9 未滿足需求傾向與住院之邏輯斯回歸分析 60

中文文獻
內政部社會司（2003）. 內政部身心障礙人口數統計. 2003.
內政部統計通報（2003）. 近年我國老年人口數一欄表. 2003.
行政院主計處（2001）. 八十九年戶口及住宅普查. 2001.
行政院經建會（2002）. 中華民國台灣地區民國91年至140年人口推計. 2002.
李錦彪（2002）. 精神病患主要照顧者之需要及其滿足程度之相關因素探討. 台北醫學大學醫務管理研究所碩士論文.
吳淑瓊、林惠生（1999）.台灣功能障礙老人家庭照顧者的全國概況剖析。中華衛誌，18(1): 44-53.
莊坤洋、陳育慧、曹愛蘭、吳淑瓊：社區失能者未滿足需求之盛行率與其相關因素。台灣衛誌，已接受.
張明正、林惠生(1999).民國八十五年台灣地區中老年保健與生涯規劃調查─調查報告。行政院衛生署家庭計畫研究所台灣老人研究叢書系列八。
葉玲玲（2003）. 台灣精神分裂症患者之健康照護需要與需求研究.國立陽明大學公共衛生研究所.
英文文獻
Agency for Healthcare Research and Quality, Rockville, MD. April 2002. http://www.ahrq.gov/research/futureltc00/
Allen,S.M. (1994). Gender differences in spousal caregiving and unmet need for care. J.Gerontol., 49, S187-S195.
Allen,S.M. & Mor,V. (1997). The prevalence and consequences of unmet need.
Anderson RM. (1995). Revisiting the Behavioral Model and Access to Medical Care: Does It Matter? Journal of Health and Social Behavior, 36, 1-10.
Contrasts between older and younger adults with disability. Med.Care, 35, 1132-1148.
Alonso,J., Orfila,F., Ruigomez,A., Ferrer,M., & Anto,J.M. (1997). Unmet health care needs and mortality among Spanish elderly. Am.J.Public Health, 87, 365-370.
Black,B.S., Rabins,P.V., German,P., McGuire,M., & Roca,R. (1997). Need and unmet need for mental health care among elderly public housing residents. Gerontologist, 37, 717-728.
Chen,J. & Wilkins,R. (1998). Seniors'' needs for health-related personal assistance. Health Rep., 10, 39-50.
Chenier,M.C. (1997). Review and analysis of caregiver burden and nursing home placement. Geriatr.Nurs., 18, 121-126.
Christ,G. & Siegel,K. (1990). Monitoring quality-of-life needs of cancer patients. Cancer, 65, 760-765.
Cox,C. (1986). Physician utilization by three groups of ethnic elderly. Med.Care, 24, 667-676.
D''Agostino,R.B., Jr. (1998). Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat.Med., 17, 2265-2281.
Desai,M.M., Lentzner,H.R., & Weeks,J.D. (2001). Unmet need for personal assistance with activities of daily living among older adults. Gerontologist, 41, 82-88.
Grytten,J., Rongen,G., & Sorensen,R. (1995). Can a public health care system achieve equity? The Norwegian experience. Med.Care, 33, 938-951.
Guadagnoli,E. & Mor,V. (1991). Daily living needs of cancer outpatients. Journal of Community Health, 16, 37-47.
Hung,L.C., Liu,C.C., & Kuo,H.W. (2002). Unmet nursing care needs of home-based disabled patients. Journal of Advanced Nursing, 40, 96-104.
Kennedy,J. (2001). Unmet and undermet need for activities of daily living and instrumental activities of daily living assistance among adults with disabilities: estimates from the 1994 and 1995 disability follow-back surveys. Medical Care, 39, 1305-1312.
LaPlante,M.P., Kaye,H.S., Kang,T., & Harrington,C. (2004). Unmet need for personal assistance services: estimating the shortfall in hours of help and adverse consequences. J.Gerontol.B Psychol.Sci.Soc.Sci., 59, S98-S108.
Lima,J.C. & Allen,S.M. (2001). Targeting risk for unmet need: not enough help versus no help at all. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 56, S302-S310.
Manning,W.G., Newhouse,J.P., Duan,N., Keeler,E.B., Leibowitz,A., & Marquis,M.S. (1987). Health insurance and the demand for medical care: evidence from a randomized experiment. Am.Econ.Rev., 77, 251-277.
Manton,K.G. (1989). Epidemiological, demographic, and social correlates of disability among the elderly. Milbank Q., 67 Suppl 2 Pt 1, 13-58.
Mor,V., Allen,S.M., Siegel,K., & Houts,P. (1992). Determinants of need and unmet need among cancer patients residing at home. Health Serv.Res., 27, 337-360.
Mor,V., Masterson-Allen,S., Houts,P., & Siegel,K. (1992). The changing needs of patients with cancer at home. A longitudinal view. Cancer, 69, 829-838.
Otero,A., de Yebenes,M.J., Rodriguez-Laso,A., & Zunzunegui,M.V. (2003). Unmet home care needs among community-dwelling elderly people in Spain. Aging Clin.Exp.Res., 15, 234-242.
Pacala,J.T., Boult,C., & Boult,L. (1995a). Predictive validity of a questionnaire that identifies older persons at risk for hospital admission. J.Am.Geriatr.Soc., 43, 374-377.
Pacala,J.T., Boult,C., & Boult,L. (1995b). Predictive validity of a questionnaire that identifies older persons at risk for hospital admission. J.Am.Geriatr.Soc., 43, 374-377.
Rosner,T.T., Namazi,K.H., & Wykle,M.L. (1988). Physician use among the old-old. Factors affecting variability. Med.Care, 26, 982-991.
Shea,D., Davey,A., Femia,E.E., Zarit,S.H., Sundstrom,G., Berg,S., & Smyer,M.A. (2003). Exploring assistance in Sweden and the United States. Gerontologist, 43, 712-721.
Siegel,K., Raveis,V.H., Houts,P., & Mor,V. (1991). Caregiver burden and unmet patient needs. Cancer, 68, 1131-1140.
Smith,M.Y. & Rapkin,B.D. (1995). Unmet needs for help among persons with AIDS. AIDS Care, 7, 353-363.
Stone,R., Cafferata,G.L., & Sangl,J. (1987). Caregivers of the frail elderly: a national profile. Gerontologist, 27, 616-626.
Tanner,J.L., Cockerham,W.C., & Spaeth,J.L. (1983). Predicting physician utilization. Med.Care, 21, 360-369.
Tennstedt,S., McKinlay,J., & Kasten,L. (1994). Unmet need among disabled elders: a problem in access to community long term care? Soc.Sci.Med., 38, 915-924.
Thomas,C.P. & Payne,S.M. (1998). Home alone: unmet need for formal support services among home health clients. Home.Health Care Serv.Q., 17, 1-20.
U.S. General Accounting Office. (1988). Long-term care for the elderly: Isssues of need, access, and cost. GAO/HRD-89-4.