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研究生:周姚均
研究生(外文):CHOU,YAO-CHUN
論文名稱:探討失能者居家醫療利用影響因素之社區性研究
論文名稱(外文):Community-based Study on Related Factors of Home Medical Care Utilization Among Disabled People
指導教授:洪啟峯
指導教授(外文):HUNG, CHI-FENG
口試委員:劉志光蔡景耀
口試委員(外文):LIU, CHIH-KUANGTSAI,CHING-YAO
口試日期:2019-06-19
學位類別:碩士
校院名稱:輔仁大學
系所名稱:跨專業長期照護碩士學位學程在職專班
學門:醫藥衛生學門
學類:其他醫藥衛生學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:98
中文關鍵詞:社區失能者合併罹病症居家醫療
外文關鍵詞:DisabilityComorbidityHome Medical Care
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研究目的:在快速老化及合併罹病症下,失能者在地老化是他們的首選,為了達成長者的心願,除了使用長期照顧資源的照顧生活外,對於就醫不便、舟車勞頓,不易獲得醫療照顧者,其居家醫療的利用更顯得為重要,因此,本研究探討社區失能者其社會人口學、健康狀況及使用長期照護服務項目與居家醫療利用間之關係。瞭解曾接受北市某區域長期照顧服務之個案,對於居家醫療利用之影響因子為何,以評估資源利用情形,有利整合性照護模式建立及提供未來施政參考。
研究方法:本研究為一回溯性研究,蒐集2017年1月1日至2017年12月31日接受北市某區域醫院長照個案管理之個案資料後,整理並排除未使用服務者,研究對象共2370位。以SPSS 22.0統計軟體進行描述性統計分析、皮爾森卡方檢定、獨立樣本t檢定、單因子變異數分析及邏輯斯迴歸分析其社會人口學、健康狀況及使用長期照護服務項目與居家醫療利用(型態、次數)的特性差異,以及探討社區失能者居家醫療利用之影響因子。
結果:社區失能者其社會人口學(年齡、福利身份、獨居與否、住處是否爬樓梯、居住地之都市化程度)、健康功能狀況(合併罹病症指數、日常生活活動、長期照護案例組合系統核定等級)、長照服務使用項目(照顧服務-日間照顧、居家復健)與居家醫療利用有顯著關係。本研究資料經校正相關因子後,發現社區失能者年齡每增加一歲居家醫療利用的勝算比將增加1.020倍,合併罹病症指數每增加一分居家醫療利用勝算比(odds ratio)將增加1.334倍,在連結長照服務總項目上,每增加一項服務其居家醫療利用的勝算比增加3.065倍;在低收戶(OR值2.367,95% CI:1.437-4.143)、居住於二樓無電梯者(OR值1.747,95% CI :1.250-2.442)、日常生活活動完全依賴者(OR值5.374, 95% CI :5.444-1.997)、長期照護案例組合系統核定(LTC-CMS)為第四級(OR值0.319, 95% CI:0.114-0.887)、第五級(OR值0.322, 95% CI: 0.110-0.943)、第七級(OR值0.222, 95% CI : 0.064-0.775)、照顧服務-日間照顧(OR值0.080, 95% CI:0.016-0.407)、居家復健(OR值0.080, 95% CI:0.016-0.407),其居家醫療利用(型態、次數)有顯著較高利用率。結論:對社區失能者而言,年齡越高、合併罹病症指數及使用長照服務項目增加時,其居家醫療需求亦相對增加,因此,在照顧社區失能者,當失能者為低收入戶、居住於二樓無電梯、日常生活完全依賴、長期照護案例組合系統核定等級第四、五、七級及使用居家復健者,更應評估其為居家醫療之需求,讓社區失能者能獲得長期照顧資源的照顧生活及醫療照顧,以實現社區失能者在地老化的願望。

Aims: Under the situation of rapid aging and comorbidity, aging in place might be the best choice for the disabled persons. In order to make the elderly's wish come true, we should use the resource of long-term care to take care of them. Besides, utilizing home medical care services is also important for the persons who can't get access to medical treatment easily. Therefore, the aim of this study was to discuss the disabled community dwellers’ social demography, physical conditions, the utilization of long¬term caring service items, and the use of home medical care. In this study, cases that have been provided with the services of long-term care from a -certain area in Taipei City were selected as the study subjects. By studying the cases, we can learn the factors that influence the utilization of home medical care resources, evaluate the situation of the use of resources, both of which could help to build an integrated care system and provided as a reference source for the government’s policy.
Method: The research was a retrospective study. The persons who were subsidized through a long-term care management at the certain hospital from January 1 to December 31 in 2017 were selected to be the study subjects. A total of 2370 people were included. The study wants to realize the characteristics and differences between disabled community dwellers' social demography, physical conditions, the utilization of long-term caring service items and the use of Home Medical Care by using SPSS 22.0, the statistical software, including descriptive statistics, chi-square test, independent sample t test, analysis of variance(ANOVA), and logistic regression.
Results: Disabled community dwellers' social demography which is concerns age, welfare identity, living alone or not, climbing stairs in the residence or not and the degree of urbanization in the place of residence is significantly associated with the utilization of home medical care services. Disabled community dwellers' health condition which includes charlson co-morbidity index by quan (CCI-Q), function in daily life, on the LTC-CMS scale is significantly associated with the utilization of home medical care services. The long-term caring service items including day care services and residential rehabilitation are significantly associated with the utilization of home medical care services. After correcting the relevant factors, the data shows that odds ratio of the utilization of home medical care services will increase 1.020 times when disabled community dwellers increase their age every year. The data also shows that odds ratio of the utilization of home medical care will increase 1.334 times when CCI-Q increases one score. In addition, odds ratio of the utilization of home medical care services will increase 3.065 times when disabled persons increase each of the long-term care services. Further analysis reveals that the utilization of home medical care services has significantly of higher low-income households (OR:2.367, 95% CI:1.437-4.143), of people living on the second floor or more without elevators (OR:1.747, 95% CI: 1.250-2.442) , of people complete dependence in daily life (OR:5.374, 95% CI:5.444-1.997) , of people are verified as the 4th (OR:0.319, 95% CI:0.114-0.887) , as the 5th (OR:0.322, 95% CI:0.110-0.943) ,and as 7 th on the LTC-CMS scale (OR:0.222, 95% CI:0.064-0.775) ,of using care services of day care (OR:0.080, 95% CI:0.016-0.407) ,of residential rehabilitation (OR:0.080, 95% CI:0.016-0.407).
Conclusion:To disabled community dwellers, the demand for home health care would increase as they become older as well as the comorbidity index and the long-term care requirement grow. Therefore, we should take deeper assessment on the disabled community dwellers’ need of home medical care if they (1) are low-income households, (2) live on the second floor or more without elevators, (3) need complete dependence in daily life, (4) are verified as the 4th, 5th, and 7th on the LTC-CMS scale, (5)are the users of in-home rehabilitation service. In this way, disabled community dwellers are able to obtain the resource of long-term care and medical services, realizing the dream of aging in place.

目錄
中文摘要 1
英文摘要 3
第一章 緒論 6
第一節 研究背景與動機 6
第二節 研究的重要性 8
第三節 研究目的 9
第四節 研究流程 9
第二章 文獻探討 11
第一節 臺灣高齡人口趨勢與失能 11
第二節 長期照顧相關議題 17
第三節 居家醫療之推動 25
第四節 重要名詞解釋 34
第三章 研究方法 35
第一節 研究架構 36
第二節 研究變項之操作型定義 38
第三節 研究資料來源與研究對象 46
第四節 資料處理與分析方法 47
第四章 研究結果 50
第一節 樣本特性分析 50
第二節 樣本特性之差異分析 57
第三節 居家醫療影響因子之分析 71
第五章 結論 79
參考資料 87


內政部戶政司全球資訊網. (2018). 人口統計資料. Retrieved from https://www.ris.gov.tw/app/portal/346
全國法規資料庫. (2017). 長期照顧服務法. Retrieved from https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0070040
全聯會國際事務工作小組. (2015). 日本居家醫療的變遷及現況. 臺灣醫界, 58(4), 42-44.
曲同光, 彭美琪, & 白其怡. (2015). 規劃長照保險重要基礎資料庫-國民長期照護需要調查. 國土及公共治理季刊, 3(1), 108-114.
江慧琪. (2007). 社區失能個案長期照護服務需求及其相關因素之探討-規範性需求之觀點. 國立台北護理學院長期照護研究所碩士論文, 台北市.
行政院. (2007). 我國長期照顧十年計畫-大溫暖社會福利套案之旗艦計畫. 台北: 行政院.
行政院. (2016). 長期照顧十年計畫 2.0 (106~ 115 年核定本). 取自 http://www. ey. gov. tw. DL. ashx.
吳淑瓊, 徐慧娟, 莊媖智, & 張明正. (1996). 功能評估在估計台灣社區老人長期照護需要之應用. 中華公共衛生雜誌, 15(6), 533-545.
李世代. (2010). “長期照護”的發展與推動. 臺灣醫界, 53(1), 44-50. doi:10.30044/tmj.201001.0011
李宗派. (2016). 高齡長者身心靈健康促進之發展-美國經驗. 臺灣老人保健學刊, 12(2), 70-92.
余尚儒. (2015). 日本在宅醫療發展對我國居家醫療的啟示. 台灣家庭醫學雜誌, 25(2), 105-119.
林幸君, 李慧琳, 許聖民, 林國榮, 李篤華, 張靜貞, & 徐世勳. (2015). 少子化與高齡化下的臺灣人口預測與經濟分析. [Baseline Forecasting for Taiwan's Population in the Face of Low Fertility Rate and Ageing Problems]. 臺灣經濟預測與政策, 46(1), 113-156.
林儀蒂, 施雅雯, 李秉翰, 李旻璋, 翁林仲, & 黃勝堅. (2018). 從日本岐南町綜合在宅醫療診所看台灣居家醫療未來. 臺灣醫界, 61(3), 43-50.
邱文達. (2011). 衛生福利的融合綜效-長期照護的前瞻. 研考雙月刊, 35(2), 123-130.
胡雅茜. (2006). 台灣老人醫療服務需求與居住安排之實證研究. 中央大學產業經濟研究所學位論文, 1-48.
胡愈寧, 酈欽菁, 李佳, 林榮輝, & 胡國琦. (2009). 老年人各項日常生活活動功能與自評健康狀態之調查及相關性探討. 台灣復健醫學雜誌, 37(2), 107-114.
國家發展委員會. (2018a). 中華民國人口推估(2018至2065年). 國家發展委員會.
國家發展委員會. (2018b). 高齡化時程. Retrieved from https://www.ndc.gov.tw/Content_List.aspx?n=695E69E28C6AC7F3
莊坤洋, 陳育慧, 曹愛蘭, & 吳淑瓊. (2004). 社會中失能者未滿足需求之盛行率與其相關因素. 台灣公共衛生雜誌, 23(3), 169-180.
陳亮恭. (2015). 高齡醫療服務的發展-由片斷走向整合. [Healthcare Services for Older People: From Fragmentation to Integration]. 護理雜誌, 62(5), 23-29. doi:10.6224/jn.62.5.23
熊曉芳, & 吳淑瓊. (2007). 社區失能老人居住安排與日常生活協助未滿足需求之關係. 台灣公共衛生雜誌, 26(6), 507-517.
衛生福利部. (2017). 老人狀況調查報告. Retrieved from https://dep.mohw.gov.tw/DOS/cp-1767-38429-113.html
衛生福利部中央健康保險署. (2017). 居家醫療整合照顧計畫. Retrieved from https://www.nhi.gov.tw/Content_List.aspx?n=229E6EBB8F3CF41B&topn=D39E2B72B0BDFA15
衛生福利部中央健康保險署. (2019). 居家醫療整合照護特約醫事機構. Retrieved from https://www1.nhi.gov.tw/QueryN/Query_HomeHealth.aspx
衛生福利部統計處 (2019). 105年身心障礙者生活狀況及需求調查. Retrieved from https://dep.mohw.gov.tw/DOS/cp-1770-3599-113.html
衛生福利部國民健康署. (2017). 民國一百零四年中老年身心社會生活狀況長期追蹤調查成果報告.
Anderson, G. (2012). Chronic care: making the case for ongoing care. Princeton, NJ: Robert Wood Johnson Foundation; 2010.
Anderson, G. F. (2003). Physician, public, and policymaker perspectives on chronic conditions. Archives of internal medicine, 163(4), 437-442.
Arend, J., Tsang‐Quinn, J., Levine, C., & Thomas, D. (2012). The patient‐centered medical home: history, components, and review of the evidence. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine, 79(4), 433-450.
Barlow, J., & Breeze, M. (2005). Teleshopping for Older and Disabled People: An Evaluation of Two Pilot Trials: Joseph Rowntree Foundation.
Bravo, G., Dubois, M. F., Hébert, R., De Wals, P., & Messier, L. (2002). A prospective evaluation of the Charlson Comorbidity Index for use in long‐term care patients. Journal of the American Geriatrics Society, 50(4), 740-745.
Bushnell, C. D., Lee, J., Duncan, P. W., Newby, L. K., & Goldstein, L. B. (2008). Impact of comorbidities on ischemic stroke outcomes in women. Stroke, 39(7), 2138-2140.
Cano Perez, M. D., Castell Alcala, M. V., Queipo Matas, R., Martín Martín, S., Mateo Pascual, C., & Otero Puime, Á. (2016). Use of primary care services, care specialized and drug use by population 65 years and more in Madrid, Spain. Revista espanola de salud publica.
Casey, R. (2015). Disability and unmet health care needs in Canada: a longitudinal analysis. Disabil Health J, 8(2), 173-181.
Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases, 40(5), 373-383.
CIA. (2017). The world factbook. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/rankorder/2127rank.html
CMS. (2017). Independence at Home Retrieved from https://innovation.cms.gov/Files/reports/iah-regressionmethodologyrpt.pdf
Cornwell, J. (2012). The care of frail older people with complex needs: time for a revolution. London: The King’s Fund.
De Leon, C. F. M., Bang, W., Bienias, J. L., Glass, T. A., Vaccarino, V., & Kasl, S. V. (2005). Changes in disability before and after myocardial infarction in older adults. Archives of internal medicine, 165(7), 763-768.
Development, O. f. E. C.-o., & OECD. (2011). Health reform: Meeting the challenge of ageing and multiple morbidities: OECD Publishing.
Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of clinical epidemiology, 45(6), 613-619.
Eskola, P. (2004). Services for supporting family carers of elderly people in Europe: Characteristics,coverage and usage. .
Ferriero, G., Franchignoni, F., Benevolo, E., Ottonello, M., Scocchi, M., & Xanthi, M. (2006). The influence of comorbidities and complications on discharge function in stroke rehabilitation inpatients. Europa medicophysica, 42(2), 91.
Forjaz, M. J., Rodriguez-Blazquez, C., Ayala, A., Rodriguez-Rodriguez, V., de Pedro-Cuesta, J., Garcia-Gutierrez, S., & Prados-Torres, A. (2015). Chronic conditions, disability, and quality of life in older adults with multimorbidity in Spain. Eur J Intern Med, 26(3), 176-181. doi:10.1016/j.ejim.2015.02.016
Fortin, M., Lapointe, L., Hudon, C., Vanasse, A., Ntetu, A. L., & Maltais, D. (2004). Multimorbidity and quality of life in primary care: a systematic review. Health and Quality of life Outcomes, 2(1), 51.
Gabriel, S. E., Crowson, C. S., & O'Fallon, W. M. (1999). A comparison of two comorbidity instruments in arthritis. Journal of clinical epidemiology, 52(12), 1137-1142.
Goldstein, L. B., Samsa, G. P., Matchar, D. B., & Horner, R. D. (2004). Charlson Index comorbidity adjustment for ischemic stroke outcome studies. Stroke, 35(8), 1941-1945.
Goodridge, D., Hawranik, P., Duncan, V., & Turner, H. (2012). Socioeconomic disparities in home health care service access and utilization: A scoping review. International Journal of Nursing Studies, 49(10), 1310-1319.
Groll, D. L., To, T., Bombardier, C., & Wright, J. G. (2005). The development of a comorbidity index with physical function as the outcome. Journal of clinical epidemiology, 58(6), 595-602.
Hayes, S. L., Salzberg, C. A., McCarthy, D., Radley, D. C., Abrams, M. K., Shah, T., & Anderson, G. F. (2016). High-Need, High-Cost Patients: Who Are They and How Do They Use Health Care? A Population-Based Comparison of Demographics, Health Care Use, and Expenditures. Issue Brief (Commonwealth Fund), 26, 1-14.
Herr, M., Arvieu, J.-J., Aegerter, P., Robine, J.-M., & Ankri, J. (2013). Unmet health care needs of older people: prevalence and predictors in a French cross-sectional survey. The European Journal of Public Health, 24(5), 808-813.
Hurst, J. (2000). Challenges for health systems in Member Countries of the Organisation for Economic Co-operation and Development. Bulletin of the World Health Organization, 78, 751-760.
Inouye, S. K., Peduzzi, P. N., Robison, J. T., Hughes, J. S., Horwitz, R. I., & Concato, J. (1998). Importance of functional measures in predicting mortality among older hospitalized patients. Jama, 279(15), 1187-1193.
Jagger, C., Arthur, A. J., Spiers, N. A., & Clarke, M. (2001). Patterns of onset of disability in activities of daily living with age. Journal of the American Geriatrics Society, 49(4), 404-409.
Kane, R. A., & Kane, R. L. (1987). Long-term care: Principles, programs, and policies.
Kellett, M. (2005). Catherine's legacy: social communication development for individuals with profound learning difficulties and fragile life expectancies. British Journal of Special Education, 32(3), 116-121.
Kelly, P., Stein, J., Shafqat, S., Eskey, C., Doherty, D., Chang, Y., . . . Furie, K. (2001). Functional recovery after rehabilitation for cerebellar stroke. Stroke, 32(2), 530-534.
Kinosian, B., Taler, G., Boling, P., Gilden, D., & Group, I. a. H. L. C. W. (2016). Projected savings and workforce transformation from converting independence at home to a Medicare benefit. Journal of the American Geriatrics Society, 64(8), 1531-1536.
Klein, S., Hostetter, M., & McCarthy, D. (2017). An overview of home based primary care: learning from the field. Issue Brief (Commonw Fund), 15, 1-20.
Liu, L.-J., Fu, Y.-F., Qu, L., & Wang, Y. (2014). Home health care needs and willingness to pay for home health care among the empty-nest elderly in Shanghai, China. International Journal of Gerontology, 8(1), 31-36.
Marengoni, A., Angleman, S., Melis, R., Mangialasche, F., Karp, A., Garmen, A., . . . Fratiglioni, L. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing research reviews, 10(4), 430-439.
Markle‐Reid, M., & Browne, G. (2003). Conceptualizations of frailty in relation to older adults. Journal of advanced nursing, 44(1), 58-68.
Mercer, S., Furler, J., Moffat, K., Fischbacher-Smith, D., & Sanci, L. (2016). Multimorbidity: Technical Series on Safer Primary Care: World Health Organization.
Mery, G., Wodchis, W. P., & Laporte, A. (2016). The determinants of the propensity to receive publicly funded home care services for the elderly in Canada: a panel two-stage residual inclusion approach. Health economics review, 6(1), 8.
Metzelthin, S. F., van Rossum, E., de Witte, L. P., Ambergen, A. W., Hobma, S. O., Sipers, W., & Kempen, G. I. (2013). Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. Bmj, 347, f5264.
Mitchell, E. M. (2001). Concentration of health expenditures in the US Civilian Noninstitutionalized Population, 2014.
Mohamad Yunus, N. a., Abd Manaf, N. H., Omar, A., Omar, M. A., & Salleh, M. (2017). Determinants of Healthcare Utilisation among the Elderly in Malaysia. Institutions and Economies, 115-140%@ 2232-1349.
Nutzel, A., Dahlhaus, A., Fuchs, A., Gensichen, J., Konig, H. H., Riedel-Heller, S., . . . Bickel, H. (2014). Self-rated health in multimorbid older general practice patients: a cross-sectional study in Germany. BMC Fam Pract, 15, 1. doi:10.1186/1471-2296-15-1
Osuchukwu Nelson Chukwudi, Inde Margaret Uyilewhoma, Osuchukwu Easter Chukwudi, Eko Jimmy Ebi, O. N. M. E., Osonwa Okorie Kalu, & Iyamba, E. E. (2015). Determinants of Health Services Utilization among the Elderly in Calabar Municipality, Cross River State, Nigeria. European Journal of Preventive Medicine, 3(5). doi:10.11648/j.ejpm.20150305.11
Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., . . . Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Medical Care, 1130-1139.
Ricciardi, W., Specchia, M. L., & Marino, M. (2014). Health of the elderlies and healthy ageing: Challenge for Europe. Studies in health technology and informatics, 203, 1-9.
Rosland, A. M., Nelson, K., Sun, H., Dolan, E. D., Maynard, C., Bryson, C., . . . Fihn, S. D. (2013). The patient-centered medical home in the Veterans Health Administration. The American journal of managed care, 19(7), e263-272.
Sakellariou, D., & Rotarou, E. S. (2017). Access to healthcare for men and women with disabilities in the UK: secondary analysis of cross-sectional data. BMJ open, 7(8), e016614.
Santoni, G., Angleman, S., Welmer, A. K., Mangialasche, F., Marengoni, A., & Fratiglioni, L. (2015). Age-related variation in health status after age 60. PLoS One, 10(3), e0120077. doi:10.1371/journal.pone.0120077
Stall, N., Nowaczynski, M., & Sinha, S. K. (2013). Back to the future: home-based primary care for older homebound Canadians: Part 1: where we are now. Canadian Family Physician, 59(3), 237-240.
Turhan, N., Saraçgil, N., Öztop, P., & Bayramoglu, M. (2006). Serum albumin and comorbidity relative to rehabilitation outcome in geriatric stroke, and possible links with stroke etiology. International Journal of Rehabilitation Research, 29(1), 81-85.
VA. (2018). Geriatrics and Extended Care. Retrieved from https://www.va.gov/GERIATRICS/geriatric_Patient_Aligned_Care_Team.asp
Van den Akker, M., Buntinx, F., Metsemakers, J. F., Roos, S., & Knottnerus, J. A. (1998). Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of clinical epidemiology, 51(5), 367-375.
Verbrugge, L. M., & Jette, A. M. (1994). The disablement process. Social science & medicine, 38(1), 1-14.
WHO. (2013). Health topics, Disabilities. Retrieved from https://www.who.int/topics/disabilities/en/
Willadsen, T. G., Bebe, A., Køster-Rasmussen, R., Jarbøl, D. E., Guassora, A. D., Waldorff, F. B., . . . Olivarius, N. d. F. (2016). The role of diseases, risk factors and symptoms in the definition of multimorbidity–a systematic review. Scandinavian journal of primary health care, 34(2), 112-121.
Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of internal medicine, 162(20), 2269-2276.
Wowchuk, S. M., McClement, S., & Bond, J., Jr. (2006). The challenge of providing palliative care in the nursing home: part 1 external factors. Int J Palliat Nurs, 12(6), 260-267. doi:10.12968/ijpn.2006.12.6.21451


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