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研究生:練健民
論文名稱:以RE-AIM架構評價 基隆社區高齡者跌倒防制網之成效
論文名稱(外文):Using the RE-AIM Framework to Evaluate the Effect of Fall Prevention Network in Community-dwelling Elderly
指導教授:高森永高森永引用關係
指導教授(外文):Senyeong Kao
口試委員:賴冠郎邱于容高森永
口試委員(外文):Kuan-Lang LaiYu-Lung ChiuSenyeong Kao
口試日期:2019-05-17
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:142
中文關鍵詞:RE-AIM架構個案管理社區長者臺灣版福康量表
外文關鍵詞:RE-AIM frameworkcase managementcommunity-dwelling elderlyTw-FROP-Com tool
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研究目的:RE-AIM架構多用以評價健康行為的介入計畫,但亦可評估公共衛生的介入效果及作為規劃及計畫成果的評估工具,該架構以涵蓋面(Reach)、效果面(Effectiveness)、參與面(Adoption)、執行面(Implementation)及維持面(Maintenance)等五大面向進行全面性評估。本研究目的利用RE-AIM架構針對社區高齡者「跌倒防制網」個案管理介入進行多面向系統性評估,藉以瞭解基隆社區高齡者跌倒防制網推動之成效,以作為跌倒防制管理、改善建議措施及計畫評估方法。
研究方法:本研究評估個案管理介入後,社區長者在預防跌倒的成效及於追蹤階段能否有效維持,說明如下:1.研究設計:追蹤型研究(longitudinal follow-up study)。2.研究對象:2014-2016年基隆市65歲以上之社區長者,KA組計103名及KB組計114名,共217名,在各階段流失32名,追蹤完成KA組共96名及KB組共89名,最後納入分析185名。3.收案流程:採立意取樣方式以三軍總醫院基隆分院為中心將研究對象分為兩組(周邊行政區域為介入組KA組及外圍區域為對照組KB組,分別比較兩組於個案管理介入後預防跌倒成效及維持效果之評估,共蒐集三次資料:第一次為社區長者跌倒風險因子的前測評估。第二次為個案管理介入六次後的後測評估。第三次為追蹤評估,在個案管理介入完成後,追蹤六個月再次進行跌倒風險因子測量,以評估介入措施之維持成效。4.研究工具:(1)臺灣版福康量表(Tw-FROP-Com)用來評估長者的跌倒風險情形,全距為0-60分,分數愈高者的跌倒風險愈高。(2)Fried衰弱量表,使用5項指標評估,符合3項以上為衰弱組。5.統計分析:以SPSS 20.0版進行統計分析。單變項檢定使用卡方檢定、獨立樣本t檢定及One-way ANOVA分析,使用廣義估計方程式(Generalized Estimating Equation, GEE)分析時間對介入成效之影響。
研究結果:1.涵蓋面(Reach):本研究團隊於基隆社區共篩檢547人,篩檢高風險族群涵蓋率7%;篩檢階段有396人進行前測,涵蓋率72%;前測階段有270人進行後測Ⅰ,涵蓋率68%;後測Ⅰ階段有219人進行後測Ⅱ,涵蓋率81%;後測Ⅱ階段有186人進行追蹤,涵蓋率85%。2. 效果面(Effectiveness):以GEE分析長者在前測的衰弱症指標與跌倒風險總分於預防跌倒的效果,結果顯示KA組在以前測為參考組時,追蹤期跌倒發生的風險減少0.851倍(p=0.033),而長者若有體重減輕的現象則會增加0.897倍風險發生跌倒(呈邊緣性顯著,p=0.092),KB組則在各階段的改變未達統計上顯著差異,而跌倒風險總分每增加1分,會增加0.372倍跌倒的風險(p<0.001)。3. 參與面(Adoption):研究團隊依據103年度社區跌倒防制網參與意願調查,共56個社區據點,12個據點表示有意願參加,針對未出席志工聯繫會報之社區據點由專人以電訪聯繫方式說明計畫內容並邀請社區據點負責人參加,有9個據點參與,共招募21個社區據點,評價基隆社區據點參與率37.5%(21個社區據點有意願參與/103年度社區據點評鑑之56個社區據點)。4.執行面(Implementation):評估據點負責人、志工、社區長者(全程/常常參與)參與度,在KA系列參與度62.5%(5/8),在KB系列參與度58.3%(7/12),整體參與度60%(12/20)。5.維持面(Maintenance):評估計畫結束後於追蹤期間是否仍持續進行,在整體篩檢階段有547人,追蹤階段有186人,整體持續性為34%。
結論與建議:本研究結果顯示個案管理介入後,能降低跌倒風險指標與跌倒發生,長者也能接受個管建議走出家門多參與社區活動,因此能降低衰弱及跌倒風險。建議後續研究可再分析長者特性找出最佳適用者,以達有效預防跌倒維持之效果。
關鍵字:RE-AIM架構、個案管理、社區長者、臺灣版福康量表
Objectives: The RE-AIM framework is often used to evaluate interventions for health behaviors, but it can also assess the effects of public health interventions and assessment tools for planning and project outcomes. The framework is based on Reach, Effectiveness, Adoption, Implementation, and Maintenance are five aspects of comprehensive assessment. The purpose of this study is to use the RE-AIM framework to conduct a multi-systematic assessment of the case-based management of the “falling prevention network” case of community-aged elderly people, so as to understand the Effect of fall prevention network in community-dwelling elderly, as a fall prevention management and improvement. Recommended measures and method of project evaluation.
Methods: This study assesses the effectiveness of the community elders in preventing falls and the ability to maintain them during the follow-up phase after case management interventions. The following are the following: 1. Study design: Longitudinal follow-up study. 2. Study subjects: Community elders over the age of 65 in Keelung City from 2014 to 2016, 103 in the KA group and 114 in the KB group, a total of 217, lost 32 in each stage, followed by a total of 96 in the KA group and KB A total of 89 people, the final analysis of 185. 3. Receipt process: The sampling method was divided into the sputum group centered on the service general hospital keelung branch(the surrounding administrative area was the intervention group KA group and the peripheral area was the control group KB group, respectively. After the intervention, the prevention of falls and the evaluation of the maintenance effect were collected. Three data were collected: the first is the pre-test assessment of the risk factors for the fall of the community elders. The second is the post-test assessment after six cases of case management intervention. The third is the follow-up assessment. Assessment, after the completion of the case management intervention, track the fall risk factor measurement again for six months to assess the effectiveness of the intervention measures. 4. Research tools: (1) Taiwanese version of the Fukang scale(Tw-FROP-Com) to Evaluate the risk of falling of the elderly, the total distance is 0-60 points, the higher the risk of falling, the higher the risk of falling. (2) The Fried Depression Scale, using 5 indicators to evaluate, 3 meets or more as the weak group. Statistical analysis: Statistical analysis was performed with SPSS version 20.0. Single-variable test using chi-square test, independent sample t-test and One-way ANOVA analysis, using Generalized Estimating Equation (GEE) to analysis the impact of time on intervention outcomes.
Results: 1. Reach: The research team screened 547 people in the Keelung community, screening the high-risk group coverage rate by 7%; 396 people in the screening stage conducted the pre-test, covering 72%; At the stage, there were 270 people who performed post-test I, covering 68%; in the post-test I stage, 219 people performed post-test II, covering 81%; in the post-test II stage, 186 people were tracked, covering 85%. 2. Effectiveness: GEE analysis of the elders' pre-test debilitating index and the total risk of falling in the prevention of falls. The results show that the risk of falls in the tracking period is reduced by 0.851 in the KA group. Times (p=0.033), while the elderly with weight loss increased by 0.897 times risk (falling marginal significance, p=0.092), and the KB group did not reach statistically significant difference in each stage. For every 1 point increase in the total risk of falling, it will increase the risk of falling by 0.372 times (p<0.001). 3. Adoption: The research team based on the 103 community fall prevention network and willingness survey, a total of 56 community bases, 12 strongholds expressed their willingness to participate, and the community bases that did not attend the volunteers’ report will be powered by special personnel. Visiting the Department of the Department to explain the project content and invite the person in charge of the community to participate in the project. There are 9 locations and a total of 21 community sites. The base rate of the Keelung community is estimated to be 37.5% (21 community bases have the will and /103 community comments) According to the 56 community bases). 4. Implementation: Evaluation of the person in charge of the base, volunteers, and community elders (full/frequently), with a degree of 62.5% (5/8) in the KA series and 58.3% in the KB series (7/12), the overall degree of compatibility is 60% (12/20). 5. Maintenance: Whether the evaluation plan continues after the end of the evaluation period, there are 547 people in the overall screening stage, 186 in the tracking stage, and the overall sustainability is 34%.
Conclusions and recommendations: The results of this study show that after the intervention of case management, the risk of falling falls and the fall can be reduced. The elderly can also accept the recommendation to go out of the house and community activities, thus reducing the risk of weakness and falls. It is recommended that follow-up studies can analyze the characteristics of the elderly to find the best applicator to achieve effective prevention of fall maintenance.
Keyword: RE-AIM framework, case management, community-dwelling elderly, Tw-FROP-Com tool
表目錄 I
圖目錄 III
附錄目錄 IV
中文摘要 I
Abstract III
第一章 緒論 6
第一節 研究背景與研究動機 6
第二節 研究之必要性與重要性 7
第三節 研究目的 9
第四節 名詞解釋 10
第二章 文獻探討 13
第一節 慢性病照護模式及個案管理照護模式簡介與應用 13
第二節 RE-AIM架構與相關研究 17
第三章 研究方法與研究材料 24
第一節 研究對象 24
第二節 研究架構 26
第三節 研究工具 28
第四節 研究變項操作型定義 30
第五節 資料處理與分析 37
第四章 研究結果 38
第一節 涵蓋面(Reach) 38
第二節 效果面(Effectiveness) 62
第三節 參與面(Adoption) 77
第四節 執行面(Implementation) 83
第五節 維持面(Maintenance) 87
第五章 討論 94
第一節 涵蓋面(Reach) 94
第二節 效果面(Effectiveness) 97
第三節 參與面(Adoption) 102
第四節 執行面 (Implementation) 103
第五節 維持面(Maintenance) 105
第六節 研究限制 106
第六章 結論與建議 107
第一節 結論 107
第二節 建議 109
參考文獻 111

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