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研究生:崔妍妍
研究生(外文):Yan-Yan Cui
論文名稱:整合型評估量表對於中國長期照護需求評估之分析:以上海為例
論文名稱(外文):The Study of Care Need Assessment with Comprehesive Assessment Tool for Long Term Care in China: Taking the Use of CARE in ShangHai as an Example
指導教授:張博論張博論引用關係
指導教授(外文):Polun Chang
學位類別:博士
校院名稱:國立陽明大學
系所名稱:生物醫學資訊研究所
學門:生命科學學門
學類:生物化學學類
論文種類:學術論文
論文出版年:2018
畢業學年度:107
語文別:英文
論文頁數:191
中文關鍵詞:整合性照護長期照護老年綜合評估連續性評估和記錄移動健康
外文關鍵詞:integrated carelong term careComprehensive Geriatric Assessment (CGA)Continuity Assessment Record and Evaluation (CARE)mHealth
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Contents
CHINESE ABSTRACT I
ENGLISH ABSTRACT III
CONTENTS VI
LIST OF FIGURES IX
LIST OF TABLES XI
CHAPTER 1 INTRODUCTION 1
1.1. BACKGROUND 1
1.2. PURPOSES 4
CHAPTER 2 LITERATURE REVIEW 5
2.1. CHARACTERISTICS OF AGEING IN CHINA 5
2.2. INTEGRATED CARE 6
2.2.1. THERIOAL BASIS OF INTEGRATED CARE 6
2.2.2. MODELS AND CONTENTS OF INTEGRATED CARE 7
2.3. THE CHANGE OF LONG TERM CARE SYSTEM IN CHINA: FROM FAMILY SUPPORT TO INTEGRATED CARE 8
2.4. COMPREHENSIVE GERIATIRC ASSESSMENT, CGA 10
2.4.1. THE OVERVIEW OF CGA 11
2.4.2. BENEFITS AND WEAKNESSES OF CGAS 11
2.4.3. INTRODUCTION OF RAI-ONE OF THE MOST WIDELY USED CGAS 13
2.4.4. INTRODUCTION OF CARE-ONE NEW GENERATION CGA 15
2.4.5. INTRODUCTION OF UNAS-ONE TIPICAL CARE NEEDS ASSESSMENT INSTRUMENT IN CHINA 17
2.4.6. COMPARASION BETWEEN MDS, CARE AND UNAS 18
2.5. MOBILE HEALTH AND CGA 26
CHAPTER 3 METHODS 28
3.1. ESTABLISHMENT OF CARE+, A COMPREHENSIVE ASSESSMENT INSTRUMENT 28
3.2. FORMING CARE AREA ASSESSMENTS INTEGRATING THE CARE AND UNAS BASED ON THE RAI 3.0 29
3.3. ESTABLISHMENT AND TESTING OF MCARE+, A SMART MOBILE CGA 32
3.3.1. INTRODUCING THE SMART MOBILE INTEGRATED LONG-TERM CARE PLATFORM 32
3.3.1.1. THEORETICAL MODEL 32
3.3.1.2. PLATFORM STRUCTURE AND COMPONENTS 33
3.3.1.3. MCARE+ ASSESSMENT INSTRUMENT 33
3.3.2. MCARE+ TECHNOLOGY ACCEPTANCE EVALUATION 40
3.4. COMPARISON OF RESIDENTS’ CAAS BETWEEN THE CARE AND UNAS 42
CHAPTER 4 RESULTS 44
4.1. MCARE+ TECHNOLOGY ACCEPTANCE EVALUATION 44
4.1.1. PERCEIVED UTILITY 44
4.1.2. PERCEIVED EASE OF USE 44
4.1.3. ACCEPTANCE 45
4.1.4. RELIABILITY 45
4.1.5. OVERALL SATISFACTION 45
4.1.6. OvERALL SUGGESTIONS 45
4.2. MCARE+ : DIFFERENCES BETWEEN RESIDENTS IN DIFFERENT FACILITIES 47
4.2.1. RESIDENTS’ DEMOGRAPHICAL INFORMATION 47
4.2.2. PREADMISSION INFORMATION 50
4.2.3. MEDICAL CONDITIONS OF PARTICIPANTS 56
4.2.4. CONSCIOUSNESS AND MOOD 61
4.2.5. PAIN 66
4.2.6. PHYSIOLOGICAL IMPAIRMENT 69
4.2.7. CORE LIVING ABILITY 74
4.2.8. SUPPLEMENTARY LIVING ABILITY 76
4.3.1. CARE ISSUES DETECTED BY CARE ALONE 90
4.3.2. CARE ISSUES DETECTED BY BOTH THE CARE AND UNAS 91
4.3.3. COMPARISON OF CAAS BETWEEN RESIDENTS WITH DIFFERENT FEATURES 93
4.3.4. COMPARISON OF CAA PREVALENCE BETWEEN DIFFERENT FACILITIES 94
CHAPTER 5 DISCUSSION 102
5.1. MCARE+ DESIGN AND EVALUATION 102
5.2. DISCUSSION OF THE CARE AND UNIFIED NEEDS ASSESSMENT RESULTS 104
5.1.1. DEMOGRAPHICAL INFORMATION AND PREADMISSION INFORMATION OF FACILITY RESIDENTS 104
5.2.2. IMPORTANT MEDICAL INFORMATION OF FACILITY RESIDENTS 106
5.3. CAAS TRIGGERED BY THE CARE AND UNIFIED NEEDS ASSESSMENT SCALE 107
5.3.1. SIX CARE ISSUES OVERLOOKED IN THE UNIFIED NEEDS ASSESSMENT SCALE 108
5.3.2. DIFFERENCES BETWEEN CAAS TRIGGERED BY BOTH THE CARE AND UNAS 111
5.4. OVERALL EVALUATION OF THE CARE AND UNAS 113
5.5. RESEARCH LIMITATION 114
CHAPTER 6 CONCLUSION 116
REFERENCES 118


圖目錄
FIGURE 3- 1 PRECISION CARE COMPASS MODEL 33
FIGURE 3- 2 CONSTRUCTURE FRAMEWORK OF SMART MOBILE INTEGRATED GERIATRIC LONG-TERM CARE PLATFORM 36
FIGURE 3- 3 SCREEN LAYOUT USING 3 HIERARCHICAL LAYERS 37
FIGURE 3- 4 SMART ASSESSMENT ASSISTANT 38
FIGURE 3- 5 PERSONALIZED CARE NEEDS COULD BE PRODUCED AFTER ASSESSMENT 39
FIGURE 3- 6 MANAGEMENT CENTER’S SCREEN LAYOUT 40
Figure 4- 1 PERCENTAGE OF OLDER ADULT RESIDENTS IN DIFFERENT FACILITIES WITH TWO OR MORE DISEASES……………………………………………………..………………...57
FIGURE 4- 2 NUMBER OF RESIDENTS’ COMORBIDITIES BY FACILITY 57
FIGURE 4- 3 DISTRIBUTION OF RESIDENTS’ CORE LIVING ABILITY AND DEPENDENCE 75
Figure 4- 4 COMPARISON OF ADL SCORES BETWEEN RESIDENTS WITH AND WITHOUT ADL/REHABILITATION CARE NEEDS………………………………………………..91
Figure 4- 5 COMPARISON OF RESIDENTS’ NUMBER OF CAAS DETECTED WHEN THE CARE AND UNAS WERE USED…………………………………………………………….96
FIGURE 4- 6 COMPARISON OF THE NUMBER OF CAAS OFRESIDENTS WHO RECEIVEDOTHER TREATMENT SERVICES OVER THEPRECEDING 2 MONTHS AND THAT OF RESIDENTS WHO DID NOT 96
FIGURE 4- 7 COMPARISON OF RESIDENTS’ CAAS BY MARITAL STATUS 97
FIGURE 4- 8 COMPARISON OF RESIDENTS’ CAAS BY AGE GROUP 97
FIGURE 4- 9 COMPARISON OF RESIDENTS’ CAAS BY COMORBIDITY………………...98
FIGURE 4- 10 COMPARISON OF RESIDENTS’ CAAS BY COGNITIVE FUNCTION 98
FIGURE 4- 11 CAA PREVALENCE AMONG SENIOR CARE CENTER RESIDENTS……...92
Figure 4- 12 CAA PREVALENCE AMONG SKILLED NURSING FACILITY RESIDENTS…92
FIGURE 4- 13 CAA PREVALENCE AMONG HEALTH CARE CENTER RESIDENTS………93
Figure 4- 16 CAA PREVALENCE AMONG SENCONDARY LEVELED HOSPITAL RESIDENTS101
FIGURE 4- 15 CAA PREVALENCE AMONG TERTIARY LEVELED HOSPITAL RESIDENTS…94
Figure 4- 16 CAA PREVALENCE AMONG ALL RESIDENTS……………………………1014


表目錄
TABLE 2- 1 SECTIONS AND NUMBER OF CORE AND ADDITIONAL ITEMS IN THE CARE-INSTITUTION INSTRUMENT 16
TABLE 2- 2 COMPARASIONS OF CARE NEEDS ASSESSMENT INSTRUMENTS IN FOUR PILOT CITIES IN CHINA 22
Table 3- 1 COMPARISON OF ITEMS TRIGGERING CAA_PRESSURE ULCERS/PRESSURE ULCER RISK IN MDS3.0: CARE VS. UNAS…………………………….30
TABLE 3- 2 COMPARISON OF THE CAAS OF THE RAI 3.0 BETWEEN THE CARE AND UNAS 31
TABLE 4- 1 ORIGINS OF ASSESSMENT TARGETS 47
TABLE 4- 2 ADMISSION INFORMATION 50
TABLE 4- 3 CURRENT MEDICAL INFORMATION 57
TABLE 4- 4 COGNITIVE/MOOD/BEHAVIOR 61
TABLE 4- 5 PAIN 67
TABLE 4- 6 FUNCTIONAL IMPAIRMENTS 71
TABLE 4- 7 FUNCTIONAL STATUS (SELF CARE) 78
TABLE 4- 8 FUNCTIONAL STATUS (CORE MOBILITY) 80
TABLE 4- 9 SUPPLEMENTAL FUNCTIONAL ABILITY 82
TABLE 4- 10 COMPARISON OF CAA DETECTION RATES FOR UNAS AND CARE 92
TABLE 4- 11 SUMMARY OF CAAS TRIGGED BY THE CARE AND UNAS IN DIFFERENT FACILITIES 95
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