照顧管理模式對長期照護的成效評估：以臺北市大安區長期照護服務
中心為例
Effects of the Care Management Model on Long-term Care:
Evaluation of the Long-term Care Service Center
中文摘要
論文名稱: 照顧管理模式對長期照護的成效評估：以臺北市大安區 長期照護服務中心為例
研究所名稱:臺北醫學大學醫務管理學研究所 研究生姓名: 紀櫻珍
畢業時間:九十一學年度第二學期
指導教授:黃國哲 臺北醫學大學醫務管理學研究所 助理教授
由於我國失能老人對長期照護服務的需求與日俱增，造成政府在醫療照護體 系和社會福利支持等方面，必須增加提供照護資源以滿足其需求。本研究的主要 目的在提供社區失能老人「照顧管理模式」的服務後，評估其模式對長期照護的 成效。
本研究採取縱貫式類實驗設計，研究樣本為居住在台北市大安區 60 歲以上 的功能障礙老人，共 331 人。其中接受照顧管理模式服務者納入實驗組計 166 人，未接受此服務者納入對照組計 165 人，實驗期間為民國 91 年 1 月 1 日至 12 月 31 日。研究架構以個案醫療服務使用情形、與健康相關之生活品質、個案及 其主要照顧者的滿意度作為成效評估之面向；以照顧管理模式為實驗因子；社會 人口學特性(如性別、年齡等)、健康狀況(如老人身體功能障礙程度等)、及照顧 資源的有無(如子女數目等)則納入為控制變項。重要研究發現如下：(1)在醫療費 用方面 - 實驗組的個案減少醫療費用的機會大於對照組的個案(OR=1.98, p<0.05)。初(國)中教育程度之個案減少醫療費用的機會大於不識字之個案
(OR=3.88, p<0.05)。而相較於只有 IADLs 功能障礙的個案而言，身體患有 1-2 項、
3-4 項、或 5-6 項 ADLs 功能障礙的個案其醫療費用減少的機會較小(OR=0.05, p<0.01；OR=0.09, p<0.05；OR=0.06, p<0.01)。(2)在與健康相關生活品質方面 - 外 省籍(OR=0.29, p<0.05)、認知功能障礙愈嚴重者(OR=0.42, p<0.01)、及子女人數 越多者(OR=0.39, p<0.01)的個案，其身體功能變差的機會較低。(3)在個案與其主 要照顧者的滿意度方面 - 實驗組的個案及其主要照顧者滿意度變差的機會均小 於對照組的個案及其主要照顧者(OR=0.05, p<0.001；OR=0.25, p<0.001)。另一方 面，認知功能障礙愈嚴重的個案，其滿意度變差的機會越大(OR=4.30, p<0.05)。
子女人數越多的個案其滿意度變差的機會則越小(OR=0.17, p<0.01)。相較於不識 字的個案而言，大專學歷之教育程度的個案其主要照顧者滿意度變差的機會較大 (OR=5.99, p<0.05)。
研究結果顯示照顧管理模式確實能減少老人對於醫療費用的使用，並使得個 案與其主要照顧者的滿意度提升。政府相關單位應立即落實一套健全之照顧管理 模式，提供全人之長期照護服務，以減緩或避免社區老人進入機構式照護，相信 必能有助於促進社區老人成功的老化。
關鍵字：照顧管理模式、成效評估、長期照護。
英文摘要
Title of Thesis: Effects of the Care Management Model on Long-term Care: Evaluation of the Long-term
Care Service Center in the DaAn District of Taipei City
Author: Chi, Ying-Chen
Thesis advised by: Huang, Kuo-Cherh Dr.PH (Assistant Professor)
In recent years, the Taiwanese government has emphasized the support for disabled elderly’s medical care and social welfare due to those people’s dramatically increasing demand for long- term care. The purpose of this research was to evaluate the care management model’s effectiveness on improving long-term care provided to disabled elders.
The research employed a quasi-experimential design. A total number of 331 disabled elderly who were over 60 years of age, and living in Taipei City’s DaAn District participated in the study. Among the elderly, 166 received the care management model’s services (as the experimental group), while the other 165 did not receive such services (as the control group). The duration of the experiment lasted for the year 2002. The independent variable was the care management model. The control variables were sociodemographic characterities of the elderly (e.g., sex, age), health conditions (e.g., the degree of physical disability of the elderly), and the availability of care resources (e.g., number of children).
The major findings of the study were: (1) Medical care utilization - Compared to the control group, the experimental group had less medical expenditures(OR=1.98,
p<0.05). The probability of using less medical care was higher for samples with junior high school degree than those who were illiterate (OR=3.88, p<0.05). Respondents with 1-2 ADL disabilities, 3-4 ADL disabilities, or 5-6 ADL disabilities were more likely to use less medical care than those with only IADL disabilities (OR= 0.05, p<0.01; OR=0.09, p<0.05; OR=0.06, p<0.01, respectively). (2) Health-related quality of life - Respondents who were mainlanders, with severer cognitive dissonance, and with more children were less likely to suffer from deteriorating health, compared to their counterparts. (3) Satisfaction — Elders in the experimental group and their caregivers were more satisfied with the services they received, compared to those in
the control group(OR= 0.05, p<0.001; OR=0.25, p<0.001, respectively). Respondents who suffered from severer cognitive dissonance were more likely dissatisfied with the services received, compared to their counterparts (OR= 4.30, p<0.05). Respondents who have more children were more satisfied with the medical services received, compared to their counterparts (OR= 0.17, p<0.01). Finally, compared to illiterate respondents, respondents who had college degree were more likely to feel dissatisfied with the services received (OR= 5.99, p<0.05).
The research had confirmed that the care management model did help decrease the usage of medical services, and increase the satisfaction level of the elderly and their caregivers. It is suggested that the government should develop a sound care
management model providing high-quality long-term care to the elderly, with the aim of decreasing the possibility of the elderly accepting institutional care.
Key Words: care management model, effectiveness evaluation, long-term care.
