台灣地區人口結構逐漸老化，伴隨而來的失能與長期照護需求不斷成長。居家照護服務是台灣目前全民健保體制下，對於需要技術性護理服務的個案，提供連續性健康照護與落實在宅照護的服務。本研究目的在於探討居家照護服務之個案的人口學及臨床特質，與其照護結果指標在接受服務前與收案四個月後的改變及其可能影響因子。
本研究收案對象為嘉義縣某區域教學醫院附設的兩所居家護理所，在2009年9月2日至2010年3月22日共7個月期間之新收案個案，以回溯性的世代追蹤研究設計，使用結構式問卷自個案病歷收集研究所需資料，共檢視156位個案的居家照護服務病歷，其中128位（82％）符合收案條件並納入研究， 28位（18％）不符合收案條件而加以排除。結果顯示居家照護個案的特質為平均年齡73.30±14.97歲，其中79.7％為大於65歲的老年族群、女性居多、已婚、低教育程度、多為醫院轉介收案、以全民健保為主要醫療補助來源、家庭經濟狀況尚可、子女為主要經濟來源及多有固定照顧者。個案於收案時的疾病主診斷以循環疾病為主，整體疾病嚴重程度為中度，意識狀況多為清醒，日常生活功能以完全依賴為主（84.4％個案的巴氏量表分數為0分）；照護需求依序為鼻胃管留置與照護、導尿管留置與照護、壓瘡照護與氣切管管留置與照護；迷你營養評估量表等級以營養不良為主，血清白蛋白分級多輕微低下，身體質量指數多為正常。主要照顧者之基本特質以女性、看護、專職為主，其中本籍照顧者與外籍照顧者各佔一半，而外籍照顧者幾乎都是外籍看護。個案的家庭與社會支持網絡狀況方面，個案都有人與之同住，個案居住地點附近都有人可幫忙照顧個案，個案接受的服務以單純居家照護服務為主，額外接受的服務以營養諮詢最多。在個案的照護指標方面，個案於收案四個月內平均住院次數為0.32±0.65次，接受急診醫療的平均次數為0.38±0.70次，與收案時的指標情形相比較，僅在壓瘡面積（p = 0.000）、迷你營養評估量表分數（p = 0.000）以及血清白蛋白數值（p = 0.001）呈現統計上顯著差異，且呈現改善的情形，而其餘指標並無統計上的顯著改變。經迴歸分析後發現，壓瘡改善的影響因子為「個案收案時的壓瘡面積」。迷你營養評估量表分數改善的影響因子為「個案收案來源」與「個案收案時的迷你營養評估量表分數」。血清白蛋白數值改善的影響因子為「個案收案時的血清白蛋白數值」。期望本研究結果能給予居家照護服務相關人員作為參考，作為改善個案照護結果與居家照護服務品質的依據。

Due to the growing of ageing population, the impact of disability and the need of long term care became more significant in Taiwan. The home care service under the payment of national health insurance is the way to achieve continuous care and ageing in place for patients who need nursing skill service. The aim of the study is to identify the demographic and clinical characters of the home care clients, and to investigate the associated factors and possible affect factors related to the changes of outcome indexes during the period of receiving home care services.
The study duration was from Sep 2, 2009 to Mar 22, 2010. The study sample was the new cases of home care services in a regional teaching hospital at Chia-yi. The study design was retrospective cohort study with the manner of chart review. We used the structured questionnaire to collect the data from 156 charts. Total 128 cases (82%) were included and 28 cases (18%) were excluded according to the inclusion and exclusion criteria. The study results showed the average age of clients was 73.30±14.97 years old and 79.7% of the clients were older than 65 years old. The dominant demographic characters of clients were female gender, married status, low education level, referred from hospital, used national health insurance as the main medical support, fair economical status and the child was the main resource of economical support. The clinical characteristics of clients including circulatory system disease as the main disease diagnosis, moderate disease severity, alert consciousness, nearly total dependence (the score of Barthel index was zero point in 84.4% of the clients). The care need were nasogastric tube care/change, Foley catheter care/change, pressure sore care and tracheostomy tube care/change in sequence. The class of clients’ mini nutritional assessment was malnutrition, the class of serum albumin deficiency was mild and the body mass index was normal in most clients. The demographic characters of main caregiver were female gender, foreign nursing worker and being full-time. Half of the caregiver was Taiwanese and the other wasn’t. Almost foreign caregiver were foreign nursing worker. In the aspect of client’s family and social network, most of the clients lived with others and had someone lived nearby could help to care them. The main service received was solely home care service and the extra-service received was nutrition consultation. In the aspect of outcome index, the number of admission was 0.32±0.65 and receiving emergency service was 0.38±0.70 within four months. Comparing the baseline data, no outcome index has difference, except the area of pressure sore (p=0.000), the score of mini nutritional assessment (p=0.000) and the level of albumin (p=0.001) had significant improvement. We used the linear regression model to analyze the results and showed “the area of pressure sore in baseline” was the affected factor of pressure sore improvement. The affected factors of improvement of mini nutritional assessment were “the referred source of clients” and “the score of mini nutritional assessment in baseline”. The affected factor of improvement of the level of albumin was “the baseline albumin level”. We hoped the study results could be the foundation for improvement of clients’ outcome and quality of home care services.

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