黃金自立給付包服務之成效初探－以新北市為例

Abstract

研究目的：新北市政府對於腦中風病患施行黃金自立給付包（包含居家職能治療、居家物理治療、居家護理及居家營養）服務，此研究之目的是檢驗黃金自立給付包計畫之先驅性研究對腦中風病患之身體活動功能介入前後之差異，並探討各項服務介入次數和服務類型之不同是否會影響身體活動功能恢復不同之成效。 研究方法：本研究以新北市政府的10家醫院參與此先驅性研究，並提供居家急性後期照顧服務，其中包括居家物理治療及居家職能治療各12次、居家護理服務6次及居家營養服務5次。在服務介入前及介入後分別進行個案之基本日常生活功能量表、工具性日常生活功能量表及改良式Rankin量表之評估。後續採用SPSS 22.0針對個案身體功能狀態之改變情形進行資料統計分析。 研究結果：從105年10月20日至106年12月31日共100位病患接受居家急性後期照顧，而其中67位病患完成事後之評估。在使用黃金自立給付包服務（居家急性後期照顧服務）前及使用後，以年齡層50歲至84歲個案之成效在ADL、IADL及mRS皆呈現顯著差異；以失能程度來看，極重度失能個案之成效一樣在ADL、IADL及mRS呈現顯著差異；而使用兩項服務及四項服務之個案其服務介入後在ADL、IADL及mRS皆有顯著改善。 討論與結論：黃金自立給付包的個案中成效較佳的特質為年紀輕，失能程度重，使用多重服務，使用物理治療與職能治療的次數多。雖然居家護理與居家營養因為使用次數較少，無法呈現單獨的效益，不過居家急性後期照顧總服務項數與次數的使用對個案功能回復亦有相當的助益，代表多重服務的使用仍舊比單一服務使用更有成效。

Background and objective: The New Taipei City Government’s implementation of the Golden Reablement Package (including home occupational therapy, home physical therapy, home care and home nutrition) on the stroke patients. The purpose of this study was to examine the effects of the pilot study of the Golden Reablement Package on stroke patients’ physical function changes before and after intervention, and to explore whether the number of services and type of services resulted in different physical outcomes. Methods: In this study, 10 hospitals in the New Taipei City participate in the pilot study are participated in this pilot project and provided post-acute care reablement home services, which included 12 times of physical therapy and occupational therapy, 6 time of home visiting nursing care, 5 time of nutritional consultation. ,Pre-post evaluation on Activity Daily Living (ADL), Instrumental Activity of Daily Living (IADL), modified Rankin Scale (mRS) were evaluated before and after the intervention. SPSS 22.0 is used to conduct statistical analysis of the changes in the physical function status of the case. Results: From 105/10/20 to 106/12/31, a total of 100 cases received post-acute reablement home care services, and 67 of them completed pre-post evaluation. After receiving the Golden Reablement Package service (home post-acute care service), the cases aged 50 to 84 years showed significant different improvements in ADL, IADL and mRS. The severely disabled cases also showed significant differences in ADL, IADL, and mRS than less severe cases. Cases received two types and four types of services showed significant improvement in ADL, IADL and mRS. Conclusion: Cases who were younger , with more severe disability, and used multiple types of services and higher frequencies of physical therapy and occupational therapy showed better improvement in physical function. Although home nursing care and home nutrition are less frequently used and these services didnot show significant benefits, using higher total number and frequencies of post-acute home care services also showed benefits physical function improvement. It means that the use of multiple services is more effectively than a single service.