目的: 通过测量长期护理机构老年人的直接护理时间并分析其影响因素,构建老年人护理分级模型。方法: 采用一般资料调查表、《长期护理失能等级评估标准（试行）》、老年人健康状况评估表对484名长期护理机构老年人进行问卷调查,采用老年人直接护理服务工时测量表对老年人进行工时测量。结果: 分位数回归结果显示,老年人的日常生活活动能力、认知能力、感知觉与沟通能力、年龄、有无特殊照护在直接护理时间的不同分位数点产生影响( P<0. 05)。此模型的方差减少量为0.36,组间差异较大,各组变异系数在0.11~0.67之间,均小于1,组内同质性高。结论: 不同分位数下针对老年人直接护理时间的影响因素作用大小不同,护理时间和老年人身心受损程度并非正比例关系,本研究构建的老年人护理分级模型评价结果良好,可为长期护理保险确定给付对象的标准提供参考,但在进一步实际应用时需对照护时间标准进行校正,以期为长期护理服务成本测量和资源的有效配置提供科学依据。
Abstract
Objective: To establish a grading nursing care model for the elderly, this essay measured the nursing time of the elderly in a long-term care institution, and analyzed the factors affecting the model. Methods: 484 old people were investigated with the general information questionnaire, the Long-term Care Disability Rating Standard (Trial), and the health assessment form of the elderly in the institution. The nursing time of the elderly was measured with the care service time measurement scale. Results: The quantile regression results showed that the activities of daily living, cognitive ability, sensation, perception and communication ability, age, and special care were the factors influencing the nursing time at different quantile points (P<0. 05). The RIV of this model was 0.36, indicating that the difference between groups was large. The CV of each group was between 0.11 and 0.67, all of which were less than 1, indicating high homogeneity within the group. Conclusion: At different quantiles, the factors affecting the nursing time for the elderly are different. In addition, the nursing time is not necessarily proportional to the physical and mental conditions of the elderly. The result of the grading nursing care model for the elderly constructed in this study is suitable, which can provide a reference for the payment standard of long-term care insurance. However, it’s suggested that the standard of nursing time should be further corrected in practice, with the purpose of providing a reference for the cost measurement of long-term care services and the allocation of resources.
关键词
老年人 /
护理分级 /
长期护理保险 /
分位数回归 /
决策树
Key words
the elderly /
grading nursing /
long-term care insurance /
quantile regression /
decision tree
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基金
国家社会科学基金一般项目“享受长期护理保险待遇的失能老人居家护理服务效果的纵向研究”（18BRK034）; 广州市教育局重点学科（护理学）项目（穗教科[2019]5号）
