居家照護成效與省思：某區域醫院的病歷回溯研究

Effect and Implication of Home Health Care Program:a Retrospective Study of a Regional Hospital

居家照護納入健保給付已14年，其成效仍需實證研究來評估。本研究對某區域醫院附設居家護理所接受居家照護3個月以上者，進行統計分析。採病歷回溯，將病患依巴氏量表分為A（巴氏量表≦20）、B（巴氏量表21-60分）兩組，比較在巴氏量表、肌力、昏迷指數、三管使用比例在接受居家照護服務期間的改變情況。自2006年1月至2007年3月共59位個案。A組49人，B組10人。男女各半，平均73.5歲。殘障約七成，中風居多。只有一次衛教服務記錄。以鼻胃管使用最多。活動能力、肌力及昏迷指數皆是A組比B組差。前十次家訪的巴氏量表、肌力及昏迷指數均無顯著進步，在使用三管服務比例上也沒有明顯變化。存活率於第六個月、第一年及第一年半各為100%、86%、81%。本研究個案在居家照護下，A、B兩組的存活率高，活動能力、肌力、昏迷指數維持不退步，又未見衛教服務記錄。建議依患者不同依賴程度加入不同型式居家復健，落實居家衛教功能，以提昇身體功能或生活自理能力。

Although the services of home health care (HHC) services have been covered by National Health Insurance, more evident-based studies are needed to examine its effect. We performed statistical analysis on patients who received HHC for more than 3 months from a regional hospital. A retrospective chart review was used. Subjects were divided into two groups, group A (completely dependent with Barthel index <20) and group B (severely dependent with Barthel index between 21 and 60). Barthel index, muscle strength, coma scale, tubes service, and survival were compared between groups A and B. From January 2006 to March 2007, 59 patients (49 subjects in group A and 10 subjects in group B) were eligible. The mean age of these patients was 75 years old and half were males. Most subjects needed an NG tube. Physical function or coma scale was worse in group A than in group B. More importantly, the score of Barthel Index, muscle strength, proportion of the tubes service were stable during the first 10 home visits. The six-month, one-year, one-andhalf-year survival rates were 100%, 86% and 81%, respectively. The service of HHC can maintain the physical ability of the patients and had a good survival rate, but no significant improvement was seen for either groups. Rehabilitation service should be provided according to the level of patients’ dependency in order to increasetheir ability of physical function or daily living. There is no record of home health education in this study. We suggest that home health education should be taken seriously.