CARE 與相關急性後期照護評估工具之介紹與應用

Introduction and Application of the Continuity Assessment Record and Evaluation (CARE) and Related Assessment Instruments for Post-Acute Care

已開發國家多面臨社會高齡化及慢性病罹患人口的增加，造成醫療費用上漲，為能提高醫療資源使用效率，提供更好的照護品質，陸續發展急性後期照護（Post-Acute Care, PAC）；美國的急性後期照護包含技術性護理機構（skilled nursing facilities, SNFs）、居家健康服務單位（home health agency services, HHAs）、住院復健機構（inpatient rehabilitation facilities, IRFs）、及長期照護醫院（long term care hospital, LTCHs）四種型態，由於不同型態機構所使用評估表格不同，無法比較失能程度相似者利用四種不同型態服務，其花費與照護品質結果是否不同，因此美國先後發展「活動測量（Activity Measure for Post Acute Care, AM-PAC^TM）」、「社交參與測量（Participation measure for post-acute care, PM-PAC）」、及「連續性評估記錄（Continuity Assessment Record and Evaluation, CARE）」等評估工具讓不同型態服務機構能夠通用。美國政府2014年通過「The Improving Medicare Post-Acute Care Transformation Act of 2014」法案，提出2018 年將全面實施以「CARE」為評估工具，去檢測使用不同急性後期照型態但失能程度相似之個案，其費用及照護結果是否存在差異；本文擬介紹AM-PAC^TM、PM-PAC及CARE，並探討其對臺灣之啟示。

Medical expenses in developed countries are rising because of the aging society and the increased population of chronic diseases. In order to improve the efficiency of medical resource and the quality of care, post-acute care (PAC) has been developed. The PAC providers in the United States can be classified into four types, skilled nursing facilities (SNFs), home health agency services (HHAs), inpatient rehabilitation facilities (IRFs) and long term care hospital (LTCHs). Since different types of PAC providers use different assessment instruments, it is hard to compare the quality and medical expense between facilities that service PAC patients with similar case mix. The integrated assessment instruments such as Activity Measure for Post-acute Care (AM-PAC^TM), Participation Measure for Post-acute Care (PM-PAC), and Continuity Assessment Record and Evaluation (CARE) were developed to evaluate the differences in costs and outcomes for patients of similar case mix who use different types of PAC in the United States. The CARE will be fully implemented in each facility since 2018 by 'The Improving Medicare Post-Acute Care Transformation Act of 2014'. This article introduces the assessment instruments, AM-PAC^TM, PM-PAC and CARE, and its' implication for Taiwan.