Outcome evaluation for assessing an effectiveness of home health care service for home-care neurology patients : 3 years follow-up survey

点击翻译按钮获取中文摘要

Research 1 : In order to assess the effectiveness of healthcare services for home-care neurology patients and families, an outcome indicator was developed based on the degree of difficulty in performing daily life activities. Furthermore, using Structural Equation Modeling (SEM) and General Linear Model, we examined the indicators' construct validity and predictive validity. To test the construct validity of the outcome indicators, we examined whether the second-order factor model was established or not using SEM. The outcome indicators consisted of five sub-indicators : 1) "Anxiety about disease and disability indicator", 2) "Family care burden and strain indicator", 3) "Motor dysfunction indicator", 4) "Appearance of symptom indicator", and 5) "Interference in social network utilization indicator", resulting in high construct validity. The result of multiple indicators model indicated that all of the indicators influenced the HRQOL (SF-36) two years after baseline survey. The aspect of SF-36 on which outcome indicators have their influences was different for each indicator. Based on whether the scores of outcome indicators were improved or not in two years, the subjects whose degree of difficulty in performing daily living activity increased in the two years showed a remarkable decrease of SF-36 domains relating to role and physical functioning.Research 2 : To determine the influences of symptoms and changes in physical disability on HRQOL, we analyzed the linkage from clinical variables to HRQOL, and tested the relationship among measures of neurology patient outcome in a health-related QOL conceptual model, using hierarchical path regression model. The model tested in the current study was constructed as the path model with paths occurring between adjacent levels : disease category → symptoms → physical disability measured by ADL scale → general health perception measured by q2 score in the SF-36 → health-related QOL measured by the eight domains in the SF-36.