The development of the case-mix index for screening cerebrovascular disorder's and intractable disease'spatients requiring home health nursing care

本研究旨在发展病例组合指数，以筛选需要居家照护的脑血管疾病及疑难杂症患者。本研究以411名20岁以上的大学医院脑外科或神经内科出院的居家健康患者为研究对象，测量了患者日常生活活动（ADL）的等级排序，并评估了居家健康护理费用与患者身体残疾水平之间的关系。主要结果如下：1）躯体日常生活活动（ADL）项目构成了一个Guttman量表，并显示了一个层次性的一维模式。2）活动从最难到最难的顺序是：穿衣、洗澡、接送、交流，3）病例组合指数随着基于Guttman量表模式的身体残疾水平的严重程度呈指数增加。4）病例组合指数对神经系统难治性疾病患者的价值高于脑血管疾病患者。5）病例组合指数可作为评估家庭护理相对需求的指标之一。

The purpose of this study is to develop the case-mix index for screening cerebrovascular disorders and intractable diseases patients who require home care. The participants of this study were 411 home health patients aged 20 and over, discharged from brain surgery or neurological medicine department at the university hospital.In the study, a hierarchic ordering among physical activities of daily living (ADL) was measured and the association between home health care costs and physical disability levels of the patients was assessed. Actual time needed home health care was converted into "proxy costs" and used in the analysis.Main results were summarized as follows.1) Items of physical ADL constituted a Guttman scale and indicated hierarchically one-dimensional pattern.2) The order of activities from most to least difficult to perform unaided is : dressing, bathing, transfer, communication, continence and feeding.3) Case-mix index exponentially increased with the seriousness of the physical disability levels based on Guttman scale pattern.4) The value of case-mix index to the patients with neuro-intractable diseases was higher than those with cerebrovascular disorders.5) Case-mix index developed on this study was available as one of the index for assessing the relative requirement of receiving home health nursing care.