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

本研究的目的是开发病例组合指数，用于筛查需要家庭护理的脑血管疾病和顽固性疾病患者。研究对象为该大学医院脑外科或神经内科出院的411名20岁及以上的家庭健康患者。在研究中，测量了日常生活活动(ADL)的等级排序，并评估了家庭医疗保健费用与患者身体残疾水平之间的关系。将家庭保健所需的实际时间转换为代理成本，并将其用于分析。主要结果如下：1)身体ADL的项目构成了Guttman量表，并分层地表示了一维模式。2)独立执行难度最大的活动顺序是：穿衣、洗澡、转移、沟通、3)病例组合指数随躯体残疾程度的加重呈指数增加。4)神经难治性疾病患者的病例组合指数高于脑血管疾病患者。5)本研究开发的病例组合指数可作为评估接受家庭卫生护理的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.