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

本研究的目的是建立病例混合指数，以筛选需要家庭护理的脑血管疾病和顽固性疾病患者。本研究的参与者是411名年龄在20岁及以上，从大学医院脑外科或神经内科出院的家庭健康患者。在本研究中，测量了日常生活体力活动（ADL）之间的等级排序，并评估了家庭保健费用与患者身体残疾水平之间的关系。家庭保健所需的实际时间被转换为“代理成本”并用于分析。主要研究结果总结如下：(1)物理ADL的条目构成Guttman量表，并呈现层次上的一维格局。2)独立完成的活动从最难到最难的顺序是：穿衣、洗澡、转移、交流、自制、喂食。3)基于Guttman量表模式的病例混合指数随身体残疾程度的加重呈指数增长。4)病例混合指数对神经难治性疾病的价值高于脑血管疾病。5)本研究建立的病例组合指数可作为评估家庭健康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.