A REIMBURSEMENT SYSTEM PROPORTIONATE TO THE AMOUNT OF NURSING CARE AND ASSISTANCE RENDERED FOR LONG-TERM PATIENTS

为了提供最合适的医疗服务和合理的报销制度，我们试图建立一个长期患者的分类，以适当反映他们的临床状况和日常生活活动中护理和援助的需求。这种分类应基于患者在住院期间相对容易获得的信息。在本次调查中，我们从三个方面进行了调查，以评估护理和援助的数量：1)患者的临床状况和援助需求；2)护士和ADL助理员对负担感的主观评价；3)实际用于护理和协助的时间。研究对象包括10家卫生保健机构的891名患者：2家特殊疗养院的203名患者；6家养老院322人；一家老年医院有268人；一家慢性病医院有98人首先，以…More主观评价的负担感为目标变量，进行方差分析，根据患者对ADL辅助的需求分为五类。接下来，将患者的想法表达作为另一个变量引入分析。这导致了ADL的六类分类。这些类别占护理人员工作负担感方差的50%。慢性病医院对差异的问责性特别低，这表明在引起工作人员的负担感方面涉及其他因素。随着患者残疾分类程度的加深，提供护理和帮助的时间也随之延长。我们目前基于护理需求和ADL辅助对长期患者的分类似乎足够可靠。根据医疗需求对患者进行类似的分类，有助于提供合理的报销制度。少

In order to offer the most suitable health service and provide a reasonable a reimbursement system, we attempted to establish a classification of long-term patients that would appropriately reflect their clinical conditions and needs for care and assistance in daily life activities (ADL). Such a classification should be based on the patients' information such as can be obtained with relative ease during their stay in institutions.In our present investigation, we conducted a survey to evaluate the amounts of nursing care and assistance in terms of three factors : 1) patients' clinical conditions and needs for assistance ; 2) subjective evaluation by nurses and ADL assistants of their sense of burden ; 3) the actual time spent for nursing care and assistance. The subjects consisted of a total of 891 patients in ten health care institutions : 203 patients in two special nursing homes ; 322 in six nursing homes ; 268 in one hospital for the aged ; 98 in one chronic hospital.First, with the … More subjectively evaluated sense of burden as the target variable, a variance analysis was carried out, which yielded five categories according to the patient's needs for ADL assistance. Next, the patient's expression of ideas was introduced as another variabale into the analysis. This led to a classification with six categories for ADL.These categories accounted for 50% of the variance for the sense of burden felt by nursing personnel in their work. The accountability of the variance was particularly low for the chronic hospital, indicating the involvement of other factors in inducing the sense of burden among the staff. The time to provide care and assistance lengthened as the categorized degree of patient's disability advanced. Our present classification of long-term patients based on the need for care and ADL assistance appeared to be sufficiently reliable. A similar classification of patients according to the need for medical care is useful for providing a reasonable reimbursement system. Less