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

研究一：为了评估家庭护理神经科患者和家庭的医疗保健服务的有效性，根据日常生活活动的困难程度制定了一个结果指标。此外，我们使用结构方程模型和一般线性模型检验了指标的结构效度和预测效度。为了检验结果指标的结构效度，我们使用结构方程检验是否建立了二阶因素模型。结果指标包括五个子指标：1)疾病焦虑和残疾指标，2)家庭护理负担和紧张指标，3)运动功能障碍指标，4)症状出现指标，5)干扰社会网络利用指标，具有较高的结构效度。多指标模型分析结果显示，基线调查两年后，所有指标均对患者的生活质量(SF-36)产生影响。SF-36对结果指标有影响的方面对于每个指标是不同的。根据两年内预后指标得分是否有所改善，日常生活活动困难程度在两年内增加的受试者在SF-36中与角色和身体功能相关的领域显著减少。研究二：为了确定症状和肢体残疾变化对HRQOL的影响，我们分析了临床变量与HRQOL的联系，并在健康相关的QOL概念模型中检验了神经病学患者预后指标之间的关系。本研究以疾病类别、→症状、→肢体残疾、日常生活能力量表、→一般健康知觉、SF-36→健康相关生活质量的Q2分数为路径构建路径模型，通过SF-36的8个领域测量健康相关生活质量。

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.