Estimation of the required care level of the disabled elderly using Minimum Data Set-Home Care

在长期护理保险中，根据基础调查的结果计算出残疾老年人所需的护理水平。然而，这种计算涉及复杂的数学过程，并且很难估计小型设施所需的护理水平。因此，我们开发了一个树形模型，可以从日常活动中明显残疾的状态简单估计所需的护理水平。该模型分别为痴呆和身体残疾准备。从在Higashiyama疗养院接受初级评估的患者中，共选择240人，其中痴呆和身体残疾的6个所需护理级别各20人，并对其初级评估结果进行审查。“穿脱夹克”被选为第一选择项，随着调查项目从“独立”到“完全协助”的增加，需要的照顾程度相对一致。在每个树模型中，“穿上和脱掉夹克”的状态对应不同的护理要求，如下所示。痴呆模型：“独立”→需要帮助，“需要观察”和“独立”在“站立”→需要护理1级，“需要观察”和“不独立”在“站立”→需要护理2级，“部分辅助”需要护理3级，“完全辅助”和“不完全辅助”在“进食”→需要护理4级，“完全辅助”和“完全辅助”在“进食”→需要护理5级。肢体残疾模型：“排尿后护理”为“独立”或“需要观察”、“独立”、“行走”为“独立”→需要帮助，“排尿后护理”为“独立”或“需要观察”、“独立”、“行走”为“依赖”→需要护理一级，“排尿后护理”为“独立”或“需要观察”、“依赖”→需要护理二级；所需护理等级3-5与痴呆模型相同。准确率，即使用该树估计的所需护理水平与主要评分之间完全匹配的频率，在痴呆患者中为70%，在身体残疾患者中为64.2%。痴呆患者的近准确率，即两个估计在一个等级内的匹配频率为98.3%，而在痴呆患者中为96.7%。在那些身体残疾的人身上。从这些结果来看，该树模型被认为对临床评分有用。少

In long-term care insurance, the required care level of the disabled elderly is calculated from the results of the basic investigation. However, this calculation involves complex mathematical processes, and the estimation of the required care level at small facilities is difficult. We, therefore, developed a tree model that allows simple estimation of the required care level from the state of noticeable disabilities in daily activities. The model was prepared separately for dementia and physical disabilities. From the patients being cared for at Higashiyama Sanatorium for the Elderly who had undergone primary rating, a total of 240 individuals consisting of 20 each in each of the 6 required care levels for both dementia and physical disabilities were selected, and the results of their primary rating were reviewed. "Putting on and taking off the jacket", in which the required care level increases relatively consistently as the investigation items progress from those for "independent" to … More those for "totally assisted", was selected as the first selection item. In each tree model, the state of "putting on and taking off the jacket" was matched for various required care levels as follows. Dementia model: "independent"→assistance needed, "observation needed" and "independent" in "standing up"→required care level 1,"observation needed" and "not independent" in "standing up"→required care level 2, "partly assisted" required care level 3,"totally assisted" and "not totally assisted" in "eating"→required care level 4,and "totally assisted" and "totally assisted" in "eating"→required care level 5. Physical disability model: "independent" or "observation needed" and "independent" in "care after urination" and "independent" in "walking"→assistance needed, "independent" or "observation needed" and "independent" in "care after urination" and "dependent" in "walking"→required care level 1,"independent" or "observation needed" and "dependent" in "care after urination"→required care level 2; required care levels 3-5 were the same as in the dementia model. The accuracy rate, i.e. the frequency of complete matching between the estimation of the required care level using this tree and that of the primary rating, was 70% in those with dementia and 64.2% in those with physical disabilities. The near accuracy rate, i.e. the frequency of matching between the two estimations within one rank higher or lower was 98.3% in those with dementia and 96.7%. in those with physical disabilities. From these results, this tree model is considered to be useful for clinical rating. Less