A study of development of quality indicator that evaluates the effect of home care service for the patients with neuro-intractable diseases

[目的]建立评价神经系统疑难杂症患者及其照顾者家庭医疗服务效果的质量指标。[方法]采用定性分析的方法，对影响家庭医疗服务持续性的因素进行分析，并编制30个条目的临时量表。本研究的参与者为442名患者及其照顾者：男性; 239名，女性; 203名。[结果与讨论]采用因子分析方法，构建了一个包含25个条目的新量表，用于测量心血管和神经系统难治性疾病患者/照顾者继续家庭护理的难度。我们将Promax旋转法应用于因子分析中，并通过改变因子的数量重复多次。最后，从25个项目中提取出5个因子，每个因子中所有项目的因子负荷都大于0.3。各因子分别命名为：（1）对疾病和残疾的焦虑;（2）照顾者压力;（3）运动功能障碍;（4）症状表现。（5）社会网络利用的干扰。所构建的量表具有较高的信度，信度范围为0.784 ~ 0.908。

[Purpose] The purpose of the research is to develop the quality indicator that judges the effect of home health care service for the patients and their caregivers with neuro-intractable diseases.[Methods] Data was analyzed qualitatively in order to examine the factors that inhibit the continuation of home health care, and provisional scale item (30 items) were made. The participants of this research were 442 patients and their caregivers : male ; 239, female ; 203.[Results ＆ Discussion] We constructed a 25-item new scale which measures the difficulty of the continuation of home health care to the patients/caregivers with cardio-vascular and neuro-intractable diseases by means of use of factor analysis. We applied the Promax rotation method in factor analysis and repeated it several times by changing the number of factors. Finally, 5 factors were extracted from the 25 item, in each of which the all items having more than 0.3 factor loadings. Each of factors were named as following : 1) the anxiety for disease and disability ; 2)caregiver strain ; 3) the motor dysfunction ; 4) the expression of symptom. ; 5) the interference of the social-network utilization. The constructed scale demonstrated high reliabilities ranging from 0.784 to 0.908.