[[alternative]]Inplement and Evaluate the Effect of Interdisciplinary Home Care Teamwork Model in Long-term Care Facilities

[[abstract]]本研究主要目的在探討「居家照護團隊整合專業模式」介入前後對養護機構老人之照護品質的成效，以了解介入前後老人養護機構住民之照護品質差異。本研究採回溯性比較研究設計，採立意取樣以大台北地區向社會局立案之老人養護所為母群體，選取評鑑乙級以上之老人養護機構，床位數為30床以上之機構共7家，並以居住於機構內由居家護理新收案65歲以上住民作為本研究之實驗組對象共42人。本研究並收集一年同一時段未引進介入性居家照護措施之個案為對照組共32人，再依登錄資料進行調查。資料收集採結構式問卷及量表，分別於介入措施之前、後，進行營養指標(營養狀況MNA、血清白蛋白、血紅素)、日常生活活動指標(ADL)及品質監測指標(鼻胃管自拔/阻塞/滑脫發生率、導尿管自拔/阻塞/滑脫發生率、泌尿道感染率、肺炎發生率、壓瘡發生率、住院率、急診使用率)檢測。所得資料以描述性統計、配對t檢定、獨立t檢定、卡方檢定進行統計分析。研究結果發現居家照護團隊整合專業模式介入：1.確實可減少營養不良者之發生，且有助於在體位測量(BMI、小腿圍)、ㄧ般評估(褥瘡或皮膚潰瘍)及飲食評估（過去三個月之中，是否因食慾、不佳消化問題、咀嚼或吞嚥困難）等營養狀況MNA單項評分的提升，且有顯著成效(p﹤.05)；另在實驗室檢查血清白蛋白及血紅素亦有顯著成效(p﹤.05) 2.可提升部分機構老人之日常生活活動能力(ADLs)，但未達統計上顯著差異。3.在機構品質監測指標：可顯著降低鼻胃管自拔/阻塞/滑脫發生率(p﹤.05)。另在泌尿道感染率及急診使用率也有降低，但未達統計上顯著差異。本研究結論為每二個月ㄧ次為期一年的居家照護團隊整合專業模式的介入措施，由居家照護團隊依機構老人之個別性，提供機構照護者以個案為中心的照護方式及建議，可提升機構老人營養、日常生活活動能力及照護品質，是目前提供機構老人較好的服務方案，亦提升機構工作人員對機構老人照護的重視。依據上述結果建議，在品質指標照護部分不論實驗組及對照組，因臺北市已立案且規模在30床以上之養護機構，皆已與評等為乙級以上之居家護理機構合作，故照護品質上有ㄧ定水準之情況下，也能有很好的成效，故未來研究可探討非台北地區的養護機構實施居家照護團隊整合專業模式的介入措施，以進一步驗證其成效。另本研究並未將團隊的成本及人力加以考量，建議未來的研究可針對此部分加以探討。關鍵字：養護機構、營養、日常生活活動能力、品質監測[[abstract]]AbstractThis study aimed to examine the quality of care in community long term care institutions by implementing the Interdisciplinary Homecare-Team Model . A historical comparative research design was applied. Total seven community long term care institutes were included as study sample, all of them are ranked B over 30 beds in size, and registered under Society Bureau of Taipei metropolitan area. There were total 42 elderly participants in the experimental group, and 32 elderly participants in control group. . Data were collected through structured questionnaire and score sheet both before and after intervention, included three parts: nutritional indicators (nutritional status MNA、albumin and hemoglobin), ADL score, and quality monitoring indicators (incidence of nasogastric tube to extricate himself, obstruction or spondylolisthesis, incidence of catheter extricate himself, obstruction or spondylolisthesis, urinary tract infection rate, incidence of pneumonia, incidence of pressure sores, hospitalization rate and emergency usage). Data was analyzed by descriptive statistics, independent, T-test, paired T-test and Chi-Square with significance level ofα=.05. The research findings were:1. The intervention model decreased the chance of mal-nutrition, helped to raise the single item score of nutrition status MNA in BMI and leg circum, general evaluation (presure sore or skin ulcer), and dietary assessment with statistical significance (p﹤.05). Moreover, the result on lab examination of albumin and hemoglobin were also significantly improved (p﹤.05).2. It increased the capability of daily movement of elderly in partial organization although it did not reach statistical significance.3. It decreased the incidence rate of negative quality monitoring index including nasogastric tube extricate, obstruction or spondylolisthesis rate (p