[[alternative]]The establishment of Chinese version CARE and its reliability in evaluating post-acute stroke patients

[[abstract]]急性後期照護乃針對病患於急性病房出院後所提供增進其功能、以成功返回社區為目標的住院服務。2014年健保署以腦中風病患為對象，首次執行急性後期照護試辦計畫。然而目前並無一個能有效反應急性後期病患功能狀態及治療進展的普遍性全方位量表可資運用。美國醫療照護保險局於2005年開始發展連貫性評估紀錄量表(Continuity Assessment Record and Evaluation, CARE)，以期整合急性後期機構量表分歧的現況，並減少醫療機構的行政負擔，進一步期待與急性醫療、長期照護資料相銜接。CARE包括四大面向，分別為醫療狀態、功能狀態、認知狀態、以及社會支持因子，共有機構入院、居家照護、出院及死亡等四種版本，具有良好信效度，並與既存量表之間存在高度相關性。本研究目的為：1. 翻譯/編修CARE為中文版(CARE-Taiwan, 簡稱CARE-T)；2. 分析此中文版量表之信度，以期未來廣為應用於急性後期病患。 研究方法包括：1. CARE翻譯，並經由專家會議針對文化差異修正並確認其內容；2. 以分層抽樣法於台大醫院北護分院復健科門診收錄腦中風病患，以CARE中文版進行前、後測評估，共收集30位腦中風病患，合計完成90份量表評估。 CARE-T具備高信度，除用於評估急性後期病患治療進展外，未來將可用於急性後期病患之資源耗用及出院準備。此外與台灣臨床常用評估量表Barthel Index、Mini-Mental Status Examination (MMSE)、EuroQol (EQ-5D)、Instrumental activities of daily living (IADL)等相比量表精神相同，但內容更周全。未來亦有機會延伸至長期照護領域，以在空間與時間軸上整合功能評估量表。此量表於急性後期領域具先驅角色，未來臨床應用與研究發展之潛力極大。[[abstract]]Post-acute care (PAC) aims to enhance the functional status of patients discharged from acute ward. Return to community is its final goal. The Administration of National Health Insurance performed PAC for stroke patients in 2014. However, we do not have a generic, easy-to-perform tool to evaluate the functional status and treatment progress of PAC patients. The Centers for Medicare & Medicaid Services in USA in 2005 developed the Continuity Assessment Record and Evaluation (CARE) to integrate the different tools used in PAC programs in order to reduce administrative burden in medical institutions. The CARE contains 4 domains. They are Medical Status/Clinical Complexity, Functional Status, Cognitive Status, and Social Support Factors. There are 4 versions, Institutional Admission, Home Health Care, Discharge and Expired. The reliability and validity is good, and the correlation with other functional evaluation tools is acceptable. The aims of this study are to translate CARE into Chinese and to analyze the reliability of the Chinese version CARE. We recruited 30 stroke patients from National Taiwan University Hospital Bei-Hu Branch Rehabilitation Clinic. There were total 90 questionnaires. Through this study, we established the Chinese version CARE with high reliability, and it will be employed in analyzing resource utilization, and discharge planning in PAC field. In addition, compared with Barthel Index、Mini-Mental Status Examination (MMSE)、EuroQol (EQ-5D) and Instrumental activities of daily living (IADL) which commonly used in Taiwan clinicals. Not only CARE has the same purpose, but also more comprehensive. There are opportunities to extend to long-term care in the future, in order to integrate functional assessment scales in timeline and space. The Chinese version CARE will be the pioneer tool, and provide potential in both clinical application and research