Institute of Gerontology, College of Medicine, The National Cheng Kung University, Tainan 701, Taiwan.
Department of Statistics, College of Management, The National Cheng Kung University, Tainan 701, Taiwan.
Int J Environ Res Public Health. 2018 Nov 21;15(11):2605. doi: 10.3390/ijerph15112605.
Among available home and community-based services in Taiwan, there should be a focus on providing people with people-centered, value-based services. This study aims to follow up the people-centered health outcomes of care recipients and to examine the factors associated with to feedback for policy and practice in long-term care. A total of 9889 persons from the long-term care dataset were followed up for two years (T0⁻T4). The Cox Proportional Hazard Regression analyses to analyze mortality and the mixed effect models for health outcomes were used. Three classes among the care recipients were identified. Health profiles (HR = 1.46 and 2.56 for FI and FD compared with RI, < 0.001), subsidy gap (HR = 1.01), and living status (HR = 0.88 for those living with spouse only) had a significant impact on mortality. The overall dropout rate was 52.3% at two years, and the health profiles at baseline significantly influenced the health outcome's change. The health heterogeneity matters and influences subsequent outcomes. To reach the goal of the HCBS, regular and exact monitoring of care recipients is crucial, while feedback regarding health outcomes and a greater focus on providing person-centered and responsive services in the community are also required.
在台湾现有的居家和社区服务中,应注重提供以人为本、注重价值的服务。本研究旨在关注照护接受者的以人为本的健康结果,并研究与长期护理政策和实践相关的反馈因素。共有 9889 名来自长期护理数据集的人员在两年内(T0-T4)进行了随访。采用 Cox 比例风险回归分析来分析死亡率,并使用混合效应模型来分析健康结果。确定了三类照护接受者。健康状况(FI 和 FD 组的 HR 分别为 1.46 和 2.56,与 RI 相比,<0.001)、补贴差距(HR=1.01)和生活状况(仅与配偶同住者的 HR=0.88)对死亡率有显著影响。两年的总体辍学率为 52.3%,基线健康状况显著影响健康结果的变化。健康异质性很重要,并影响后续结果。为了实现 HCBS 的目标,对照护接受者进行定期和准确的监测至关重要,同时还需要对健康结果进行反馈,并更加注重在社区提供以人为本和响应性的服务。