再能力化服务的结果及其测量:来自英国再能力化服务评估的发现。
Outcomes of reablement and their measurement: Findings from an evaluation of English reablement services.
机构信息
Social Policy Research Unit, University of York, York, UK.
Centre for Health Economics, University of York, York, UK.
出版信息
Health Soc Care Community. 2019 Nov;27(6):1438-1450. doi: 10.1111/hsc.12814. Epub 2019 Aug 1.
Reablement - or restorative care - is a central feature of many western governments' approaches to supporting and enabling older people to stay in their own homes and minimise demand for social care. Existing evidence supports this approach although further research is required to strengthen the certainty of conclusions being drawn. In countries where reablement has been rolled out nationally, an additional research priority - to develop an evidence base on models of delivery - is emerging. This paper reports a prospective cohort study of individuals referred to three English social care reablement services, each representing a different model of service delivery. Outcomes included healthcare- and social care-related quality of life, functioning, mental health and resource use (service costs, informal carer time, out-of-pocket costs). In contrast with the majority of other studies, self-report measures were the predominant source of outcomes and resource use data. Furthermore, no previous evaluation has used a global measure of mental health. Outcomes data were collected on entry to the service, discharge and 6 months post discharge. A number of challenges were encountered during the study and insufficient individuals were recruited in two research sites to allow a comparison of service models. Findings from descriptive analyses of outcomes align with previous studies and positive changes were observed across all outcome domains. Improvements observed at discharge were, for most, retained at 6 months follow-up. Patterns of change in functional ability point to the importance of assessing functioning in terms of basic and extended activities of daily living. Findings from the economic evaluation highlight the importance of collecting data on informal carer time and also demonstrate the viability of collecting resource use data direct from service users. The study demonstrates challenges, and value, of including self-report outcome and resource use measures in evaluations of reablement.
康复治疗——或恢复性护理——是许多西方国家支持和使老年人能够留在自己家中并最大限度减少社会护理需求的方法的核心特征。现有证据支持这种方法,尽管需要进一步研究来增强结论的确定性。在已经在全国范围内推出康复治疗的国家,出现了一个新的研究重点——为交付模式开发证据基础。本文报告了一项对三个英国社会康复服务机构的个人进行的前瞻性队列研究,每个机构代表不同的服务交付模式。结果包括与医疗保健和社会护理相关的生活质量、功能、心理健康和资源利用(服务成本、非正式护理人员时间、自付费用)。与大多数其他研究不同,自我报告的测量是结果和资源使用数据的主要来源。此外,以前的评估都没有使用心理健康的全球衡量标准。在进入服务、出院和出院后 6 个月时收集了结果数据。在研究过程中遇到了一些挑战,并且在两个研究地点招募的人数不足,无法对服务模式进行比较。结果的描述性分析结果与先前的研究一致,并观察到所有结果领域都有积极的变化。出院时观察到的改善,对于大多数人来说,在 6 个月的随访中得到了保留。功能能力变化的模式表明评估基本和扩展日常生活活动能力的重要性。经济评估的结果强调了收集非正式护理人员时间数据的重要性,并证明了直接从服务用户那里收集资源使用数据的可行性。该研究表明,在康复治疗评估中包括自我报告的结果和资源使用措施存在挑战和价值。