Hale F A, Jacobs A R
Public Health Rep. 1976 Nov-Dec;91(6):545-51.
While home health services have traditionally been an underused component of the health care system, current trends suggest the desirability of expanding these services. These trends include an increase in the number of elderly who need the benefits of home care, the recognition that long-term chronic illnesses require appropriate management at home, and concern that patients have access to care at the level most appropriate to their illnesses. In New Hampshire, 41 certified home health agencies offer services. Little systematic research has been conducted on the kinds of services they provide and the patients seen by their staffs. Patient encounter data were collected from a sample of eight agencies for a 4-week period. Staff of the agencies used the patient contact record developed by the National Functional Task Analysis Cooperative Study to collect data. The data reflected differences among the agencies in the size of the populations they serve, organizational characteristics, reasons for patients' visits, expected sources of the revenue that supported them, and the diagnosis of the patients they cared for. The agencies served areas with populations ranging from 1,000 to 40,000. The staffs ranged from 1 to 14 full-time persons. Two were public agencies; the others had voluntary sponsorship. When data on reasons for visits were averaged for the eight agencies, it was shown that 72% of the visits were made for disease control activities such as care for a chronic or acute condition or for treatment or a laboratory test. Disease prevention activities such as a checkup for adults, children, prenatal or postnatal care, or health education accounted for only 24% of the visits. This result may indicate that, in areas short of physician manpower, the community health nurse is taking on increasing responsibility for medical care as well as health and education. Reimbursement for the visits came from Medicare, 25%; Medicaid-welfare, 14%; the patients, 18%; and health insurance, 3%. For 35% of the visits there was no charge; they were underwritten by community resources.
虽然传统上家庭健康服务在医疗保健系统中未得到充分利用，但当前的趋势表明扩大这些服务是可取的。这些趋势包括需要家庭护理福利的老年人数量增加、认识到长期慢性病需要在家中进行适当管理，以及担心患者能够获得与其疾病最相适应水平的护理。在新罕布什尔州，有41家经认证的家庭健康机构提供服务。对于它们提供的服务种类以及其工作人员所接待的患者，几乎没有进行过系统的研究。在为期4周的时间里，从8家机构的样本中收集了患者诊疗数据。这些机构的工作人员使用由国家功能任务分析合作研究开发的患者联系记录来收集数据。数据反映了各机构在所服务人口规模、组织特征、患者就诊原因、支持其运营的预期收入来源以及所护理患者的诊断方面存在差异。这些机构服务的地区人口从1000人到40000人不等。工作人员数量从1名全职人员到14名全职人员不等。其中两家是公立机构；其他机构有志愿赞助。当将这8家机构的就诊原因数据进行平均时，结果显示72%的就诊是为了疾病控制活动，如护理慢性或急性病症、进行治疗或实验室检查。疾病预防活动，如成人检查、儿童检查、产前或产后护理或健康教育，仅占就诊的24%。这一结果可能表明，在医生人力短缺的地区，社区健康护士在医疗护理以及健康和教育方面承担着越来越大的责任。就诊费用的报销来源为：医疗保险，25%；医疗补助福利，14%；患者自付，18%；健康保险，3%。35%的就诊是免费的；由社区资源承担费用。
