老年人居家医疗护理服务需求等级评估工具研究现状

Research Status of Grade Assessment Tools for Older Adults Home-based Health Care Needs

居家医疗护理服务已成为部分失能、半失能老年慢性病患者的刚性需求。如何将此类患者的居家医疗护理服务需求分级,以提供有针对的个性化服务是目前面临的挑战。通过文献回顾国内外常用的需求等级评估工具,包括各评估内容和指标、评判标准和用法、工具信度和效度以及其应用状况时发现,国内相关评估工具主要针对老年人设计,注重其功能状态评估,以失能水平来评价患者日常生活照料需求及其程度,未涉及具体的居家医疗护理服务内容;而国外相关工具在功能状态评估基础上,更注重对患者具体医疗护理服务需求的评估,其评估内容全面,适用人群也不局限于老年人,对提供居家医疗护理服务有更强的指导价值,但其条目繁多,对评估技术要求高且相对耗时。建议根据国内基层医疗卫生特点精选和量化居家医疗护理服务需求评估指标,构建能确实反映老年慢性病患者居家医疗护理服务需求等级评估工具,并利用信息技术实现需求等级的动态监测。

Home-based health care services(HHCs)is a rigid requirement for some disabled and semi-disabled elderly patients with chronic disease.The challenge is how to grade needs of such patients for HHCs in order to deliver targeted and personalized services.Based on the literature review,this paper described the common tools of patient needs assessment at home and abroad,including the assessment content and metrics,judgment criteria and usage,reliability and validity of tools,as well as their application status.Relevant assessment tools in China are mainly designed for older adults,focusing on the assessment of their functional status,and evaluating the patients'daily life care needs and degree based on the level of disability,without involving the specific content of HHCs.However,the tools abroad pay more attention to the assessment of patients'needs about specific content of the HHCs based on the function status assessment.Its evaluationcontent is comprehensive,and applicable population also is not limited to older adults,which has a stronger guiding value for HHCs.However,it has numerous items,requires high technical evaluation and is relatively time-consuming.It is suggested to select and quantify the needs assessment metrics of HHCs according to the characteristics of domestic primary medical and health care.To build an assessment tool that can truly reflect the needs level of HHCs of elderly chronic disease patients,and to use information technology to realize the dynamic monitoring of needs level.