文献分享·第89期|家庭长期护理高级护理管理的结果：一项基于人群的回顾性观察研究

文献分享 | Outcomes of advanced care management in home-based long-term care: A retrospective population-based observational study

来源：International journal of nursing studies

DOI：10.1016/j.ijnurstu.2024.104862

Abstract 

Background：In home-based long-term care, care management aims to facilitate the independence of community-dwelling older adults and mitigate the escalation of their care needs. We examined the association between the types of care management (advanced vs. conventional) and the progression of care needs among recipients with moderate care needs and compared care services offered in care plans between care management types.

背景：在以家庭为基础的长期护理中，护理管理的目的是促进居住在社区的老年人的独立性，并减少他们护理需求的提升。我们研究了护理管理类型（高级护理管理与常规护理管理）与中度护理需求的受助者对护理需求增长之间的关系，并比较了不同护理管理类型的护理计划中提供的护理服务。

Methods：A retrospective, population-based observational study was conducted in Tsukuba City in Japan. The individual-level secondary data from the suburban municipal government was collected between May 2015 and March 2019. The primary outcome was the progression of care-need levels certificated in Japanese long-term care insurance. The exposure variable was advanced care management. First, we conducted propensity-score matching to adjust for differences in recipient characteristics. Second, we performed Kaplan–Meier survival analyses and log-rank tests, with the outcome measure being the progression of care-need levels. Third, Pearson's chi-square tests were performed to compare care services for recipients of advanced vs. conventional care management.

方法：在日本筑波市开展了一项基于人群的回顾性观察研究。在 2015 年 5 月至 2019 年 3 月期间，从郊区市政府收集了个人层面的二手数据。主要结果是日本长期护理保险中认证的护理需求等级的进展情况。暴露变量为高级护理管理。首先，我们进行了倾向分数匹配，以调整受助者特征的差异。其次，我们进行了 Kaplan-Meier 生存分析和对数秩检验，结果指标是护理需求水平的进展。第三，我们进行了皮尔逊卡方检验，以比较高级护理管理与传统护理管理的护理服务。

Results：Of the 1010 long-term care recipients, we selected 856 propensity score-matched recipients receiving advanced or conventional care management. The proportions of four-year cumulative progression-free survival in the groups receiving advanced and conventional care management were 82.2 % and 78.5 %, respectively (p = .69). The proportions of the groups with advanced and conventional care management were 17.1 % and 23.8 % using home-help services (p < .05), and 4.0 % and 8.2 % using community-based day care services (p < .05), respectively.

结果：在 1010 名长期护理受助者中，我们选择了 856 名倾向得分匹配的受助者接受先进或常规护理管理。接受先进护理管理组和常规护理管理组的四年累积无进展生存率分别为 82.2% 和 78.5%（p = .69）。接受高级和常规护理管理的组别中，使用家庭帮助服务的比例分别为17.1%和23.8%（p < .05），使用社区日间护理服务的比例分别为4.0%和8.2%（p < .05）。

Conclusion：Advanced care management in home-based long-term care was not associated with a slowing of the progression of care needs among older adults with moderate care needs compared with conventional care management. There was a notable discrepancy in the use of care services, with the advanced care management group having lower rates of use of home-help services and community-based day care services compared with the conventional care management group.

结论：与传统的护理管理相比，居家长期护理中的高级护理管理并没有减缓中度护理需求的老人对护理需求的增长速度。在护理服务的使用方面存在明显差异，与传统护理管理组相比，高级护理管理组使用家庭帮助服务和社区日间护理服务的比例较低。

Keywords：Community health services;Gerontological nursing;Health services for the aged;Long-term care;Patient care management;Patient-centered care

关键字:社区保健服务；老年护理；老年人保健服务；长期护理病人；护理管理；以病人为中心的护理

（译文仅供参考）