Effects of Integrated Care for Severely Disabled Residents Living in a Long-Term Care Facility in Kaohsiung City

某高雄市長照機構內嚴重失能住民的整合照護成效

10.3966/168232812018062802001

林艾薇(I-Wey Lim)；江瑞錦(Jui-Chin Chiang)；王培銘(Pei-Ming Wang)；駱聰成(Song-Seng Loke)；陳朝棟(Chao-Tung Chen)；黃琨祥(Kun-Siang Huang)；黃志芳(Chih-Fang Huang)

disease management ； integrated care ； nutritional status ； quality improvement ； 整合照護 ； 營養狀況 ； 疾病照護 ； 品質改善

台灣家庭醫學雜誌

28卷2期（2018 / 06 / 01）

55 - 64

英文

Background: Research on the effects of integrated care for severely disabled residents living in long term care facilities (LTCF) in Taiwan are still scarce. Therefore, this study compared the clinical parameters of severely disabled residents living in a LTCF before and after the implementation of an integrated care model. Methods: We recruited 67 severely disabled residents (defined as Eastern Cooperative Oncology Group performance status of 4) (mean age =55.6 years, men: women =41:26) living in a LTCF located in Kaohsiung, Taiwan. An integrated care model was implemented by an interdisciplinary medical team in the LTCF from July 2013 to June 2014. We compared the body weight, body mass index, and nutritional status of the LTCF residents before and after implementation of the integrated care model. Results:A significant increase in the body weight (p＜ 0.001), body mass index (p＜ 0.001), triglyceride level (p= 0.040), and creatinine level (p＜ 0.001) were observed in the LTCF residents at the end of the implementation of the integrated care model. We also observed a significant decrease in the serum level of sodium (p＜ 0.001), potassium (p= 0.050), and total cholesterol (p= 0.003). Except for the low serum sodium level, those of the other biochemical markers were within the normal range at both the beginning and the end of the intervention. The average monthly rates of unexpected hospitalization also lowered during the intervention of the integrated care model. Conclusion: The implementation of a one-year integrated care model was able to improve the body weight and body mass index in the LTCF residents.

背景：目前針對居住在台灣長期照護機構(long term care facilities)中的嚴重失能住民實施整合照護的成效研究仍非常稀少。因此，本研究在某長照機構實施「整合照護模式」(integrated care model)，並比較此模式實施前後，嚴重失能住民的臨床參數變化。方法：我們共收錄了67位嚴重失能住民（定義為美國東岸癌症臨床研究合作組織體力狀態為4分者）（平均年齡=55.6歲，男：女=41：26）居住在台灣高雄市某長期照護機構的住民，於2013年7月至2014年6月期間實施整合照護模式。比較在實施整合照護模式前和後，住民的體重、身體質量指數和營養狀況之變化。結果：在整合照護模式實施結束時，長照機構住民的體重(p＜ 0.001)、身體質量指數(p＜0.001)、三酸甘油酯(p= 0.040)及肌酸酐檢驗值(p＜ 0.001)呈顯著增加。血清中鈉(p＜ 0.001)、鉀(p= 0.050)和總膽固醇的檢驗值(p= 0.003)顯著降低。此外，每月平均非預期性轉至醫院住院比率在實施「整合照護模式」期間也比實施前為低。結論：在長期照護機構實施一年的整合照護模式能夠改善住民的體重、身體質量指數和營養狀況。至於實施此整合照護模式前和後，住民血清中鈉離子檢驗值仍低於正常值，值得關注且須更進一步的探討。

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