| Summary: | 碩士 === 國立臺灣大學 === 衛生政策與管理研究所 === 90 === In order to improve the quality of care in long-term care (LTC) facilities in Taiwan, this study was aimed at investigating the care in domestic institutions, and to examine important factors which affect the outcome of care. The framework of the study is based on Donabedian’s (1966) quality management model, examining the institute for the influence of structural and process quality factors on the outcome of care. Data in this study are from the project “Development of Nursing Home Quality indicator in Taiwan”, 1998~2000, conducted by Doctor Shwu-Chong Wu. The survey was done in 10 long-term care facilities. There were 297 residents in the LTC facilities sampled, and the assessment of 243 residents was accomplished for further analysis. The data of the facility quality were from experts’ evaluation, and the data of health condition of the residents were collected by nurses in these facilities.
The purpose of the study is to realize the outcome of care received by the residents in LCT facilities, and to examine the factors which affect the outcome, including structure factors (facility character, the compose of workers in the facility, the facility environment, and the compose of residents), and process factors (the service of life care, the service of professional care, the right of the residents, the procedure of management, the arrangement of activities). Also, resident factors were put into the analysis model as control factors. The measure of the outcome includes 7 variables: physical function, incontinence, cognition function, depression symptoms, accidents events, bedsore and urinary infection. The first four variables can be generalized as the outcome of resident’s functional change, while the later three can be generalized as the outcome of poor care in the facilities.
In addition to the qualitative analysis, bivariate analysis is applied to examine the effect of the variables of structure and process on the outcome of care. Multiple variable analysis method is used to examine the factors in determining the outcome of care. The major findings are presented below:
1. For the quality of structure, the facilities selected in the study do not work well regarding environmental comfort, such as in providing private space and homelike decorates. As for the quality of process, the facilities do not work well in valuing rights of residents, such as privacy and self-decisions; neither in individual procedures of management, such as restrains and food.
2. In view of the variables which determine the outcome of care, the outcome of resident’s function does not change obviously during the three months: physical function deteriorated in 46.1% and improved in 27.6% of the samples, while mental function improved in 38.3% and deteriorated in 26.7% of the samples. The prevalence of outcome of poor care in the selected 10 facilities ranged between 0.07 and 0.24, with the mean value of 0.15. There were five facilities each with higher and lower prevalence than the mean value.
3. As for the relation between the outcome of residents’ functional change and factors of structural and process quality, from the results of t-test and one-way ANOVA analysis, it showed that the physical function of the residents changed with four variables, i.e. facility size, bed occupation, the ratio of resident and nurse aid, and the percentage of residents with the usage of trachea tubes in the facility. However, mental function changed with only one variable, i.e. the procedure of management.
4. The results of Mann-Whitney U test and Kruskal-Wallis analysis showed that no variables structural and process quality has significant effect on the outcome of poor management. However, the factors of structural and process quality are still related to the outcome of poor care in the facilities. The structural and process factors still exist some relations with the outcome of care(0.05<p<0.5).
5. The linear multiple regression method was applied to analyze residents’ functional change in both the physical and mental functions. The major results were showed below:
(1) The regression model of physical function change can explain 14.8% of the model. If the facility type is a nursing home, the facility size is larger, the ratio of residents to nurses is larger, the workers in the facility are more professional, the environment security is worse, or the percentage of dependent residents in the facility is lager, the physical function of the residents in the facility will deteriorate easier.
(2) The regression model of mental function change can explain 10.6% of the model, but no variable is significantly related to the change of mental function.
Our findings showed that the facilities in our study should strengthen themselves in environmental privacy, homelike decorates, the right of self-choice of the residents, and individual management. In addition, the result of our study showed that the outcome of care was indeed affected by the quality of structure. It is thus obvious that regulation on structural quality is very important in setting a LTC facility. Therefore, if we continue to make the standard even looser, the rights of these residents who live in the facility will be seriously threatened. Finally, in order to ensure the rights of the residents in LTC facilities, decision makers are strongly suggested to strengthen the evaluation on the facilities especially in the factors which affect substantially the outcome of care.
|
|---|
