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  • Link 綜論 Review Article
  • 整合性健康照護系統Integrated Delivery Systems
  • 林恆慶、趙儷淨
    Herng-Ching Lin, Li-Jing Zhao
  • 管理式醫療 ; 整合性健康照護系統 ; 臨床整合 ; 功能整合
    managed care ; IDSs ; clinical integration ; functional integration.
  • 從1990年開始,因為美國管理式醫療機構(Managed Care Organization)大量使用論人計酬制度來做為對醫療服務提供者的支付方式,而造成醫療服務提供者之間必須相互結合,以便能有足夠的納保人數來分擔財務風險,此種支付方式的改變,不但改變了醫療服務提供者之間的互動關係,也推動了整合性健康照護系統(Integrated Delivery System, IDS)在美國健康照護體系中的蓬勃發展。本文希望藉由介紹美國的整合性健康照護系統,能讓一般民眾更清楚的瞭解促成健康照護系統整合的動力、整合性健康照護系統的參與者及整合性健康照護系統的組成元素。 整合性健康照護系統的主要參與者包括醫師、醫院及保險公司。而整合性健康照護系統的組成元素可包括:臨床整合(Clinical integration)、功能整合(Functional integration)及醫師系統整合(Physician-system integration)。而臨床整合又包含了垂直整合(Vertical Integration)及水平整合(Horizontal Integration),多家醫院系統(Multihospital system)即為水平整合中的一種。 整合性健康照護系統還一直在持續發展,所以它的模式及所提供的醫療服務,也因應市場的需求而不斷的在更新中,然而整合性輸送系統是否真能降低醫療成本及提供納保人最適當的連續性治療則還未有定論。這種大型整合性輸送系統的形成雖然可以帶給民眾類似大型超級市場的所有服務,但是它也容易造成醫療市場的壟斷。在醫療機構的整合過程中迫切需要資訊系統的輔助,然而醫療機構之間資訊系統的連接往往跟不上整合的腳步,因此如何強化資訊系統實是整合過程中所面臨的最大挑戰。
    Managed care organizations (MCOs) have been paying health providers through capitation since 1990s. Under the capitation system, financial risk has been shifted from the MCOs to providers. As a result, health providers including physicians and hospitals began to merge or consolidate to share the financial risk by increasing the number of enrollees. Thus, not only did payment through capitation change the health care delivery system in U.S., it also accelerated the development of Integrated Delivery Systems (IDSs). The purpose of this article is to introduce the forces behind the IDSs as well as their players and components. The major players in IDS include physicians, hospitals, and health plans. However, the role of health plan remains controversial. The IDSs is composed of both clinical integration and functional integration. Clinical integration also consists of vertical integration and horizontal integration. Multi-hospital system is one kind of horizontal integration. The development of IDSs is still in process. The players and components in IDSs are also changing with the demand in the health market. Whether IDSs can lead to cost containment remains unclear. In addition, although the IDSs can provide one-stop medical care shopping for enrollees, it is likely they will monopolize the health care market. How to keep the information system updated is also the greatest challenge for IDSs
  • 1-8
  • 10.6288/TJPH2002-21-01-01
  • Link 原著 Original Article
  • 探討醫院病歷部門主管與疾病分類人員對人力需求之認知差異及其實際工作情形A Study of Different Perceptions on Manpower between Directors and Disease Coders in Medical Record Departments and Practical Working Situation of Taiwanese Hospitals
  • 黃慧娜、林為森、李淑宜
    Hui-Na Huang, Weir-Sen Lin, Shu-I Lee
  • 疾病分類 ; 編碼人員 ; 人力需求
    classification of disease ; disease coders ; manpower.
  • 目標:疾病分類人員在醫療研究、衛生統計、費用申報上扮演了相當重要的角色,從學者研究得知我國疾病分類編碼整體正確率只有46.6%,其重要原因之一在於疾病分類人員的素質和人力。本研究目的是探討病歷部門主管與疾病分類人員對人力需求的認知差異及其實際工作情形。方法:一般病床100床以上醫院的病歷部門主管和疾病分類人員為研究對象,採問卷調查法,回收率各為86.7%和75.7%,有效樣本各為157份、345份。結果:醫學中心疾病分類人員有61%認為人力太少,地區醫院有21.9%認為人力太多,這與兩者主管認知有差異。實際工作情形是:醫學中心每人每日平均花最多時間從事最多本病歷的編碼,但仍覺得人力不足,因有92.9%人員尚需協助病歷量的審查、癌症登記、疾病統計、保險申報等工作。而地區醫院疾病分類人員平均每本病歷編碼時間與其他層級醫院比較明顯偏高,且通過疾病分類甄審考試人數比率最低。其他影響編碼速度與完整性的因素是醫師病歷書寫品質、病理檢驗報告未出來、花時間與醫師討論等。結論:醫學中心與地區醫院的病歷部門主管與疾病分類人員對人力需求的認知不同,建議加強地區醫院疾病分類人員的編碼訓練,增加醫學中心人員數,加強醫師病歷書寫品質和檢驗報告的時效性。
    Objectives: Disease coders playa very important role in medical research, health statistics and insurance claims. Previous studies showed that the overall correct rate of disease coding was 46.6% in Taiwan, and it was influenced by quality and manpower of coding personnel. The purpose of this study was to explore the different perceptions on manpower between directors and disease coders of the Medical Record Department (MRD) and to examine the practical Working situation of coders. Methods: Samples were directors and disease coders of MRD in hospitals with over 100 beds. We received 157 and 345 valid questionnaires from directors and disease coders, respectively. The return rate of directors is 86.7% and that of coders is 75.7%. Results: We found that 61 % of the disease coders from medical centers consider manpower insufficient, while 21.9% of the disease coders from district hospitals find it excessive. But their perceptions are different from those of their directors. The coders from medical centers spent lots of work-time on disease coding, and they still had to assist other works such as review quantity of charts, cancer registration, statistics of disease and health insurance claims. The average coding time of each chart from district hospitals was higher than that from other hospitals ,but fewer coders have obtained professional qualifications. Other factors influencing speed and completeness of coding were quality of written medical records from doctors, and the efficiency of pathological or exam reports. Conclusion: More professional training courses are needed for coders from district hospitals, manpower for medical centers should be increased, and the efficiency on reports and written quality of charts should be improved.
  • 9-16
  • 10.6288/TJPH2002-21-01-02
  • Link 原著 Original Article
  • 健保支付標準與醫師執業耗用資源對牙科服務量之影響The Effects of BNHI Payment Rates and Resource-input on the Changes of Dental Service Volume
  • 陳琇玲、溫信財、楊志良、黃文駿、黃意婷、徐慧娟
    Hsiu-Ling Chen, Hsyien-Chia Wen, Chih-Liang Yaung, Wen Jiun Huang, I-Ting Huang, Hui-Chuan Hsu
  • 支付標準;耗用資源;牙醫師;服務量;醫師行為
    physician behavior ; payment scheme ; resource-input ; dentist ; service volume
  • 目標:文獻顯示醫師行為會受到支付制度所形成的經濟誘因影響,本研究以牙科為研究對象,嘗試了解牙醫師在執業耗用資源考量下,支付標準改變與服務數量之間的關係。方法:以牙科79項主要處置87年與88年下半年同期服務量均超過1,000次之13項調高支付標準的處置與44項未調價處置為研究對象,並引用其他研究之醫師執業耗用資源的成本資料,分析調價與未調價處置之服務量及總點數差異情況,同時探討牙醫師在執業耗用資源考量下,點數調整對醫師行為的影響。結果:(1)由Pearson's相關係數得知調整點數與服務量增減數、調整點數與該處置較前一年度增加之總支付點數、調價佔醫師成本之比率與服務量增減數之相關不顯著。而服務量變動比率分別與點數調整比率、醫師實得收入調整比率、調價佔醫師成本之比率均呈顯著相關,以及該處置總支付點數較前一年度增加比率與點數調整比率均呈顯著相關。(2)排除有相互替代性的「銀粉充填」及「樹脂充填」單、雙面各二項後,支付標準調價11項與未調價42項處置服務量增加之項目分別為10項(10:11=91%)及18項(18:42=43%)。調價處置成長率均超過平均成長率5.47%;而未調價處置中只有11項(26%)超過平均成長率。調高支付標準處置之總服務量增加5%,而未調價處置增加1%;支付標準調價處置和「數量」有關的因素所導致的「總點數差異率」為5%,大於支付標準未調價處置之2%。結論:(1)支付標準調整點數和服務量增減相關性不顯著,但是點數調整幅度(百分比)越高,牙醫師服務量增加幅度(百分比)越高。(2)排除有替代性處置外,牙醫師比較會對支付標準調高之處置增加服務量以及提高所得。
    Objectives: There is considerable evidence indicating that physicians’ behavior may be affected by economic incentives in the payment system. We investigated the relationship between price-adjusted and volume-increased under the consideration of resource-consumed in the dental practice. Methods: We evaluated 79 major dental procedures that were performed more than 1,000 times in the second half of both 1998 and 1999. The reimbursement for 13 of these procedures (designated price-adjusted procedures, PAP) was adjusted upward in 1999, while it remained the same for 44 procedures (designated price unadjusted procedures, UAP). Using resource-input data from other research, we analyzed differences in service volume and total payment between PAP and UAP and the effects these had on dentists’ behavior. Results: (1) Pearson’s coefficients showed no significant correlation was found between price-adjusted and volume-increased, between price-adjusted and total payment-increased, and between the ratio of price-adjusted to the cost of physician work and the volume-increased. However, there was a significant correlation between the volume-increased rate and the price-adjusted rate, between the volume-increased rate and the physicians’ real-income-adjusted rate, between the volume-increased rate and the ratio of price-adjusted to the cost of physician work, and between the price-adjusted rate and the total payment-increased rate (p<0.05). (2) After excluding four procedures (2 each from PAP and UAP) which can be replaced by each other and whose change in volume was significantly affected by patient demand, we found the volume of 10 PAP (91%) increased in 1999, compared with 18 UAP (43%), All of the PAP had a higher payment-increased rate than the average, but only 11 UAP (26%) did. The total volume of PAP increased by 5% and of UAP by 1 %. The corresponding increases in total payment were 5% and 2% due to the factor of “quantity”. Conclusions: (1) Price-adjusted and volume-increased were not significantly correlated, but the price-adjusted rate and volume-increased rate were significantly correlated. (2) Excluding procedures replaceable by each other and influenced by patient demand, dentists increased the volume of PAP more than UAP, presumably to increase their revenue.
  • 17 - 26
  • 10.6288/TJPH2002-21-01-03
  • Link 原著 Original Article
  • PDA在社區醫學應用之實證研究Empirical Study of the Use of PDA in Community Medicine
  • 張博論、吳肖琪、周碧瑟、何捷民
    Polun Chang, Shiao-Chi Wu, Pesus Chou, Chieh-Min He
  • 個人數位助理(PDA);機動資訊系統;社區醫學;界面設計;工作流程
    PDA ; Mobile Information Systems ; Community Medicine ; Interface Design ; Work Flow.
  • 目標:本研究以社區醫學家訪為例,評估PDA在公衛調查之應用長處、限制與因應之道。方法:原始問卷以蒐集社區老人生活品質與健康情形。PDA問卷以ThinkDB2.0開發。測試機型為Visor Deluxe。本次家訪總共訪問174位民眾。訪員以2人為一組,皆未使用過PDA。訪員完成工作後,填答對於PDA之畫面清晰度、使用便利性、訪問工作受限性、輸入問題等心得與建議。研究以質性討論為主。結果:PDA問卷遺漏題份數43%(74份),平均漏題數1.7%,較傳統問卷相對應之10%、1%高。所有訪員指出訪談會受PDA限制;大部分認為中文輸入不便。對於PDA使用的整體滿意度平均僅66分。最常被提及負面經濟為「畫面小、問卷被切割不連貫」,其次為「無法例外註記、無法詳細記述」。一致指出減少鍵碼工作為最大好處。結論:PDA與工作流程配合重要性高於對PDA本身功能要求,且應格外重視「界面設計」。未來PDA工具的潛在價值將在其合後端分析中心整合後所產生的整體與及時化效益。而PDA的實際成效,則有賴進一步成效分析加以研究。
    Objectives: This study was to evaluate empirically the potential benefits and limitations of Personal Digital Assistant (PDA) in public health survey. Methods: The original questionnaire was developed to survey the life quality and health status of the elderly aged over 65. The PDA questionnaire was designed using the ThinkDB2.0 mainly because of its support of Chinese codes. The Visor Deluxe PDAs were used in this study. A total of 174 elderly were interviewed. The Interviewers who had never used PDAs were organized into nine 2-student squads. All interviewers filled a evaluation form with seven questions concerning the clarity, convenience, constraints, time spent, Chinese Input, English Input, and overall satisfaction of the PDAs after performing all the survey tasks. The qualitative, instead of quantitative, analysis of the results were made due to the small sample size. Results: Forth-three precent (74) of the questionnaires were found to have an average missing value of the 1.7% of questions, which was greater than that using paper questionnaires. Most of the interviewers found the PDA inconvenient. The majority did not find the Chinese Input as easy as the English Input. The average overall satisfactory score was only 66.The top two frequently mentioned negative experiences were “too many but small screens, hard to keep on track” and “lack of flexibility of making notes on special observation.” On the other hand, the greatest advantage acknowledged by all interviews with respect to using PDAs was that the questionnaires need not be recoded. Conclusions: The va1ues of PDA in pub1ic hea1th survey would depend greatly on how well PDA usage fit in the workflow, rather than its technical specifications. The majority of problems could be solved or improved by a good PDA interface design. The potential benefit of PDA would be its capability of integrating into the entire field of survey management support systems by serving as a front-end mobile data collection tool. However, the re-al benefits, or disadvantages, of PDA in public health survey can only be understood by the cost-effectiveness analysis.
  • 27 - 35
  • 10.6288/TJPH2002-21-01-04
  • Link 原著 Original Article
  • 以綜合分析法量化臨床作業系統和衛生教育介入方案對影響預防保健服務提供的成效Effects of Office System and Educational Interventions in Increasing the Delivery of Preventive Health Services: A Meta-Analysis
  • 郭鐘隆、Nell H. Gottlied、黃久美
    Jong-Long Guo, Nell H. Gottlied, Chiu-Mieh Huang
  • 綜合分析 ; 預防保健服務 ; 臨床作業系統 ; 衛生教育介入
    meta-analysis ; preventive health services ; office system ; educational intervention.
  • 目標:利用綜合分析法量化臨床作業系統和衛生教育介入方案影響預防保健服務的成效。方法:首先以設定之關鍵字在MEDLINE, HEALTH STAR, CINALE, DISSERTATION ABSTRACTS, ERIC和 PSYCH INFO等資料庫中,以四個標準對相關文獻進行篩選:1.發表於1990年代;2.統計結果可以計算成效值;3.包含一或多個預防保健服務項目;4.有實施臨床作業系統或衛生教育介入方案。結果:綜合分析後發現,不同的臨床作業系統和衛生教育介入方案對所研究的預防保健服務項目皆有正向的校果。對於「健康諮詢」和「預防接種」兩項的效果為中等強度,其成效值界於0.45至0.64及0.50之間。對於「預防性篩檢」的效果較低,其成效值界於0.07至0.22之間。就介入期程而言,以介入七個月至一年者有最好的成效值。就臨床作業系統或介入方案而言,指導醫師對實習醫師的個案監督與直接回饋的介入效果最好。對「健康諮詢」和「預防接種」而言,三種以上的介入比單一或兩種介入的效果為佳。對「預防性篩檢」和「健康諮詢」而言,針對病人設計的介入比針對醫師設計的介入成效佳。結論:臨床作業系統與衛生教育方案對於提昇預防保健服務的利用率有顯著的成效可獲證實。本研究的結果可供有意推廣預防保健服務的公共衛生計畫參考。
    Objectives: To examine quantitative effect of office system and educational intervention in selected preventive health services (PHS) in primary care practices and whether effectiveness differed by study and intervention characteristics. Methods: Fifty studies that conducted office based interventions for improving PHS were retrieved from various computerized databases. Selected studies were based on the following criteria: (I) published since 1990, (2) contain results on the practices of primary care providers allowing calculation of at least one effect size, (3) data related to one or more of the following classifications of preventive health services: screening, lifestyle counseling and adult immunization, and (4) use office system tools or educational components. Results: There were small to medium effects for office system and educational interventions focusing on life style counseling (effect sizes range from 0.45 to 0.64, P<0.0001) and adult immunizations (effect sizes range from 0.26 to 0.50, P<0.0001). However, interventions produced smal1er effects for screening tests (effect sizes range from 0.07 to 0.22). Greater success was found for studies lasting 7 to 12 months and using chart audit measurement regardless of the type of preventive health service. With the exception of screening tests, delivery rates improved most when the subjects were the targets of a combination of three or more interventions. Interventions targeting patients were more successful than those targeting providers for screening tests and lifest~1e counse1ing. Conclusions: The effectiveness of office system and educational interventions for improving delivery rates is well-supported, especially for lifestyle counseling and adult immunizations.
  • 36 - 51
  • 10.6288/TJPH2002-21-01-05
  • Link 原著 Original Article
  • 家戶處理垃圾行為及其相關因素以臺北市中山區為例A Study of Household Wastes Handling Behavior and its Related Factors-The Chung-Shan District in Taipei as a Case
  • 陳沼舟、王順美
    Tsao-Chou Chen, Shun-Mei Wang
  • 垃圾處理行為 ; 家戶垃圾
    waste handling behavior ; household waste
  • 目標:本研究透過問卷調查的方式,探討台北市中山區兩個里的一般家戶的處理垃圾行為及其相關因素,以提供未來政府擬定垃圾處理政策與環境宣導的基礎資料。方法:本研究以系統抽樣法方式選取1213戶進行施測,共得到590份有效問卷。結果:發現這兩個里的家戶以三至五人的小家庭為主,其住宅面積約三十多坪;這些家戶的垃圾處理傾倒多由二十六至五十歲的婦女進行,並且以直接拿到清潔隊垃圾車的方式為主,但也有四成居民委託他人收集丟棄,七成以上的家庭每天傾倒垃圾。家戶的垃圾量,會因不同垃圾丟棄處理方式及傾倒的頻度而有顯著差異,並且家戶人口數、自覺住家空間擁擠與垃圾量顯著相關。結論:提倡垃圾減量及專用垃圾袋的策略可能可以減少家戶垃圾量並對環境有所助益。
    Objectives: This purpuse of this research was to study household wastes handling behavior and its related factors in two “Li” (communities) of the Chung-Shan District. The outcome of this basic research will be helpful for the Taipei city government’s handling of waste treatment and its educational intervention. Methods: This research used a self-developed questionnaire for survey in the Chung-Shan District. It chose the family member who frequently treated the household waste. The researchers adopt the systematical sampling method to investigate 1213 families. It received back 590 questionnaires, which was 12.6% of the two communities population. Results: The research finds the average family size of these two communities is mainly 3-5 people. The mean of house size is about 30 “Pin” (equal to 100 square meters). Women, whose age is between 26-50, are the main persons who handle their household waste. We find that more than half of households dump their waste to the garbage collection truck directly, but about 40% of the households hired others to dump their garbage for them. The dumping method and frequency influence household garbage volume. This is also related to family size and perceived house size. The households who paid other to dump their garbage have less garbage production and the household did not store their garbage at home. Conclusions: Promoting garbage reduction, material recycling and using paid garbage bags could be useful strategies for reducing household garbage.
  • 52 - 60
  • 10.6288/TJPH2002-21-01-06
  • Link 原著 Original Article
  • 社區幼童居家事故傷害預防介入研究Community Home Injury Prevention for Children under Five
  • 李玲玲、白璐、盛培珠
    Ling-Ling Lee, Lu Pai, Pei-Chu Shen
  • 幼童 ; 居家事故傷害 ; 社區 ; 居家環境安全 ; 介入措施 ; 平衡控制實驗研究
    children ; home injury ; community ; home environment safety ; parallel controlled experiment study
  • 目標:事故傷害為國內外兒童主要死因,五歲以下兒童事故傷害主要發生於家中,居家環境安全對幼童事故傷害的防制扮演重要角色。本研究採用以社區為基礎之介入方式進行幼童居家事故傷害預防,並評價介入措施之效果。方法:以『含對照組、前後測設計』之平衡控制實驗研究,於台北市某國宅社區進行幼童居家事故傷害防制介入活動。內容包括:「安全的家」居家事故傷害防制活動、寄送防制手冊及定期以電話與幼童母親聯繫。活動介入前後由訪員針對五歲以下幼童之家戶收集「居家環境安全改善情形」、「幼童母親之居家事故傷害預防認知程度」、「幼童母親居家事故傷害預防行為」及幼童母親考慮改善居家環境之主要考量因素等,以評價兩組前後測是否有顯著差異。結果:經由重複量數二因子變異數分析顯示,活動前後,實驗組與對照組「客餐廳」、「浴室」、「主臥室」、「書房」、「樓梯間」、「玩具」等居家環境安全改善幅度及幼童母親居家事故傷害預防行為達顯著差異;實驗組後測時,幼童母親考慮改善居家環境時之主要考量因素,亦部分由幼童安全直接相關之因素取代間接之因素;幼童母親拘居家事故傷害預防認知則無顯著差異。結論:本研究跨越傳統幼童居家事故傷害防制單一宣導方式之窠臼,以多元化、動態之活動設計,提昇訊息、資源可近性,呈現居家環境安全改善及幼童母親居家事故傷害預防行為提昇之活動效果,可提供未來規劃以社區為基礎相關介入措施之參考。
    Objectives: Injury ranks as one of the most crucial health problems for children. Most of children’s injuries occur at home and are the result of environmental hazards. A safe home environment, therefore, plays a leading role in preventing home-related injuries for children. This paper performed and evaluated a set of community-based interventions designed to prevent related injuries. Methods: A parallel controlled experiment and pre-post test study design is applied to evaluate the implementation of interventions aimed to reduce the childhood home hazard in two of Taipei’s communities. The interventions consist of “Safe Home” injury prevention activities in the community, distributing pamphlets and materials showing how to improve home safety, and keeping in contact with mothers by telephone to reinforce their safety behavior execution. Trained home visitors collected data with a home inspection instrument and questionnaire at pre- and post visiting to assess rectification of injury-related home hazard, mothers’ perceptions of home safety and injury preventive behavior, and their considerations before the decision to improve home safety. Results: The results analyzed by repeated measures two-way ANOVA showed that the interventions of multifarious design led to significant differences in the safety of several home environments, including the ”living room”, ”dining room”, ”bath room”, ”chief bedroom”, ”room for children”, ”study room”, ”staircase”, and ”toys”, and mothers’ behavior between the intervention and control homes. Some of the mothers in the intervention group began to be aware of factors related to the safety of their children when they considered modifying their home environment. Mothers’ perception of home-related injury did not show significant differences. Conclusions: The community based intervention design of home-related injury prevention could serve as a model for children under 5 in the urban community.
  • 61 - 72
  • 10.6288/TJPH2002-21-01-07
  • Link 原著 Original Article
  • 台灣中部某鄉村社區老人跌倒之危險因子Risk Factors for Elderly Falls in a Rural Community of Central Taiwan
  • 林茂榮、蔡素蘭、陳淑雅、曾信嘉
    Mau-Roung Lin, Su-Lan Tsai, Shu-Ya Chen, Shinn-Jia Tzeng
  • 追蹤研究 ; 計時起走測試 ; 老人 ; 跌倒 ; 鄉村
    elderly ; fall ; prospective study ; rural ; timed Up & Go test.
  • 目標:以一年的追蹤式研究探討台中縣新社鄉368位六十五歲以上老人跌倒的年發生率及其危險因子。 方法:基線資料收集包括(1)面對面訪視:人口學、健康行為、前一年跌倒經驗、基本及工具性日常生活活動能力、憂鬱程度、健康相關生活品質、視、聽力、認知能力以及慢性疾病數等,以及(2)當場計時起測試(timed Up & Go)。跌倒發生的追蹤由老人或其同住親友以明信片通知研究者以及研究者每兩個月一次的電訪;另外,我們並驗證研究期間老人自述跌倒發生的信、效度。多變項分析以PWP(Prentice, Williams, Peterson)比例危險模式檢驗測量變項與跌倒發生的相關性。 結果:一年內有54位老人共發生78次跌倒,年發生率為226次/1000人年。多變項分析結果顯示前一年曾發生跌倒(危險比為1.76,95%信賴區間=1.08~2.88)、執行工具性日常生活活動需人協助項數(危險比為1.22,95%信賴區間=1.08~1.39)、以及起走測試秒數較多(以≦10秒為參照組,11至20秒的危險比=1.99,95%信賴區間=1.00~3.97,≧21秒的危險比=3.01,95%信賴區間=1.22~7.41)與發生跌倒有顯著相關。另外,75%老人所自述的跌倒能被其親友正確指認;老人自述就診的跌倒中,有69.6%在病歷查閱後獲得證實。 結論:前一年是否曾發生跌倒、工具性日常生活活動能力、以及計時起走測試等簡易的指標可用來篩選鄉村社區易發生跌倒的老人。
    Objectives: A one-yea~ prospective study was conducted to determine the incidence rate and risk factors for falls among 368 rural elderly people aged 65 years or older in Shin-Sher Township, Taichung County, Taiwan. Methods: Information on demographics, health-related behaviors, previous fall history, activities of daily living (ADL), health-related quality of life, vision, hearing, cognitive function, and number of chronic diseases was collected through personal interviews at each subject’s home. Furthermore, timed Up & Go test was examined in the field. The elderly were asked to send a postcard to inform researchers when a fall occurred, and researchers also called them every two months to ascertain whether they experienced a fall in the past two months. We validated the” self-reported falls using their next of kin and medical records. The PWP (Prentice, Williams, Peterson) proportional hazards model was employed to investigate the relationship between the potential risk factors and falls. Results: The incidence rate of falls among the rural elderly was 226 per 1000 person years. Furthermore, previous fall history. (relative hazard (RH)= 1.76, 95% confidence interval (CI)= 1.08 to 2.88), impaired number of instrumental activity of daily living (IADL)(RH= 1.22, 95% CI=1.08 to 1.39), and longer duration of timed UP & Go (compared with the elderly with ?10 second, RH 11-20= 1.99, 95% CI= 1.00 to 3.97; RH?21=3.01, 95% CI= 1.22 to7.41) were positively associated with the risk of falls. Seventy-five percent of the self-reported falls were identified by their next of kin , and 69.6% of those who reported to seek medical care due to a fall were corroborated by medical records. Conclusions: A high-risk group of falling among rural elderly people can be identified using a set of simple measures such as Fall history, IADL, and timed Up & Go.
  • 73 - 82
  • 10.6288/TJPH2002-21-01-08