訪問看護のアウトカム評価と費用対効果に関する研究

Outcome Evaluation and Cost-Effectiveness of Home Care Services

要旨

　本研究の目的は訪問看護を受けている利用者のアウトカム評価と費用対効果分析を行い，費用対効果に影響を及ぼす利用者背景やケア内容の特徴を明らかにすることである．対象はNステーションの全利用者64人と全訪問看護職者11人とした．その結果，訪問看護のアウトカムとしてのニーズ解決度では改善が，「清潔」，「排泄」等で，現状維持は，「ADL障害」であった．利用者満足度は全体的に高かった．ニーズ解決度からみた費用対効果比と満足度からみたそれの両者の度数分布は2相性であり，費用対効果のよい群と悪い群に分けられた．費用対効果に影響を与える条件には自立度があり，よい群は悪い群に比べ高かった（t値＝2.14, p＜0.05）．またよい群には，「機能訓練」（t値＝3.69, p＜0.01），悪い群には，「医療処置」（t値＝－2.44, p＜0.05）が多かった．看護職者は自立度を高めるケアの工夫と社会資源利用等が必要である．

Abstract

　The purpose of this study was to evaluate outcome of home care clients and to identity cost-affecting factors in client' condition and care characteristics by cost-effectiveness analyze. Subjects were 64 clients who received home care services and 11 nurses in a visiting nursing station. As a result, the solution rate of clients' needs was improved in areas such as“cleanliness”and“excretion”while the stability rate was high in“ADL disability”. Overall client satisfaction was high. Two areas of distribution, better and worse groups, were shown in the cost-effectiveness with the solution rate of clients' need and satisfaction. Independency affected the cost-effectiveness, and it was high in the better group but low in the worse group (t=2.14, p＜0.05).“Rehabilitation”was high in the better (t=3.69, p＜0.01), whereas“medical treatment”was high in the worse group (t=-2.44, p＜0.05). It is necessary for nurses to improve clients' independency by care provision and utilization of social resources.