Validation of the National Disability Rating Criteria for the Elderly with Long-term Care: a hierarchical model-based empirical analysis
-
摘要:
目的 验证长期护理失能等级评估标准分级模型的可靠性和合理性。 方法 于2022年3月,采用分层抽样法、目的抽样法和随机抽样法,对全国12个省(直辖市)共9 577名养老机构老年人采用长期护理失能等级评估标准进行失能状况评估,采用层次分析法、秩和比法、配对χ2检验进行长期护理失能等级与综合评价技术失能等级行比分析。 结果 老年人平均年龄(81.43 ± 8.46)岁,综合评价技术失能等级评价整体失能率达80.0%,中度及以上失能率为47.0%。层次分析法和秩和比法得到的回归方程WRSR = – 0.5679 + 0.2097 × probit,根据4级分级法确立综合评价技术失能等级判别标准。与原分级模型比对后,Kappa值为0.540(P < 0.001),McNemar-Bowker 检验值为3376.471(P < 0.001),2种分级模型具有一定差异,总吻合率为63.6%,基于2种分级模型评定的重度失能老年人为566人(5.9%),长期护理失能等级评估标准规定的失能分级模型中将30.1%的中度失能老年人划分到重度失能人群中。 结论 长期护理失能等级评估标准是评定老年人失能状况和等级的基础,经过数据模型验证,原标准分级模型存在问题,其科学、可靠性将直接影响对老年人失能状况的判断以及长护险相关政策的制定。 -
关键词:
- 失能 /
- 长期护理失能等级评估标准 /
- 分级模型
Abstract:Objective To verify the reliability and rationality of the National Disability Rating Criteria for the Elderly with Long-term Care – Trial Edition using hierarchical model. Methods Using complex sampling method and a self-designed questionnaire, we conducted face-to-face interview and onsite assessment among 9 577 long-term caretakers aged 60 years and above in urban nursing facilities in 23 cities of 12 provincial level administrative divisions across various geographical areas in China during March 2022. The collected data were analyzed with analytic hierarchy process, rank sum ratio method and paired Chi-square test to comprehensively evaluate the long-term caretakers' disability degrees and to compare the evaluations with those based on the national criteria. Results For the 9 577 valid participants averagely aged 81.43 ± 8.46 years, 80.0% were assessed as having disability and 47.0% as having moderate and severe disability. A four-level hierarchical model was established based on the regression equation (weighted rank-sum ratio [WRSR] = – 0.5679 + 0.2097 × probit) obtained with analytic hierarchy process and rank sum ratio method. Paired comparison with the original hierarchical model, the Kappa value of the analysis was 0.540 (P < 0.001) and the value of McNemar-Bowker test was 3 376.471 (P < 0.001). There were some differences between the two hierarchical models, and the overall coincidence rate between the two models was 63.6% although there were some differences. Of all the elderly long-term caretakers, 566 (5.9%) were assessed as having severe disability based on combined evaluation with the two hierarchical models; whereas, of all the long-term caretakers assessed as having moderate disability using the hierarchical model established in the study, 30.1% were assessed as having severe disability according to the evaluation with the National Disability Rating Criteria. Conclusion Based on the analysis using the hierarchical model established in the study, there are some defects in the original hierarchical model adopted by the National Disability Rating Criteria and further researches are needed to address the issue. -
表 1 长期护理综合失能等级判定方式
日常生活活动能力等级 认知能力/感知觉与沟通能力
(以失能等级严重的判断)能力完好 轻度受损 中度受损 重度受损 能力完好 基本正常 基本正常 轻度失能 轻度失能 轻度受损 轻度失能 轻度失能 轻度失能 中度失能 中度受损 中度失能 中度失能 中度失能 重度失能 重度受损 重度失能 重度失能 重度失能 重度失能 表 2 失能等级判别方式
失能等级 日常生活活动能力
(级别)认知能力
(级别)感知觉与
沟通(级别)能力完好 0 0 0/1 轻度失能 0 0 2 0/1 1 0/1/2 1 0 0/1 1 2/3 0 2 0 0/1 中度失能 1 2/3 1/2/3 2 1 0/1/2 2 2/3 1/2/3 3 0 0/1 3 1 0/1/2/3 3 2 1/2 3 3 0/1 重度失能 3 2 3 3 3 2/3 表 3 长期护理失能等级评估标准(试行)分级模型比较(n = 9577)
国家标准 – 长期护理失能
等级(试行)综合评价技术失能等级划分 McNemar-Bowker
检验值P 值 能力完好 轻度失能 中度失能 重度失能 总计 人数 % 人数 % 人数 % 人数 % 人数 % 基本正常 1 916 20.0 468 4.9 0 0.0 0 0.0 2384 24.9 3376.471 <0.001 轻度失能 0 0.0 2649 27.7 98 1.0 0 0.0 2747 28.7 中度失能 0 0.0 38 0.4 960 10.0 0 0.0 998 10.4 重度失能 0 0.0 0 0.0 2882 30.1 566 5.9 3448 36.0 -
[1] 李强, 厉昌习, 岳书铭. 长期照护保险制度试点方案的比较与思考 —— 基于全国15个试点地区的比较分析[J]. 山东农业大学学报(社会科学版), 2018, 20(2): 23 – 30. [2] 国家医保局, 财政部. 关于扩大长期护理保险制度试点的指导意见[EB/OL]. (2020 – 09 – 10)[2022 – 06 – 20]. http://www.gov.cn/zhengce/zhengceku/2020-11/05/content_5557630.htm. [3] 国家医保局. 国家医疗保障局对十三届全国人大五次会议第4582号建议的答复[医保函〔2022〕29号][EB/OL]. (2022 – 07 – 20)[2022 – 09 – 19]. http://www.nhsa.gov.cn/art/2022/7/20/art_110_8613.html. [4] 国家医保局办公室, 民政部办公厅. 关于印发《长期护理失能等级评估标准(试行)》的通知[EB/OL]. (2021 – 08 – 03)[2022 – 06 – 20]. http://www.nhsa.gov.cn/art/2021/8/3/art_37_5692.html. [5] 孙振球, 王乐三. 综合评价方法及其医学应用[M]. 北京: 人民卫生出版社, 2014. [6] 王振杰, 刘蓓, 郭占元, 等. 中国老年人失能情况Meta分析[J]. 中国老年学杂志, 2020, 40(8): 1671 – 1674. doi: 10.3969/j.issn.1005-9202.2020.08.031 [7] 王晓晰, 张志强. 脑卒中患者社会支持与日常生活能力和焦虑关系[J]. 中国公共卫生, 2015, 31(4): 501 – 503. doi: 10.11847/zgggws2015-31-04-37 [8] 蒋曼, 戴瑞明, 宋阳, 等. 基于日常生活活动能力量表的长期护理保险评估结果比较[J]. 中国初级卫生保健, 2019, 33(7): 26 – 27, 30. doi: 10.3969/j.issn.1001-568X.2019.07.0008 [9] 冯文猛. 失能等级评估标准公布老年人长期照护加速解题[J]. 中国卫生, 2021(11): 68 – 69. [10] 陈俊磊, 潘伟毅, 王琴, 等. 福建省疫苗追溯系统质量评价[J]. 中国公共卫生, 2021, 37(1): 97 – 99. doi: 10.11847/zgggws1130290 [11] 徐培兰, 孜克娅·乃吉木, 木日扎提·买买提, 等. 基于秩和比法新疆地区基本公共卫生服务评价[J]. 中国公共卫生, 2021, 37(3): 542 – 545. doi: 10.11847/zgggws1124873 [12] 国家统计局. 2021年国民经济和社会发展统计公报[EB/OL]. (2022 – 02 – 28)[2022 – 09 – 03]. http://www.stats.gov.cn/tjsj/zxfb/202202/t20220227_1827960.html. [13] 潘萍, 覃秋蓓. 中国长期护理保险制度模式选择与发展路径[J]. 西南金融, 2022(2): 89 – 100. [14] 石秦川, 杨敏, 柏亚妹, 等. 应用层次分析法和秩和比法构建老年人能力等级划分方式的研究[J]. 中国卫生统计, 2017, 34(2): 319 – 321. [15] 郭红艳, 王黎, 王志稳, 等. 老年人能力等级划分方式的研究[J]. 中国护理管理, 2013, 13(9): 35 – 38. [16] 民政部. 第四次中国城乡老年人生活状况抽样调查成果[EB/OL]. (2016 – 10 – 09)[2022 – 06 – 20]. http://old.cnr.cn/2016csy/gundong/20161010/t20161010_523186698.shtml. [17] 中国保险行业协会, 中国社会科学院人口与劳动经济研究所. 《2018 — 2019中国长期护理调研报告》[EB/OL]. (2020 – 07 – 06)[2022 – 06 – 20]. http://www.iachina.cn/art/2020/7/6/art_22_104560.html. [18] 陈鹤, 刘艳, 伍小兰, 等. 中国老年人失能水平的比较研究 —— 基于四项全国性调查数据[J]. 南方人口, 2021, 36(5): 1 – 12. doi: 10.3969/j.issn.1004-1613.2021.05.001 [19] 闫伟, 何梦娇, 路云, 等. 基于CLHLS的我国老年人失能现状及其影响因素研究[J]. 护理研究, 2021, 35(10): 1807 – 1811. doi: 10.12102/j.issn.1009-6493.2021.10.021 [20] World Health Organization. WHO multi-country studies data archive: World Health Survey[EB/OL]. (2015 – 05 – 26)[2022 – 08 – 28]. https://apps.who.int/healthinfo/systems/surveydata/index.php/catalog/whs. -

计量
- 文章访问数: 35
- HTML全文浏览量: 8
- PDF下载量: 4
- 被引次数: 0