目標：瞭解居家失能老人的經濟狀態與居家護理低訪視及照護品質間的相關性。方法：採回溯性世代研究法，以2002年至2006年65歲以上首次使用全民健保居家護理服務且住在家中之的新個案為研究對象，運用廣義估計模式的邏輯斯迴歸分析影響居家護理低訪視(<3次/年)，並以Cox Regression分析發生感染住院及壓瘡感染住院之影響因素。結果：2002-2006年首次使用居家護理服務的居家失能老人共4,856人，校正其他因素後，高經濟組較低經濟組老人少發生居家護理低訪視情形(O.R. =0.92,95% CI: 0.86-0.99,p=0.0307)，少發生因感染住院(HR=0.95,95% CI: 0.92-0.98,p=0.0025)，少因壓瘡感染住院之風險(HR=0.92,95% CI:n0.85-1.00,P=0.0422)。結論：全民健保雖提供居家護理服務，但低經濟組之失能老人使用居家護理訪視次數較低，且有較差的照護品質；建議相關單位應朝低社經者提供更完善服務如考量 居家護理交通費補助、加強出院準備服務與居家護理訪案時的專業照護指導及加強其居家環境衛生改善等方向努力。

Objectives: The aims of this study were to determine the effects of the economic status of the disabled elderly on the risk of too infrequent use of homecare and the quality of long-term care. Methods: The subjects of the study were a retrospective cohort of disabled elderly in Taiwan who received homecare services for the first time and were covered by the National Health Insurance from 2002 to 2006. A generalized estimate equation (GEE) used for the logistic regression was utilized to analyze the factors affecting the risk of fewer homecare visits (＜3 times per year). The factors affecting the risks of infection-related hospitalization or pressure sore-related hospitalization were analyzed with a comprehensive Cox regression. Results: A total of 44,856 disabled elderly received homecare for the first time from 2002 to 2006. After the confounding variables were controlled, the comparative risks between different economic status groups were as follows: the risk of fewer homecare visits for the disabled elderly with high economic status was lower than the risk for those with low economic status (Odds ratio [OR]=0.92; 95% confidence interval [CI], 0.86-0.99, p=0.0307). The risk of infection-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (Hazard ratio [HR]=0.95, 95% CI:0.92-0.98, p=0.0025). The risk of pressure sore-related hospitalization for the disabled elderly with high economic status was lower than the risk for those with low economic status (HR=0.92, 95% CI:0.85-1.00, p=0.0422). Conclusions: The disabled elderly of low economic status made less use of homecare services and received a lower quality of homecare even though it was provided by National Health Insurance for free. Based on these findings, we suggest that policy makers provide a traffic subsidy to the economically disadvantaged disabled elderly who receive homecare services, improve household sanitation, and promote specialized instruction about homecare during discharge planning and home visits.

失能老人 ； 居家護理 ； 經濟狀態 ； 照護品質 ； 全民健保

Disabled elderly, Home nursing, Economic status, Care quality, Health Insurance