虚拟养老模式效果初探

发布时间：2018-04-28 20:31

本文选题：人口老龄化 + 养老模式　；参考：《兰州大学》2017年硕士论文

【摘要】：背景人口老龄化是指总人口中老年人比例逐年增高的现象,通常国际上将总人口中60岁以上老年人的比例达到10%或65岁以上老年人的比例达到7%作为评判某一国家或地区步入老龄化的重要标准。2016年中国统计年鉴数据显示我国65岁老年人达到了14386万人,占全国总人口的10.5%。2017年,《“十三五”国家老龄事业发展和养老体系建设规划》提出了更高、更新的目标,如建设居家社区养老服务工程,即依托城乡社区公共服务综合信息平台,整合建立居家社区养老服务信息平台、呼叫服务系统和应急救援服务机制,为居家老年人提供助餐、助洁、助行、助浴、助医、日间照料等服务;同时实施“互联网+”养老工程,建设虚拟养老院。我国首家虚拟养老院于2007年10月在江苏省苏州市沧浪区创建,并投入运营,沧浪区虚拟养老院是信息化养老的典型案例之一。甘肃省兰州市城关区基于沧浪区的经验,于2009年12月建立了我国西北地区第一家虚拟养老院。尽管全国政策支持开展虚拟养老,但尚未有研究系统阐述和评价接受虚拟养老服务的老年人的生活质量、成本投入等问题的探究。目的本研究旨在通过系统评价与实况调研相结合的方法,明确接受虚拟养老服务的老年人的生活质量,成本投入情况,为虚拟养老工程的开展和国家政策的制定提供参考。方法主要采用三种研究方法:1)系统评价再评价:对现有国内外养老模式进行探究并用AMSTAR进行评价,为本文进行研究奠定理论基础;2)系统评价:运用系统评价的方法对虚拟养老模式的效果与成本进行分析,主要从通过系统评价明确接受虚拟养老服务的老年人的生活质量,并分析成本投入情况;结果(1)养老模式的系统评价主要来源于发达国家,根据AMSTAR评分结果,该主题系统评价的平均质量较低,只有少部分系统评价符合支撑指南推荐意见的标准。研究方案未注册、未检索灰色文献、及未说明相关利益冲突是该主题系统评价AMSTAR评分不高的主要原因。(2)在虚拟养老模式的效果与成本分析的系统评价中,共纳入13篇RCT。在生活质量评价方面,总体评分和患者健康状况上,虚拟养老组和对照组的差异无统计学意义;在心理与认知状态以及抑郁、焦虑评分上,虚拟养老组高于对照组,而在躯体功能水平上,虚拟养老组比对照组的评分低。卫生保健服务的使用方面,在门诊就诊次数、急诊就诊次数、住院次数、住院天数、护士或全科医生家访次数和呼吸治疗师家访次数上虚拟养老组与对照组的差异均无统计学意义;同时两组在病死率上的差异也无统计学意义,但在住院率上,虚拟养老组低于对照组。满意度方面,在1~3月和6月的总体满意度评分上,虚拟养老组高于对照组,而在9月及12月的总体满意度评价、卫生保健机构用户或辅助生活机构老年人的内部和外部系统满意度上,两组的差异无统计学意义。成本方面,在门急诊就诊费用、门诊检查和药费、住院费用、护士家访费用、呼吸治疗师家访费用、总费用上两组的差异均无统计学意义。结论1)虚拟养老模式是居家养老模式的创新,通过企业化管理与市场机制运营,依托信息管理平台,大大提高了居家养老服务模式的效益,缩短了养老服务的经济成本,虚拟养老作为新型养老模式,在我国社会文化背景下可行性较高。2)低质量证据提示虚拟养老模式对比常规护理或常规居家养老服务在总体生活质量、卫生保健服务的使用和成本投入上的差异无统计学意义。国内尚未开展相关试验性研究验证虚拟养老模式在中国实施的成本效果,因此建议加大此领域的研究投入。
[Abstract]:Background population aging is the phenomenon that the proportion of the elderly in the total population is increasing year by year. Generally, the proportion of people aged 60 or above in the total population reaches 10% or over 65 years old to reach 7% as an important criterion for judging a country or region into aging in.2016 year, China Statistics yearbook data show that China is 65 years old The annual population has reached 143 million 860 thousand people, accounting for the 10.5%.2017 year of the total population of the country. The "13th Five-Year" "the national aging development and the pension system construction plan" proposed a higher, updated target, such as the construction of home community pension service project, that is, relying on the comprehensive information platform of urban and rural community public service, to integrate and establish the home community pension service information flat. Taiwan, call service system and emergency rescue service system for the elderly at home can provide meals, help clean, help, help bath, medical help, day care and other services; at the same time the implementation of "Internet plus pension" project, the construction of virtual nursing homes. The first virtual nursing home in China created in Canglang District of Suzhou city in Jiangsu Province on October 2007, and put into operation, Canglang District Virtual nursing home is one of the typical cases of informatization for the aged. Based on the experience of cangang District in Lanzhou city of Gansu Province, the first virtual nursing home in Northwest China was established in December 2009. Although the national policy supports the development of virtual endowment, there is no systematic exposition and evaluation of the elderly who accept virtual care for the elderly. The purpose of this study is to clarify the quality of life of the elderly and the cost input through the combination of systematic evaluation and live survey, and provide reference for the development of virtual pension project and the formulation of national policy. The main methods are three methods: 1) System evaluation re evaluation: the existing domestic and foreign old-age mode is explored and evaluated with AMSTAR to lay a theoretical foundation for this study. 2) systematic evaluation: the effect and cost of virtual pension model are analyzed by the method of system evaluation, mainly from the students who accept virtual pension service through the system evaluation. The result (1) the system evaluation of the old-age model mainly comes from the developed countries. According to the AMSTAR score, the average quality of the system is low, only a few system evaluation meets the standard of the recommendation of the support guide. The research scheme is not registered, the grey literature is not retrieved, and the correlation is not explained. Conflict of interest is the main reason for the poor evaluation of AMSTAR in this subject system. (2) in the systematic evaluation of the effect and cost analysis of the virtual pension model, the differences in the quality of life assessment, the overall score and the health status of the patients were not statistically significant, and the difference between the virtual group and the control group was not statistically significant; in the psychological and cognitive state, there was no significant difference in the evaluation of the quality of life. On the level of depression and anxiety, the virtual care group was higher than the control group, and the virtual care group was lower than the control group in the physical function level. The use of health care service, the number of out-patient visits, the number of emergency visits, the number of hospitalization, the number of days of hospitalization, the number of visits of nurses or general practitioners, and the number of visits of the respiratory therapists home. There was no significant difference in the difference between the aged group and the control group; at the same time, there was no significant difference in the mortality rate between the two groups, but in the rate of hospitalization, the virtual care group was lower than the control group. In terms of satisfaction, the virtual elderly group was higher than the control group in the overall satisfaction score of 1~3 month and June, and the overall satisfaction evaluation was evaluated in September and December, There was no statistically significant difference between the two groups on the internal and external system satisfaction of the elderly in the health care institutions or the auxiliary living institutions. In the cost aspect, there was no significant difference in the total cost of the two groups in the total cost, the out-patient inspection and the cost of out-patient inspection and medicine, the cost of hospitalization, the cost of home visits of the nurses, the home visits of the respiratory therapists. 1) virtual old-age pension model is the innovation of home old-age mode. Through enterprise management and market mechanism operation, relying on information management platform, it greatly improves the benefit of home old-age service mode, shortens the economic cost of the old-age service, the virtual endowment is a new type of old-age model, and is low quality.2 under the social and cultural background of our country. The quantitative evidence suggests that the virtual pension model compares the general quality of life with the general quality of life, the use of health care service and the cost input. Research input.

【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：D669.6

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