《中国康复理论与实践》

《中国康复理论与实践》 ›› 2025, Vol. 31 ›› Issue (7): 802-811.doi: 10.3969/j.issn.1006-9771.2025.07.007

• 功能测量与评估 • 上一篇    下一篇

福利机构成年残疾人照护服务需求分级评估工具研制

孙嘉遥1, 马春华2, 吕军1,3,4(), 唐琪1,3(), 邵志民5, 胡康宁1, 黄昊鹰2, 黄爱华2   

  1. 1.复旦大学公共卫生学院，上海市 200433
    2.上海市第二社会福利院，上海市 202158
    3.复旦大学中国残疾问题研究中心，上海市 200032
    4.国家老年疾病临床医学研究中心，上海市 200040
    5.复旦大学附属华东医院，上海市 200040
  • 收稿日期:2025-04-27 修回日期:2025-05-08 出版日期:2025-07-25 发布日期:2025-07-30
  • 通讯作者: 吕军(1968-)，女，汉族，河北唐山市人，博士，教授，主要研究方向：卫生管理与卫生政策，E-mail： lujun@shmu.edu.cn； 唐琪(1990-)，女，汉族，安徽淮北市人，博士，副研究员，主要研究方向：卫生政策与管理。E-mail： tangqi@fudan.edu.cn
  • 作者简介:孙嘉遥(1998-)，女，汉族，江苏无锡市人，硕士研究生，主要研究方向：健康服务政策与治理。
  • 基金资助:
    1.上海市民政局科研课题(MZKT-2024-01-23);2.唐仲英基金会资助项目(C32-0201-2401);3.中国残疾人联合会2024年残疾人服务标准研制计划课题;4.国家社会科学基金重大项目(17ZDA078)

Development of a needs assessment tool for grading care services for adults with disabilities in welfare institutions

SUN Jiayao1, MA Chunhua2, LÜ Jun1,3,4(), TANG Qi1,3(), SHAO Zhimin5, HU Kangning1, HUANG Haoying2, HUANG Aihua2   

  1. 1. School of Public Health, Fudan University, Shanghai 200433, China
    2. Second Social Welfare Institute of Shanghai, Shanghai 202158, China
    3. China Research Center on Disability, Fudan University, Shanghai 200032, China
    4. National Clinical Research Center for Geriatrics, Shanghai 200040, China
    5. Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China
  • Received:2025-04-27 Revised:2025-05-08 Published:2025-07-25 Online:2025-07-30
  • Contact: LÜ Jun, E-mail: lujun@shmu.edu.cn; TANG Qi, E-mail: tangqi@fudan.edu.cn
  • Supported by:
    Shanghai Municipal Civil Affairs Bureau Research Project(MZKT-2024-01-23);Tang Zhongying Foundation(C32-0201-2401);China Disabled Persons' Federation 2024 Disability Service Standard Development Plan;National Social Science Foundation of China (Major)(17ZDA078)

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摘要：

目的 研制适用于福利机构的成年残疾人照护服务需求分级评估工具，形成照护需求等级划分标准。

方法 以《国际功能、残疾和健康分类》理论为基础，对国内外照护服务评估标准核心内容进行分析，结合福利机构实践现状，形成评估工具初稿。11位照护服务领域专家对初稿进行论证，根据专家意见修改评估工具。2024年5至6月，在上海市第二社会福利院选择340例成年残疾人进行评估，分析评估工具的信度和效度。采用评估工具对上海市第二社会福利院1 046例评估对象进行评估，采用聚类分析法确定5个照护等级对应的评分区间。

结果 评估工具共包括4个一级维度，11个二级维度，39个三级维度，43个评估指标。专家论证，各维度和指标变异系数均< 0.25，各条目重要性均> 4.63分，满分率均> 0.86。评估工具整体Cronbach α系数为0.956，重测信度0.997，各指标内容效度指数0.83~1.00；探索性因子分析提取4个公因子，累计方差贡献率86.679%；各指标载荷系数为0.675~0.878，各维度间相关系数0.325~0.476。聚类分析将残疾人机构照护需求等级划分为1级(重度)、2级(中重度)、3级(中度)、4级(轻中度)和5级(轻度)。

结论 本研究制定的福利机构成年残疾人照护服务分级评估工具有良好的信效度，可用于机构为残疾人提供针对性照护服务。

关键词: 成年人, 残疾人, 机构照护, 评估工具, 需求分级, 信度, 效度

Abstract:

Objective To develop a tool for assessing the needs for care services for adults with disabilities in welfare institutions, and formulate criteria for classifying care needs.

Methods Based on the theory of the International Classification of Functioning, Disability and Health, the core contents of domestic and international care service assessment standards were analysed, and the first draft of the assessment tool was formed integrating with the current practice of welfare institutions. A total of eleven experts in the field of care services validated the first draft, and the assessment tool was revised according to the experts' opinions. From May to June, 2024, 340 adults with disabilities from Second Social Welfare Institute of Shanghai were graded to analyze the reliability and validity of the assessment tool. And then, 1 046 subjects from Second Social Welfare Institute of Shanghai were graded using the assessment tool, and the scoring intervals for the five levels of care were determined using cluster analysis.

Results The assessment tool included four first-level dimensions, eleven second-level dimensions, 39 third-level dimensions and 43 indicators. The coefficients of variation of each dimension and indicator were less than 0.25 for expert validation, while the average score of the importance of each indicator was above 4.63, with a full score rate more than 0.86. The overall Cronbach's α coefficient was 0.956, the test-retest reliability was 0.997, and the content validity index of each indicator was 0.83 to 1.00. The exploratory factor analysis extracted four common factors, with a cumulative variance contribution of 86.679%; the loading coefficients of indicators were 0.675 to 0.878, and the correlation coefficients among the dimensions were 0.325 to 0.476. Cluster analysis determined the level of institutional care needs as level 1 (severe), level 2 (medium-heavy), level 3 (medium), level 4 (light-moderate), and level 5 (light).

Conclusion The needs assessment tool for care services for adults with disabilities in welfare institutions developed in this study is good in reliability and validity, and can be used in guiding the care services provided for people with disabilities more efficient and targeted.

Key words: adults, people with disabilities, institutional care, assessment tools, grading care needs, reliability, validity

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