《中国康复理论与实践》

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (8): 946-958.doi: 10.3969/j.issn.1006-9771.2026.08.008

• 应用研究 • 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应用评价

唐琪1,2, 吕军1,2,3(), 马春华4(), 黄昊鹰4, 孙嘉遥1,5, 陶冉1,2, 鲁春蕾1,2, 黄爱华4   

  1. 1 复旦大学公共卫生学院， 上海市 200032
    2 复旦大学中国残疾问题研究中心， 上海市 200032
    3 国家老年疾病临床医学研究中心(华山)， 上海市 200040
    4 上海市第二社会福利院， 上海市 202158
    5 复旦大学附属华东医院， 上海市 200040
  • 收稿日期:2026-01-04 修回日期:2026-03-01 接受日期:2026-03-03 出版日期:2026-08-25 发布日期:2026-08-25
  • 通讯作者: 吕军，E-mail： lujun@shmu.edu.cn；
    马春华，E-mail： 2445219050@qq.com
  • 作者简介:唐琪(1990-)，女，汉族，安徽淮北市人，博士，青年副研究员，主要研究方向：卫生政策与管理。
    吕军(1968-)，女，汉族，河北唐山市人，博士，教授，主要研究方向：卫生政策与管理；
    马春华(1971-)，女，汉族，上海市人，副主任护师，主要研究方向：医疗护理与残疾人养护。
  • 基金资助:
    国家社会科学基金重大项目(17ZDA078);上海市民政局科研项目(MZKT-2024-01-23);唐仲英基金会资助项目(C32-0201-2401);中国残疾人联合会2024 年残疾人服务标准研制计划课题

Application evaluation of the care-need grading assessment tool for adult with disabilities in welfare institutions

Tang Qi1,2, Lü Jun1,2,3(), Ma Chunhua4(), Huang Haoying4, Sun Jiayao1,5, Tao Ran1,2, Lu Chunlei1,2, Huang Aihua4   

  1. 1 School of Public Health, Fudan University, Shanghai 200032, China
    2 China Research Center on Disability, Fudan University, Shanghai 200032, China
    3 National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China
    4 Second Social Welfare Institute of Shanghai, Shanghai 202158, China
    5 Huadong Hospital, Fudan University, Shanghai 200040, China
  • Received:2026-01-04 Revised:2026-03-01 Accepted:2026-03-03 Published:2026-08-25 Online:2026-08-25
  • Contact: Lü Jun, E-mail： lujun@shmu.edu.cn；Ma Chunhua, E-mail： 2445219050@qq.com
  • Supported by:
    National Social Science Foundation (Major)(17ZDA078);Shanghai Municipal Civil Affairs Bureau Research Project(MZKT-2024-01-23);Cyrus Tang Foundation Project(C32-0201-2401);Disability Service Standard Development Plan of China Disabled Persons' Federation

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摘要：

目的 应用并系统评价福利机构成年残疾人照护服务需求分级评估工具。

方法 2025年6月至7月，选择上海市4家残疾人照护机构，采用自研福利机构成年残疾人照护服务需求分级评估工具对1 002例成年残疾人实施评估。采用照护需求分级结果和等级分布变化评价其应用效果；采用各功能维度得分差异、各等级降维聚类散点图、校标变量评价应用效度；采用平均评估时长和学习曲线评价其应用效率；采用各等级服务清单的分布特征和映射关系评价效用价值。

结果 评估后各等级分布为：1级84例、2级298例、3级92例、4级246例、5级282例，呈现由原体系较高等级向新体系中、低等级转移的趋势。工具在各功能维度上均表现强辨别力(P < 0.001)，区分效度良好；所划分的5个等级在降维空间中呈现清晰的聚类边界，结构效度良好；分级结果与年龄、残疾类型、残疾等级、患病种类数和主要疾病诊断等校标间理论预期一致(P < 0.05)，外部效度良好。工具评估时长中位数5.80 min，且表现出显著的学习效应(P = 0.037)，体现出较高的评估效率。形成针对不同等级的服务清单，各等级间的服务内容存在梯度差异，并映射各等级照护需求特征，体现效用价值。

结论 本研究应用的评估工具将成年残疾人照护服务需求有效划分为5个等级，工具效度良好、评估效率高，所形成的不同照护等级服务清单可用于指导实践，适用于成年残疾人需求分级评估。

关键词: 成年残疾人, 福利机构, 照护服务需求, 分级评估工具, 应用评价

Abstract:

Objective To apply and systematically evaluate the care-need grading assessment tool for adults with disabilities in welfare institutions.

Methods From June to July, 2025, four disability care institutions in Shanghai were selected, and a total of 1 002 adults with disabilities were assessed using the self-developed care-need grading assessment tool for adults with disabilities in welfare institutions. The application effectiveness of the tool was evaluated by analyzing the classification results of care need grading and the reclassification in grade distribution. The application validity was assessed through score differences across functional dimensions, reduced-dimension clustering scatter plots for each grade, and external variables. The application efficiency was evaluated based on the average assessment duration and learning curves. The application utility value was assessed through the distribution characteristics and mapping relationships of service lists across different grades.

Results The distribution across disability levels was 84 in Level 1, 298 in Level 2, 92 in Level 3, 246 in Level 4, and 282 in Level 5, indicating a trend where individuals from higher levels in the original system shifted toward the middle and lower levels of the new system. The tool demonstrated strong discriminatory power across the four functional dimensions (P < 0.001), indicating favorable discriminant validity. The five classified levels exhibited clear clustering boundaries in the reduced-dimension space, reflecting robust structural validity. The classification results were consistent with theoretical expectations regarding external variables, including age, disability type, disability grade, number of comorbidities, and primary clinical diagnoses (P < 0.05), demonstrating sound external validity. The median assessment duration was 5.80 minutes, with a significant learning effect (P = 0.037), showcasing high efficiency. Finally, service lists tailored to different care levels were developed, where service content exhibited graded differences across care levels and accurately mapped the care-need characteristics of each grade, reflecting substantial utility value.

Conclusion This tool can classify the care needs of adults with disabilities into five levels, with sound validity and high assessment efficiency; while the resulting service lists for different care levels can be used to guide practical implementation, which can be used for the graded assessment of care needs among adults with disabilities.

Key words: adults with disabilities, welfare institutions, care needs, grading assessment tool, application evaluation

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