研究背景：
　　台灣近年高齡人口快速增加，將導致長照服務需要量增加，針對不斷攀升的需求，如何提供合適的長照服務、妥善運用資源為一重要的課題。許多國外研究證據顯示，復能(reablement)服務能有效幫助高齡者提高生活功能、減少持續性的長照服務使用且整體長照服務使用成本較低。而國內的長期照顧十年2.0計畫自2018年導入復能等專業服務，並針對復能服務陸續訂定指引與相關規範，復能服務施行至今已逾4年，有必要執行其成效評估，因此本研究將以新北市為例，探討近年復能服務之成效，以了解現行狀況，作為未來長照服務政策規劃之參考依據。

研究方法：
　　本研究參考Andersen第三階段健康服務利用行為模式做為理論架構，採事前事後控制組比較研究設計。研究使用新北市政府衛生局照顧服務管理資訊平臺進行次級資料分析，納入2018至2020年開案且有使用長期照顧服務之個案，排除意識木僵/昏迷暫無訓練潛能者、0-12歲不適用照顧管理評估量表之生活功能評估者、只有一筆評估紀錄或兩筆評估紀錄間隔少於3個月或超過15個月者，並以使用復能服務6次以上者作為介入組、無使用復能服務者做為對照組，將兩組以性別、年齡、復能需要等級與開案年分進行1:1傾向分數配對，以確保介入組與對照組之可比較性。研究納入個案之傾向、使能、需要因素及長照體系特質作為控制變項，以廣義估計方程式（Generalized Estimating Equation, GEE）分析復能服務介入對日常活動功能（ADL）、工具性日常活動功能（IADL）、情緒及行為型態、主要照顧者負荷及長照需要等級(Case-mix system, CMS)之影響。

研究結果：
　　本研究樣本中有使用復能服務者4251人、沒有使用復能服務者5705人，有使用復能服務個案為42.7%，與全國復能服務使用率為25.5%相比明顯較高。研究結果發現，在以傾向分數1:1配對後，與無使用復能者比較，復能服務介入對日常活動功能(ADLs分數) ( β=0.020)、工具性日常活動功能(IADLs分數) ( β= -0.011)，情緒及行為型態( β= -0.148)與長照需要程度(CMS等級) ( β= -0.033)，皆有顯著改善。對主要照顧者負荷部分雖有改善，但未達到統計上的顯著差異(p=0.06)。而傾向、使能、需要因素與長照體系特質，對於復能服務效果有所影響，以需要因素的影響最為顯著。

結論與建議：
　　復能服務介入有助於改善個案的日常活動功能、工具性日常活動功能、情緒及行為型態狀況與CMS等級。建議檢討現有制度對於復能服務利用與成效之影響、鼓勵復能需要者復能服務之利用以把握個案恢復功能的機會，並考量將ADLs、IADLs、情緒及行為型態、照顧負荷、CMS等級之改變納入未來長照服務成效品質指標參考。

Background:
The elderly population in Taiwan rapidly increased in recent years, which would lead to an increase in the demand for long-term care (LTC) services. Therefore, the provision of appropriate long-term care services and the proper use of resources is an important issue in response to the rising demand. Many international studies have shown that reablement services are effective in helping people improve their physical function, reduce the need for LTC services and lowering the overall cost of LTC services. The Long-Term Care 2.0 Program has introduced professional services such as reablement services since 2018, and has gradually set guidelines and regulations for reablement services. It has been more than four years since the implementation of the reablement service, and it is necessary to conduct an evaluation of its effectiveness. This study will use the LTC data of New Taipei City to explore the effectiveness of reablement services in recent years, in order to know the current LTC provision situation and serve as a reference for future LTC service policy making.

Method:
The study used the Phase 3 of Andersen’s Behavioral Model of Health Services Use as the reference of study framework, and adopted a pretest-protest control group design. This study used the long-term care data of New Taipei City for the secondary analysis. The inclusion criteria are those applied for LTC 2.0 service between 2018 and 2020 and had used the LTC service. The exclusion criteria are those who lost conscious (with no training potential), those aged 0-12 years, those with only one assessment record or two assessment records less than 3 months or more than 15 months apart. Those who used reablement services more than 6 times were the intervention group, and those who did not use reablement services were the control group. Intervention group were matched 1:1 with the control group, the propensity score matching factors are gender, age, level of reablement needs, and the applied year. The study included predisposing, enabling, need, and the long-term care system characteristic as control variables, and the GEE (generalized estimating equation) was used. The aim of this study is investigating the effectiveness of the intervention in reablement services on ADLs (Activities of daily living), IADLs (Instrumental activities of daily living), problem behaviors, caregiver’s burden, and CMS (Case-mix system, CMS) levels.

Result:
In this study, 4251 people used reablement services and 5705 people did not use reablement services. 42.7% of the cases used reablement services, which was higher than the national rate of the reablement services use. The results of the study showed that after matching the intervention group and the control group, the interventions showed significant improvements in ADLs (β=0.020), IADLs (β=-0.011), problem behaviors (β=-0.148), and CMS level (β=-0.033) compared to those who did not use reablement services. Although there was an improvement in the caregiver’s burden , it did not reach a statistically significant difference (p=0.06) with the control group. The propensity, enablement, needs, and long term care system characteristics had an effect on the reablement services, and the most significant effect is need factors.

Conclusion:
Reablement service interventions can help LTC 2.0 cases improve ADLs, IADLs, problem behaviors, and CMS levels. It is recommended to review the impact of the policy on the utilization and effectiveness of reablement services, encourage the utilization of reablement services for people with reablement needs, and to consider including ADLs, IADLs, emotional and problematic behaviors, caregiving load, and CMS levels as reference for future quality indicators of the effectiveness of long-term care services.

誌　謝　　i
摘　要　　ii
Abstract　iv
目　錄　　vi
圖目錄　　viii
表目錄　　ix

第一章 緒論　　　1
　第一節 研究背景　1
　第二節 研究目的　3
　第三節 研究問題　3
　第四節 重要名詞定義　4
第二章 文獻探討　5
　第一節 復能服務與國內復能相關政策　5
　第二節 健康服務利用行為模式　11
　第三節 國內外復能或居家復健服務成效評估之實證研究　15
　第四節 影響復能或居家復健服務利用與成效之因素　26
第三章 研究方法　33
　第一節 研究設計、研究架構與研究假說　33
　第二節 研究資料來源　35
　第三節 研究對象與樣本　36
　第四節 研究變項定義與測量　38
　第五節 樣本處理過程　44
　第六節 統計分析　46
第四章 研究結果　47
　第一節 描述性統計分析　47
　第二節 差異中的差異法及雙變量分析　61
　第三節 廣義估計方程式　93
第五章 討論　　　107
　第一節 研究方法討論　107
　第二節 研究結果討論　110
　第三節 研究限制　113
第六章 結論與建議　114
　第一節 結論　　　114
　第二節 建議　　　114

參考文獻　116
附　錄　　120

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