Abstract: Objective　To develop an integrative long-term care services grading model for the elderly receiving home-based care，community-based care，or nursing facility-based care. Methods　Item pool was established on the basis of literature review，theoretical analysis and qualitative interview. Delphi method was used to screen the items to form the Integrative Long-term Care Services Grading Questionnaire for the Elderly（ILCSGQE）.Then the questionnaire was used to a survey，and according to the results，its items were revised，then the item system was determined finally，and the reliability and validity of the model〔Integrative Long-term Care Services Grading Model for the Elderly（ILCSGME） 〕 with the item system derived from the questionnaire was tested. Comprehensive scoring method，trisection method，and cluster analysis were used to calculate the total score，item grading of the ILCSGME，and dependency state grading covered by the ILCSGME，respectively. Results　The final item system of the ILCSGME consists of 7 first-tier items and 119 second-tier items. The Cronbach's α for the 7 first-tier items ranged from 0.782 to 0.986，and the re-measured Pearson correlation coefficients were 0.917-0.980（P<0.05）. 4 first-tier items，activities of daily living，cognitive ability，fall risk and pressure ulcer risk were selected from the most widely used and mature scales. But other 3 first-tier items，medical and nursing services，abnormal manifestations/symptoms and needs of self-care knowledge were developed by our research team. The results of Bartlett's sphericity test ranged from 0.745 to 0.883. The common factors extracted by principal component analysis were 4，3 and 1 in turn，explaining 68.044%，59.492% and 65.395% of the total variance，respectively. After confirmatory factor analysis，the revised common factors were 4，4 and 3，respectively. The weights of the 7 first-tier items were 0.24，0.15，0.15，0.12，0.12，0.11 and 0.11，respectively. The total score calculated by the comprehensive scoring method were divided into 5 grades：independent，low dependency，medium dependency，high dependency and very high dependency. The higher the grade，the lower the total score was，indicating the intensity or difficulty of care for the elderly is greater.Conclusion　The 7 first-tier items in the ILCSGME were proved to have good reliability and validity. The comprehensive scoring method was easy to use when calculating the total score of the model，and the division of assessment for all grades of dependency state was good. So the model can comprehensively，concretely and accurately assess the dependence state of elderly people，and can provide an aid for the study of the classified pricing system of long-term care insurance.

Key words: Aged, Long-term care, Classification evaluation, Comprehensive evaluation

摘要： 目的　构建适用于居家、社区及养老服务机构的普适性“老年长期照护分级综合评价模型”。方法　在文献研究、理论析取及质性访谈基础上建立模型指标项目池；采用德尔菲法初步筛选指标形成老年长期照护分级评估问卷；采用问卷调查法再次筛选指标形成最终模型指标体系并进行信效度检验；采用综合评分法计算模型总分，三等分法探讨指标分级，聚类分析法探讨模型分级。结果　最终模型指标体系包括7个一级指标和119个二级指标。7个一级指标的Cronbach's α系数为0.782~0.986，重复测量Pearson相关系数为0.917~0.980（P<0.05）。其中，日常生活能力、认知能力、跌倒风险、压疮风险这4个一级指标采用目前已广泛应用且十分成熟的量表；医疗护理项目、异常表现/症状、自我照护知识需求这3个指标均为本研究自主建立，Bartlett's球形检验结果0.745~0.883，探索性因子分析主成分分析萃取公因子依次为4、3、1个，对总累计方差贡献率分别达68.044%、59.492%、65.395%；经验证性因子分析，修正后公因子分别为4、4、3个。7个一级指标权重依次为0.24、0.15、0.15、0.12、0.12、0.11、0.11，应用综合评分法计算总分后模型可分为5级，分别为：无须依赖、轻度依赖、中度依赖、重度依赖、极重度依赖，级别越高总分越低，表示所需照护强度、力度或难度就越大。结论　老年长期照护分级综合评价模型7个一级指标均具有良好的信效度，采用综合评分法计算模型总分简便易行，各级评分区分度较好，能较全面、具体、确切地反映老年人群对他人照护的依赖程度，可为后期长期护理保险分级定价制度研究提供参考依据。

关键词: 老年人, 长期照护, 分级评估, 综合评价法