心臟衰竭病人出院後照護連續性對照護結果及醫療費用之影響

The Effect of Continuity of Post-Discharge Care on Heart Failure Outcomes and Expenses

邱翰憶(Han-Yi Chiu)

指導教授 ： 董鈺琪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/碩士(2015年)

https://doi.org/10.6342/NTU.2015.02545

摘要

背景：過去十年，心臟衰竭病人出院後死亡及再住院風險有增加的趨勢，因此病人需要持續性的接受門診照護。
目的：探討心臟衰竭病人出院後12個月內，門診照護連續性與照護結果及費用之相關性。
方法：本研究使用全民健康保險研究資料庫全國代表性樣本。以2007年至2011年因心臟衰竭出院，且出院後12月內門診就醫三次以上者為研究對象。依出院後12月內門診資料計算照護連續性指標(Continuity of Care Index, COCI)，等分為低、中、高三組。研究以廣義估計方程式控制病患及醫院特質，探討COCI低、中、高三組對出院後12個月內照護結果及總醫療費用之相關性。
結果：本研究共納入2,927人。心臟衰竭病人出院後照護連續性較高與12個月內住院次數及再住院風險較低有關，照護連續性高與12個月內死亡風險較低有關，而照護連續性較高與總醫療費用較低有關。
結論：心臟衰竭病人出院後門診照護連續性高與降低住院次數、再住院風險、死亡風險及總醫療費用有關。

關鍵字

心臟衰竭 ； 照護連續性 ； 照護結果 ； 醫療費用

並列摘要

Background:
Over the past decade, trends in mortality and readmission after discharge have increased among heart failure patients. Thus, patients need to receive consistently outpatient care.
Objectives:
This study was to examine the associations of continuity of outpatient care with outcomes and expenses for heart failure patients in the 12 months after discharge.
Methods:
This study used data from the nationwide representative sample through the National Health Insurance Research Database. Heart failure patients who were discharged from hospital be-tween 2007 and 2011 and had outpatient visits with more than three times were selected for analysis. We measured Continuity of Care Index (COCI) by using outpatient data in 12 months after discharge, and COCI scores were divided into three groups: high, medium, low. General-ized estimating equation was performed after adjustment for patient and hospital characteristics to examine the associations of outpatient continuity with 12 months outcomes and total medical expenses of post-discharge care.
Results:
In this study, a total of 2,927 patients were included. Higher continuity of care after discharge was associated with fewer admissions and lower risk of readmission within 12 months after discharge. High continuity of care was associated with lower risk of 12 months mortality. Higher continuity of care was associated with lower total expenses.
Conclusions:
Heart failure patients who had higher continuity of care after discharge is associated with fewer admissions, lower risk of readmission, decreased risk of mortality and lower total expenses.

並列關鍵字

heart failure ； continuity of care ； outcomes of care ； medical expenses

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