老人急診病患三天內重返急診相關因素分析

Factors Associated with Three-Day Revisit to Emergency Room among Elderly Patients

陳楚杰(Chu-Chieh Chen) ； 蔡佳妍(Jia-Yan Cai) ； 陳靖宜(Chin-Yi Chen) ； 柯明中(Ming-Chung Ko) ； 湯淑貞(Shu-Chen Tang)

《台灣老年醫學暨老年學會雜誌》 13卷4期 (2018/11) Pp. 205-223

https://doi.org/10.29461/TGGa.201811_13(4).0001

摘要

目的：探討病患、醫師及醫療機構相關特性與老人急診病患三天內重返急診的關係。方法：本研究使用國家衛生研究院發行之全民健康保險研究資料庫2010年百萬人歸人檔資料。首先以2013年所有老人急診病患急診就醫資料分析三天內因相同診斷類別重返急診率、三天內因相同診斷類別到不同醫院重返急診及住院率；其次，使用複邏輯斯迴歸分析自變項與依變項的相關性。以調整後勝算比檢視各單一自變項對依變項有無達統計上的顯著水準，本研究以p＜0.05為達到統計上的顯著水準。統計分析採用SAS 9.4。結果：2013年65歲以上老人急診病患首次急診的就醫人數為27,021人，有1,946人（7.20%）三天內重返急診，有1,790人（6.62%）因相同疾病診斷類別三天內重返急診，有876人（3.24%）因相同疾病診斷類別三天內重返不同醫院急診，有525人（1.94%）因相同疾病診斷類別三天內重返急診住院。結論：本研究發現老人急診病患三天內重返急診率為7.20%，高於多數研究的結果。因此，建議醫療管理者及衛生政策制定者，推動急診醫療提供者接受老年醫學相關訓練，以提升老人急診病人的整體照護品質，降低老人急診病患三天內重返急診率。

關鍵字

老人 ； 急診 ； 返診 ； 全民健康保險

並列摘要

Objectives: This study aims to explore the relationship between three-day revisit to emergency room among elderly patients and its contributing factors related to patients, physicians and hospitals. Methods: Utilizing the National Health Insurance Research Database and the LHID (Longitudinal Health Insurance Database) 2010, the study analyzed the 2013 records about the rate of three-day revisit to emergency room at the same hospital due to health problems in an identical diagnostic category, the rate of three-day revisit to emergency room at different hospitals for health problems in an identical diagnostic category, and the rate of hospitalization following the revisit. Correlation between dependent and independent variables were then analyzed with multivariate logistic regression. The adjusted odd ratio was used to measure the level of statistical significance of each independent variable relative to the dependent variable with a significance level of p＜0.05. SAS 9.4 was used for data analysis. Results: Of the 27,021 elderly patients visiting emergency room in 2013, 1,946 (7.20%) made return visits within 3 days at the same hospitals, 1,790 (6.62%) were due to health problems in identical diagnostic categories, 876 (3.24%) made return visits within three days at different hospitals due to health problems in identical diagnostic categories, and 525 (1.94%) were hospitalized. Conclusion: The 7.20% rate of three-day revisit to emergency room in elderly patients appears to be higher than the results from other studies. Both hospital administrators and health policy makers should therefore promote emergency medical providers to receive geriatric related training so as to help reduce the rate of three-days revisit and to enhance the overall quality of elderly care.

並列關鍵字

elderly ； emergency ； return visits ； National Health Insurance

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