台灣六十五歲以上出院病人居家照護分析

目的：我國自1993年起已達聯合國世界衛生組織所定義的高齡化社會之標準，65歲以上老年人口比率達7.1%，老年人易罹患特定疾病(中風、失智症、癌症…等)，面對疾病住院治療，接續返家後的照護需求，社會上有許多的長期照護機構、居家照護等因應而生。而回首台灣走過長期照顧十年計畫（期程為2007年至2016年），依循在地老化的政策目標，建構一個符合多元化、社區化（普及化）、優質化、可負擔及兼顧性別、城鄉、族群、文化、職業、經濟、健康條件差異之長照制度，居家照護是否能有效承接醫療機構之後的照護品質？因此本篇研究將分析台灣在2010年至2013年間的65歲以上之老年人，其罹患特定疾病且接受居家照護下的情形。研究方法：本研究以衛生福利資料科學中心收錄的全民健康保險資料庫進行分析200萬歸人健保數據。研究對象為65歲以上之老年人，探討因中風、失智症、嚴重腦或脊椎損傷、癌症以及嚴重器官衰竭、敗血症等住院者，出院後居家照護之利用，與後續的死亡率、住院利用及急診利用是否存在相關性，並討論投保金額、性別、年齡及特定疾病住院是否修飾居家照護造成的影響。使用之統計方法包含描述性統計、卡方檢定、廣義線性迴歸分析與存活分析。研究結果：對於六十五歲以上出院病人，其接受居家照護後之死亡風險、住院天數、急診次數皆相對於未接受居家照護者高，且有顯著上的差異。結論：本研究結果明顯地在居家照護的介入並沒有對死亡率或死亡相對風險上有所幫助，因個案身體的老化是不可抗逆之因素，又罹患特定疾病，且經濟因素也會影響個人健康，於此治癒疾病之任務非居家照護所能及。而且經濟因素對於取得有品質的居家護理資源存在關鍵，如果政府在健保居家照護上有不提供給付部分，對經濟弱勢者而言便是一大負擔。再者，從本研究之接受居家照護者於指標日前及指標日後，對於醫療利用情形來看，居家照護者仍有相對醫療高度依賴度屬性，因此個案需入住醫院治療疾病而後返家的照護問題，應該要銜接且避免片段式照護，以達醫療機構及居家照護之品質。

關鍵字

居家照護；全民健康保險研究資料庫；醫療利用

並列摘要

Purpose：Since 1993, Taiwan has reached the standards of an aging society defined by the World Health Organization. The proportion of the elderly over 65 years old is 7.1% in Taiwan. The elderly are prone to specific diseases (stroke, dementia, cancer... etc.). In the face of hospitalization for diseases and the need for care after returning home, there are many long-term care institutions and home-care in the society. Looking back at Taiwan’s Ten-Year Long-term Care Program (from 2007 to 2016), and following the policy targets of aging in place, we will build a diversified, community-oriented (popularization), premium, affordable system which also has the differences of gender, urban and rural areas, population, culture, occupation, economy, and health conditions. This study will analyze the situation of the elderly over 65 years old in Taiwan from 2010 to 2013 who suffer from chronic diseases and receive home-care. Research method：This study used the National Health Insurance Research Database collected by the Health and Welfare Data Science Center to analyze the health insurance data of 2 million people. The research object is the elderly who are over 65 years old. This study not only discusses patients’ use of home-care after discharge from hospitals, the mortality rate and the correlation between hospitalization utilization and emergency department utilization of the inpatients who have stroke, dementia, severe brain or spine injury, cancer, severe organ failure, sepsis etc., but also discusses the insurance value, gender, age, and whether they affect the specific illness hospitalization home-care. The statistical methods included descriptive statistics, chi-square test, general linear regression analysis and survival analysis. Results：For senior citizens who are over 65 years of age suffering from chronic diseases and receiving home-care, the mortality risk, the length of stays, and the emergency department utilization are all significantly higher than those who are without home-care. Conclusion：The results of this study show intervention of home-care clearly did not reduce the mortality or relative risk of death because the aging of those suffering from specific diseases is an irreversible factor. Besides, the economic factors also affect personal health. The task of curing diseases is therefore beyond the reach of home-care. Moreover, economic factors are key to obtaining quality home-care resources. If the government does not provide payment for health insurance home care, it will be a great burden for the economically disadvantaged. Furthermore, from the perspective of the medical utilization of the home-care recipients in this study before and after the indicator date, the home-care recipients still have a relatively high degree of medical dependence. Therefore, the individual needs to be admitted to the hospital to treat the disease and then return home. Patients, policy makers, and the health system need to work together, to avoid fragmented care and to achieve the quality in medical institutions and home-care.