動機及目的:氣喘盛行率持續快速增加,使醫療耗用不斷上漲,本研究針對「小兒氣喘緩解期中醫優質門診照護試辦計畫」之探討,由氣喘病童、醫療提供者、醫療政策特質來瞭解參加中醫小兒氣喘試辦計畫與否,其醫療資源耗用之差異。研究方法:以試辦計畫當介入因素,參加試辦計畫患童為實驗組,未參加任何氣喘試辦計畫且就醫特質相近患童為對照組。資料來源為國家衛生研究院提供之「全民健康保險學術研究資料庫」2005至2007年之健保申報資料檔,實驗組共計128人,對照組則以實驗組性別、年齡交叉分佈分析後篩選128人。研究結果:實驗組參與計畫後,住、急診醫療次數與費用均下降。不同特質探討發現:5歲以下參加試辦計畫患童與其他年齡相比成效較差;不同就醫層級別,層級越高門、急診醫療資源耗用下降差異越大;參加計畫次數越多,醫療次數與費用下降最多。實驗組與對照組相比,對照組醫療次數與費用較實驗組高,實驗組相較於對照組確實有明顯改善。結論與建議:實施氣喘疾病管理後,確實達到降低急性氣喘發作的頻率,與發作的嚴重度之目的。建議醫院管理者積極參與,及早適應並規劃其運作模式;衛生主管機關可擴大適用範圍,訂定回饋指標及獎懲規範,避免醫療院所偏重爭取給付,而忽略醫療品質與病患就醫權益。
Purpose: This study is to explore the effect of medical service cost down for the asthma children of Taiwan who participate in the high quality pediatric asthma outpatient clinic project. Methods: Based on “National Health Insurance Research Database”, 128 participators included in experimental group who were enrolled in the data base from 2005 to 2007 and compared with 128 non-participators. There are no significant differences in gender and age distributions between experimental group (participators) and control group (non-participators). Results: The frequency and cost were decreased in both of hospitalization and emergency service. Furthermore, we also found the participators presented a significant decreasing degree of medical resources when they searched for clinic or emergency services in the hospitals with a higher accreditation level. Compared with controls, the experimentalists revealed a superior effect in reductions of therapeutic frequencies and costs. Conclusions and suggestions: The asthma children who participated in the high quality pediatric asthma outpatient clinic project presented a dominant effect to reduce their illness severity and to enhance their therapeutic effectiveness. We suggest that both asthma children and hospital managers pay attention to this program to improve therapeutic policy of asthma.