以健保資料庫分析台灣地區醫療照護連續性與基層照護品質

Assessment of Continuity of Care and Primary Care Quality in Taiwan: Findings from a National Sample

蘇本華(Pen-Hua Su)

指導教授 ： 蔡雅芳

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2016年)

摘要

目標：本研究旨在探討在就醫選擇自由且無完善家庭醫師制度及轉診制度的台灣全民健保情境下，民眾照護連續性現況及照護連續性對基層照護品質的影響。
方法：本研究採用縱向研究法，利用2008-2009年門診就醫資料推算照護連續性指數(COCI)做為自變項，探討民眾之照護連續性強度對住院利用及可避免住院之影響。統計分析方法包含邏輯斯迴歸分析、零膨負二項式迴歸分析。
結果：研究結果顯示，照護連續性平均值為0.21(Min=0, Max=1)。迴歸分析結果顯示，高照護連續性者其住院風險的勝算比為低照護連續性者的0.79(95% CI=0.75-0.82)，高照護連續性者較低照護連續性者住院次數減少14.5%(RR=0.855)；高照護連續性者發生可避免住院風險的勝算比為0.79(95% CI=0.71-0.88)，但曾經住院者中，高照護連續性者發生可避免住院風險的勝算比為1.21(95% CI=1.05-1.39)。照護連續性顯著影響民眾住院利用的發生風險、住院次數，及可避免住院的發生
結論：本研究證實實施全民健康保險制度但缺乏家庭醫師制度及轉診制度的台灣，照護連續性與住院利用間存在正向關係，顯示提升照護連續性，將有助健康照護系統。

關鍵字

照護連續性 ； 住院利用 ； 可避免住院

並列摘要

Objectives: This study aims to understand the continuity of care (COC) and to explore the effects of COC on primary care quality in Taiwan’s universal health care system but lacks family physicians and an effective referral mechanism.
Methods: This study used a longitudinal health insurance database compiled for 2010 from the National Health Insurance Research Database in Taiwan. COC was calculated using the continuity of care index (COCI), which reflects visit concentration with individual clinicians. Multivariate logistic regression and zero-inflated negative binomial regression were performed to determine the effects of COC on the hospitalizations, hospital admissions, and preventable hospitalizations in 2010, respectively.
Results: The average COC score in Taiwan was 0.21 (Min=0, Max=1). The results from the regression models revealed that individuals with higher COC are less likely to have hospitalizations (OR=0.79, 95%CI=0.75-0.82) and have fewer 14.5% (RR=0.855) hospital admissions when compared with individuals with low COC. This study further found that the probability of having preventable hospitalizations was reduced for individuals with high COC (OR= 0.79, 95%CI=0.71-0.88), however, among those hospitalized individuals, the probability of having preventable hospitalizations was increased for individuals with high COC (OR=1.21, 95%CI=1.05-1.39). This study showed that individuals with high COC was significantly associated with hospitalizations, hospital admissions, and preventable hospitalizations.
Conclusions: This study showed that COC is associated with decreased hospitalizations, hospital admissions, and preventable hospitalizations, respectively, even in Taiwan’s universal health care system. Improving the COC is beneficial for Taiwan’s health care system.

並列關鍵字

Continuity of care ； hospitalization ； preventable hospitalization

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