照護連續性對住院醫療利用之影響

The Effects of Continuity of Care on Hospitalizations in Taiwan: Findings from a National Sample

蘇本華(Pen-Hua Su) ； 蔡雅芳(Ya-Fang Tsai) ； 張華蘋(Hua-Pin Chang) ； 梁亞文(Yia-Wun Liang)

《健康科技期刊》 4卷1期 (2017/07) Pp. 44-64

https://doi.org/10.6979/TJHS.201707_4(1).0004

摘要

目的：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，民眾照護連續性性對住院醫療利用的影響。方法：本研究為一縱向研究，分析資料取自國家衛生研究院20萬人抽樣歸人檔，先以2008-2009年門診就醫資料計算照護連續性指數(COCI)，再探討其對民眾2010年住院風險及住院頻率之影響。統計分析方法包含邏輯斯迴歸分析及零膨負二項式迴歸分析。結果：108,197人的照護連續性平均值為0.21。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)。照護連續性顯著影響民眾住院利用的發生風險及住院次數。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，照護連續性有助降低住院醫療利用，顯示醫療政策制訂者應將提升照護連續性列為未來健康照護體系改革重要目標。

關鍵字

照護連續性 ； 住院

並列摘要

Purposes: This study aims to explore the effects of continuity of care (COC) on hospitalizations in Taiwan's universal health care system, which lacks a comprehensive system of family physicians and effective referral mechanisms. Methods: This study is a longitudinal study, and analyzes data from 200,000 patients compiled by the National Health Research Institutes in Taiwan. The continuity of care index was calculated using data regarding outpatient doctor visits in 2008-2009, and its effect on hospitalization risk and hospitalization frequency in 2010 was examined. Multivariate logistic regression and zero-inflated negative binomial regression were performed for statistical analysis. Results: 108,197 subjects were analyzed and the average COC score in Taiwan was 0.21. The results from the regression models revealed that individuals with higher COC are less likely to suffer from hospitalization risks (OR=0.79, 95%CI=0.75-0.82) and have 14.5% fewer (RR=0.855) hospital admissions when compared with individuals with low COC. This study showed that COC was significantly associated with hospitalization risks and the number of hospital admissions. Conclusions: This study showed that COC is associated with decreased hospitalizations and hospital admissions, 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

參考文獻

梁亞文、 陳文意、 張曉鳳(2016)。照護連續性對高齡者急診與非緊急急診之影響探討。台灣公共衛生雜誌。35(2)，152-163。

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黃郁清、支伯生、鄭守夏(2010)。照護連續性與醫療利用相關性探討。台灣衛誌。29，46-53。

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衛生福利部(2015)。中華民國103年全民健康保險醫療統計。台北市：衛生福利部。