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題名：臺灣急重症跨區就醫之變化情形：2001~2010年
書刊名：臺灣公共衛生雜誌
作者：李虹映／黃信忠／許怡欣 引用關係／林文德 引用關係
作者(外文)：Lee, Huang-ying／Huang, Hsin-tsung／Hsu, Elsa Yi-hsin／Lin, Wender
出版日期：2014
卷期：33:1
頁次：頁64-74
主題關鍵詞：急重症；跨區就醫；醫療次區域；Emergent care visit；Cross-boundary flow；Medical subregions
原始連結：連回原系統網址new window
相關次數：
  • 被引用次數被引用次數:期刊(3) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:3
  • 共同引用共同引用:36
  • 點閱點閱:89
目標：本研究以急重症就醫流向為基礎，探討過去10年間民眾急重症跨區就醫流向的變化情形。方法：本研究利用全民健康保險資料庫約200萬人的就醫及承保資料做為分析的主要檔案，首先利用保險對象基層醫療利用次數最多地區及投保地區定義其居住地，接著採美國紐約大學急診緊急分類規則將門診之急診案件依其診斷判定急重症，而住院之急診案件則直接視為急重症；接著利用50個醫療次區域做為地區單位，計算各地區在2001及2010年的急重症跨區就醫比例，並以配對t檢定比較此10年間的急重症跨區就醫比例差異，最後將跨區就醫分為低、中、高三組，分別檢定其10年間的急重症跨區就醫比例及急診能量的差異。結果：整體之急重症跨區就醫比例自2001年的43.4%降至2010年的41.2%，但差異未達顯著，而第三個四分位數和第一個四分位數的比值則由2.19降為2.13。急重症跨區就醫比例較高地區10年間的跨區就醫比例有顯著的下降，但平均仍達57.7%。地區的急重症跨區就醫比例愈高，其急診能量有愈小的趨勢。結論：整體而言，我國2001年至2010年急重症跨區就醫比例並沒有顯著的下降，區域間的跨區就醫差異亦未大幅縮小，但急重症跨區就醫比例較高地區的急診能量有顯著的改善，其跨區就醫比例亦有顯著降低，未來應將緊急醫療資源優先分配至跨區就醫比例較高的地區。
Objectives: This study explored the changes in the proportions of cross-boundary emergent care (CBEC) visits from 2001 to 2010 based on the emergent care flow among 50 subregions in Taiwan. Methods: Approximately 2 million randomly sampled representative beneficiaries from the National Health Insurance database were used as the data source for analysis. A modified New York University algorithm was applied to classify emergency department (ED) visits to emergent care, as well as ED visits resulting in hospitalization. Subsequently, 50 medical subregions were used as the analytical units to calculate the proportion of CBEC visits between 2001 and 2010 in Taiwan. Paired t tests were applied to examine the differences in CBEC flow over one decade, and the ratio of the third quartile (Q3) to the first quartile (Q1) was presented to reflect the regional variation in CBEC flow. Finally, the 50 subregions were divided into low, medium, and high groups according to their CBEC flows in 2001, and the differences in the CBEC and emergent care capacities between 2001 and 2010 were compared. Results: The average proportion of CBEC visits nonsignificantly declined from 43.4% in 2001 to 41.2% in 2010. The Q3 to Q1 ratio slightly decreased from 2.19 to 2.13 in that decade. However, the CBEC flow in the subregions in high CBEC groups significantly decreased, accompanied by a significant increase in emergent care capacity, even when the CBEC rate remained as high as 57.7% in 2010. Conclusions: The proportion of CBEC visits did not significantly decrease from 2001 to 2010 in spite of health policies dedicating to allocate emergent care resources more equitably across subregions. Nevertheless, the subregions with higher CBEC flows improved significantly as emergent care capacity was enhanced, in spite of continuously maintaining higher CBEC flow, indicating that allocating more emergent care resources into these subregions is necessary.
期刊論文
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2.Tsai, J. C. H.、Chen, W. Y.、Liang, Y. W.(2011)。Nonemergent emergency department visits under the National Health Insurance in Taiwan。Health Policy，100(2/3)，189-195。  new window
3.Wharam, J. F.、Landon, B. E.、Galbraith, A. A.、Kleinman, K. P.、Soumerai, S. B.、Ross-Degnan, D.(2007)。Emergency department use and subsequent hospitalizations among members of a high-deductible health plan。Journal of the American Medical Association，297(10)，1093-1102。  new window
4.Brazier, J.(1987)。Accounting for cross boundary flows。BMJ，295，898-900。  new window
5.Cooper, R. F.(1986)。Are inpatient cases at a teaching hospital more difficult than district general hospital cases?。Comm Med，8，78-79。  new window
6.Chan, C. L.、Lin, W.、Yang, N. P.、Huang, H. T.(2013)。The association between the availability of ambulatory care and non-emergency treatment in emergency medicine departments: a comprehensive and nationwide validation。Health Policy，110，271-279。  new window
7.林維娟、張鴻仁、王本仁、周穎政、李丞華(20041200)。影響住院病患跨區利用之因素。臺灣公共衛生雜誌，23(6)，453-461。new window  延伸查詢new window
8.Thompson, D. R.、Clemmer, T. P.、Applefeld, J. J.(1994)。Regionalization of critical care medicine: task force report of the American college of critical care medicine。Crit Care Med，22，1306-1313。  new window
9.Billings, J.、Parikh, N.、Mijanovich, T.(2000)。Emergency room use: the new york story。Commonwealth Fund，434，1-12。  new window
10.Burt, C. W.、Arispe, I. E.(2004)。Characteristics of emergency departments serving high volumes of safety-net patients: United States。Vital Health Stat，155，1-16。  new window
11.Wolinsky, F. D.、Liu, L.、Miller, T. R.(2008)。Emergency Department Utilization Patterns Among Older Adults。The Journals of Gerontology Series A Biological Sciences and Medical Sciences，63，204-209。  new window
12.Miller, S.(2012)。The effect of insurance on emergency room visits: an analysis of the 2006 Massachusetts health reform。J Public Econ，96，893-908。  new window
13.Kaskie, B.、Obrizan, M.、Cook, E.(2010)。Defining emergency department episodes by severity and intensity: a 15-year study of medicare beneficiaries。BMC Health Serv Res，10，173。  new window
14.Ballard, D. W.、Price, M.、Fung, V.(2010)。Validation of an algorithm for categorizing the severity of hospital emergency department visits。Med Care，48，58-63。  new window
15.Mistry, R. D.、Brousseau, D. C.、Alessandrini, E. A.(2008)。Urgency classification methods for emergency department visits: do they measure up?。Pediatr Emerg Care，24，870-874。  new window
16.Ng, C. J.、Yen, Z. S.、Tsai, J. C. H.(2011)。Validation of the Taiwan triage and acuity scale: a new computerised five-level triage system。Emerg Med J，28，1026-1031。  new window
17.陳珮青、楊銘欽、江東亮、鄭守夏(20030200)。病人跨區住院與醫療區資源分佈之探討。臺灣公共衛生雜誌，22(1)，27-32。new window  延伸查詢new window
18.Dong, S. L.、Bullard, M. J.、Meurer, D. P.、Blitz, S.、Akhmetshin, E.、Ohinmaa, A.、Holroyd, B. R.、Rowe, B. H.(2007)。Predictive validity of a computerized emergency triage tool。Acad Emerg Med，14(1)，16-21。  new window
19.林民浩、楊安琪、溫在弘(20110800)。利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則。臺灣公共衛生雜誌，30(4)，347-361。new window  延伸查詢new window
20.洪維河、鄭守夏、張睿詒、江東亮(19981000)。臺灣醫療區跨區住院比例之變遷，1985-1995。中華公共衛生雜誌，17(5)，388-394。new window  延伸查詢new window
會議論文
1.王本仁、李待弟(2003)。保險對象就醫流向之分析。中央健康保險署數據處理中心成立週年發表會。台北：衛生福利部中央健康保險署。  延伸查詢new window
研究報告
1.吳肖琪、吳秋芬(2008)。研究跨區域緊急醫療體系之建置規劃--依問卷調查探討其現況 (計畫編號：DOH96-TD-H-113-003)。台北：行政院衛生署醫事處。  延伸查詢new window
2.吳肖琪(2010)。醫療次區域重新劃分及區域輔導評估指標之發展。台北：衛生福利部。  延伸查詢new window
圖書
1.馬惠明、柯昭穎、林志豪、江文莒、溫在弘、紀俊麟(2008)。台灣地區跨區域緊急醫療救護體系之建置規劃。台北：國家災害防救科技中心。  延伸查詢new window
2.衛生福利部(2009)。醫療機構現況及醫院醫療服務量統計年報：醫療院所家數。台北：衛生福利部。  延伸查詢new window
3.衛生福利部(2009)。醫療機構現況及醫院醫療服務量統計年報：醫院專科醫師專任人數統計。台北：衛生福利部。  延伸查詢new window
4.衛生福利部(1996)。醫療網第三期計畫(建立醫療網第二期計畫)。台北：衛生福利部。  延伸查詢new window
其他
1.(2000)。The Center for Health and Public Service Research，http://wagner. nyu.edu/faculty/billings/nyued-background， 2012/08/18。  new window
2.Wennberg, J. E.(1999)。Appendix on the geography of health care in the United States，http://www.dartmouthatlas. org/downloads/methods/geogappdx.pdf， 2012/12/31。  new window
3.衛生福利部(2010)。急診五級檢傷分類基準，http://www.doh.gov.tw/CHT2006/DM/DM2_p01.aspx?class_no=472&now_fod_list_no=11322&level_no=3&doc_no=76943， 2012/08/19。  new window
 
 
 
 
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