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題名：照護連續性對高齡者急診與非緊急急診之影響探討
書刊名：臺灣公共衛生雜誌
作者：梁亞文 引用關係／陳文意 引用關係／張曉鳳
作者(外文)：Liang, Yia-wun／Chen, Wen-yi／Chang, Hsiao-feng
出版日期：2016
卷期：35:2
頁次：頁152-163
主題關鍵詞：照護連續性；高齡者；急診；非緊急急診；Continuity of care；Elderly；Emergency；Non-urgent ED visits
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  • 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:14
  • 點閱點閱:14
目標：本研究旨在探討實施全民健康保險制度下的台灣高齡者照護連續性對高齡者急診及非緊急急診的影響。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，探討高齡者之照護連續性強度對急診利用及非緊急急診之影響。統計分析方法包含負二項式迴歸分析、邏輯斯迴歸分析，及趨勢卡方檢驗。結果：研究結果顯示，照護連續性顯著影響高齡者急診利用及非緊急急診的發生。在控制其他變項後，迴歸分析結果顯示，相較於低度照護連續性高齡者，中度照護連續性及高度照護連續性的高齡者，其急診利用次數的相對風險分別減少25.17%及35.60%；中度照護連續性及高度照護連續性高齡者，非緊急急診發生風險的勝算比分別為低度照護連續性高齡者的0.87(95% C.I.=0.76-0.99)及0.81(95% C.I.=0.69-0.94)。結論：本研究證實實施全民健康保險制度但缺乏轉診制度的台灣，高齡者照護連續性仍然顯著減少高齡者的急診利用，顯示提升高齡者照護連續性，對高齡者及健康照護系統都有助益。
Objectives: This study determined whether or not continuity of care (COC) is associated with emergency department (ED) visits and non-urgent ED visits by the elderly in Taiwan’s universal health care system. 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. Negative binominal regression and multivariate logistic regression were performed to determine the effects of COC on the ED and non-urgent ED visits in 2010, respectively. Results: This study showed that lower COC was associated with increased ED and non-urgent ED visits. After adjusting for age, gender, socio-economic status, region, physician visits, Charlson index, and physician density, patients in the medium and high COC groups had 25.17% and 35.60% less ED visits, respectively. In an additional analysis of non-urgent ED visits in which we compared patients in the medium and high COC groups with patients who were in the low COC group, we further showed that the probability of having non-urgent ED visits was reduced for elderly patients with medium and high COC (adjusted odds ratio = 0.87 and 95% CI=0.76-0.99; adjusted odds ratio =0.81 and 95% CI=0.69-0.94, respectively). Conclusions: This study showed that higher COC is associated with decreased ED and non-urgent ED visits by the elderly, even in a universal health care system that lacks a referral system. We conclude that improving the COC is beneficial for patients and the health care system.
期刊論文
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2.Christakis, D. A.、Mell, L.、Wright, J. A.、Davis, R.、Connell, F. A.(2000)。The association between greater continuity of care and timely measles-mumps-rubella vaccination。Am J Public Health，90，962-965。  new window
3.Gill, J. M.、Mainous, A. G.(1998)。The role of provider continuity in preventing hospitalizations。Arch Fam Med，7，352-357。  new window
4.Gill, J. M.、Mainous, A. G. III、Nsereko, M.(2000)。The effect of continuity of care on emergency department use。Archives of Family Medicine，9(4)，333-338。  new window
5.Bond, T. K.、Stearns, S.、Peters, M.(1999)。Analysis of chronic emergency department use。Nurs Econ，17，207-213+237。  new window
6.Dickinson, E. T.、Verdile, V. P.、Kostyun, C. T.、Salluzzo, R. F.(1996)。Geriatric use of emergency medical services。Ann Emerg Med，27，199-203。  new window
7.Pitts, S. R.、Niska, R. W.、Xu, J.、Burt, C. W.(2008)。National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary。National Health Statistics Reports，7，1-38。  new window
8.Billings, J.、Parikh, N.、Mijanovich, T.(2000)。Emergency department use: the New York Story。Issue Brief (Commonw Fund)，434，1-12。  new window
9.Menec, V. H.、Roos, N. P.、Black, C.、Bogdanovic, B.(2001)。Characteristics of patients with a regular source of care。Canadian Journal of Public Health，92(4)，299-303。  new window
10.Haggerty, J. L.、Reid, R. J.、Freeman, G. K.、Starfield, B. H.、Adair, C. E.、McKendry, R.(2003)。Continuity of care: A multidisciplinary review。British Medical Journal，327(7425)，1219-1221。  new window
11.Strange, G. R.、Chen, E. H.、Sanders, A. B.(1992)。Use of emergency departments by elderly patients: projections from a multicenter data base。Ann Emerg Med，21，819-824。  new window
12.Wofford, J. L.、Schwartz, E.、Byrum, J. E.(1993)。The role of emergency services in health care for the elderly: a review。J Emerg Med，11，317-326。  new window
13.Starfield, B.(2005)。Measurement of outcome: a proposed scheme。Milbank Q，83，1-11。  new window
14.Ettner, S. L.(1996)。The timing of preventive services for women and children: the effect of having a usual source of care。Am J Public Health，86，1748-1754。  new window
15.O'Connor, P. J、Desai, J.、Rush, W.、Cherney, L. M.、Solberg, L. I.、Bishop, D. B.(1998)。Is having a regular provider of diabetes care related to intensity of care and glycemic control。J Fam Pract，47，290-297。  new window
16.Siemiatycki, J.、Rihardson, L.、Pless, I. B.(1980)。Equality in medical care under national health insurance in Montreal。N Engl J Med，303，10-15。  new window
17.Mustard, C. A.、Mayer, T.、Black, C.、Postl, B.(1996)。Continuity of pediatric ambulatory care in a universally insured population。Pediatrics，98(6 pt.1)，1028-1034。  new window
18.Rogers, J.、Curtis, P.(1980)。The achievement of continuity of care in a primary care training program。Am J Public Health，70，528-530。  new window
19.Hanninen, J.、Takala, J.、Keinanen-Kiukaanniemi, S.(2001)。Good continuity of care may improve quality of life in Type 2 diabetes。Diabetes Res Clin Pract，51，21-27。  new window
20.Kearley, K. E.、Freeman, G. K.、Heath, A.(2001)。An exploration of the value of the personal doctor-patient relationship in general practice。Br J Gen Pract，51，712-718。  new window
21.Schumacher, J. G.、Deimling, G. T.、Meldon, S.、Woolard, B.(2006)。Older adults in the emergency department: predicting physicians’ burden levels。J Emerg Med，30，455-460。  new window
22.梁亞文、蔡哲宏、陳文意(20111000)。非緊急急診病人特性及其相關因素探討。臺灣公共衛生雜誌，30(5)，505-516。new window  延伸查詢new window
23.黃金安、翁瑞宏、蔡文正、胡為雄、楊大羽(20030300)。Analysis of Emergency Department Utilization by Elderly Patients under National Health Insurance。The Kaohsiung Journal of Medical Sciences，19(3)，113-120。  new window
24.Ionescu-Ittu, R.、McCusker, J.、Ciampi, A.(2007)。Continuity of primary care and emergency department utilization among elderly people。CMAJ，177，1362-1368。  new window
25.Christakis, D. A.、Mell, L.、Koepsell, T. D.、Zimmerman, F. J.、Connell, F. A.(2001)。Association of lower continuity of care with greater risk of emergency department use and hospitalization in children。Pediatrics，107，524-529。  new window
26.黃郁清、支伯生、鄭守夏(20100200)。照護連續性與醫療利用之相關性探討。臺灣公共衛生雜誌，29(1)，46-53。new window  延伸查詢new window
27.Bice, T. W.、Boxerman, S. B.(1997)。A quantitative measure of continuity of care。Med Care，15，347-349。  new window
28.陳啟禎、鄭守夏(20130400)。照護連續性之文獻回顧。臺灣公共衛生雜誌，32(2)，116-128。new window  延伸查詢new window
29.Gill, J. M.(1997)。Can hospitalizations be avoided by having a regular source of care?。Family Medicine，29，166-171。  new window
30.梁亞文、洪錦墩、李卓倫(2005)。歐洲各國總額支付制度之跨國比較--以德國、英國與荷蘭為例。健康管理學刊，3(2)，155-172。  延伸查詢new window
31.Starfield, B.(1980)。Continuous confusion?。Am J Public Health，70，117-119。  new window
32.Sturmberg, J.(2000)。Continuity of care: towards a definition based on experiences of practising GPs。Fam Pract，17，16-20。  new window
33.Mainous, A. G. Ⅲ、Gill, J. M.(1998)。The importance of continuity of care in the likelihood of future hospitalization: is site of care equivalent to a primary clinician?。Am J Public Health，88，1539-1541。  new window
會議論文
1.衛生福利部(2015)。全民健康保險20周年國際研討會。臺北：衛生福利部。  延伸查詢new window
2.王信忠、余清祥(2008)。人口老化對全民健保醫療費用影響之探討。「二十一世紀的台灣社會脈動--婦幼人口發展與健康政策」國際學術研討會。台北：台灣人口學會。  延伸查詢new window
學位論文
1.梁煙純(2004)。我國多重慢性病患盛行率及醫療利用分析(碩士論文)。國立陽明大學。  延伸查詢new window
圖書
1.衛生福利部(2013)。95-100年全民健康保險醫療統計年報--急診主要疾病就診率統計--按性別及年齡別分。台北：衛生福利部。  延伸查詢new window
2.劉詩婷(2010)。台灣醫院數分佈對與急診可近性之影響： 長期資料分析。台北：國立台灣大學公共衛生學院健康政策與管理研究所。  延伸查詢new window
3.Greene, William H.(2008)。Econometric Analysis。Upper Saddle River, NJ：Pearson Education。  new window
其他
1.中華民國衛生福利部統計處(2014)。中華民國102年老人狀況調查報告，臺北：衛生福利部。，https://dep.mohw.gov.tw/dos/lp-5095-113-xCat-y102.html。  延伸查詢new window
2.衛生福利部(2015)。民國102年國民醫療保健支出，http://www.mohw.gov.tw/cht/DOS/DMl JP.aspx?f_list_no=557andfod_list_no=365anddoc_no=48453， 2015/09/02。  new window
3.Centers for Medicare and Medicaid Services(2013)。NHE fact sheet，https://www.cms_gov/Research-Statistics-Data-and-Systems/Statis-tics-Trends-and-Reports/NationalHealthExpendData/ NHE-Fact-Sheet.html， 2015/09/02。  new window
4.Healthcare and Cost Utilization Project(2015)。Chronic Condition Indicator，http://www.hcup-us.ahrq.gov/toolssofware/chronic/ chronic.jsp， 2015/11/11。  new window
圖書論文
1.Hwang, M. N.(2008)。Aging society: emerging issues and perspectives from the Republic of China。Longevity and Productivity: Experiences from Aging Asia。Taipei：Asia Productivity Organization。  new window
2.(1999)。Evaluating the geriatric patient。Essentials of Clinical Geriatrics。New York：McGraw-Hill。  new window
 
 
 
 
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