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題名：遠距健康照護對可避免住院與醫療利用之影響
書刊名：臺灣公共衛生雜誌
作者：陳文意 引用關係／梁亞文 引用關係／謝輝龍／蔡味娟／莊碧焜／林玉惠 引用關係
作者(外文)：Chen, Wen-yi／Liang, Yia-wun／Hsieh, Hui-lung／Tsai, Wei-chuan／Chuang, Bi-kun／Lin, Yu-hui
出版日期：2016
卷期：35:5
頁次：頁524-541
主題關鍵詞：遠距健康照護；可避免住院；差異中取差異；傾向分數配對；Tel-healthcare；Preventable hospitalizations；Difference-in-differences；Propensity score matching
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(2) 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:2
  • 共同引用共同引用:7
  • 點閱點閱:12
目標：本研究旨在探討遠距健康照護能否減少可避免住院及抑制醫療費用成長？方法：研究對象為中部某醫院遠距健康照護計畫「銀髮族U-Care計劃」之收案個案(實驗組)以及該地區未參與計畫的居民(對照組)。我們以傾向分數配對模型自健保資料庫2009-2011年的醫療利用檔擷取對照組，以住院總次數的成長平均數為中點，區分「高醫療利用成長」與「低醫療利用成長」兩族群，再以差異中取差異迴歸探討遠距健康照護對可避免住院與醫療利用之影響。結果：遠距健康照護使得高醫療利用成長族群的門診次數增加約2次、可避免住院次數減少0.052次，每次住院費用、每次門診費用與門診住院總費用分別約減少8,743、225與15,917點；遠距健康照護使得低醫療利用成長族群住院總次數減少0.036次、門診次數增加約1次。結論：遠距健康照護對高醫療利用成長族群的可避免住院次數與醫療利用有顯著的抑制效果。然而，研究個案參與此計畫無須支付任何費用，對於遠距健康照護有助於健保財務管理的正向效益推論仍須持著謹慎保留的態度。
Objectives: The aim of this study was to investigate whether tel-healthcare intervention could reduce preventable hospitalizations and healthcare expenditures. Methods: The case group was made up of those who participated in the Senior U-Care program (a tel-healthcare intervention) administrated by a hospital in central Taiwan. We utilized the Propensity Score Matching model to create a control group from the National Health Insurance Research Database over the period from 2009 to 2011. All patients in both groups were divided into high growth utilization and low growth utilization groups based on the mean growth in the total number of hospital admissions. The difference-in-differences model was used to investigate the impact of the tel-healthcare intervention on preventable hospitalizations and healthcare utilization. Results: The tel-healthcare intervention increased outpatient visits by approximately 2 but decreased preventable hospital admissions by 0.052 in the high growth utilization group. Additionally, inpatient expenditure (per admission), outpatient expenditure (per visit), and total healthcare expenditure in the high growth utilization group decreased by 8,743, 225, and 15,917 point values respectively due to the tel-healthcare intervention. The tel-healthcare intervention decreased approximately 0.036 inpatient admissions but it increased 1 outpatient visit for the low growth utilization group. Conclusions: Tel-healthcare intervention effectively decreased preventable hospitalization and healthcare expenditures in the high growth utilization group. Nevertheless, the services provided by the tel-healthcare intervention under study were free of charge to participants. We should therefore be cautious about concluding that tel-healthcare intervention would generate a positive effect on the financial management of the national insurance system.
期刊論文
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2.譚秀芬、吳明容、曾泓富(20041200)。臺灣遠距醫療未來遞送模式之探討。中山管理評論，12(6)，65-91。new window  延伸查詢new window
3.林玉惠、陳文意、謝輝龍、蔡味娟、莊碧焜(20131200)。遠距健康照護介入措施對門診醫療利用之影響--以「銀髮族U-Care計畫」為例。長期照護雜誌，17(3)，297-314。  延伸查詢new window
4.周歆凱、甄瑞興、林怡君、蔡明足、陳楚杰、翁林仲(20120900)。A Pilot Study of the Telecare Medical Support System as an Intervention in Dementia Care: The Views and Experiences of Primary Caregivers。The Journal of Nursing Research，20(3)，169-180。new window  new window
5.Jia, H.、Chung, H. C.、Wu, S. S.、Wang, X.、Chumbler, N. R.(2009)。Long-term effect of home telehealth services on preventable hospitalization use。J Rehabil Res Dev，46，557-565。  new window
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7.Weissman, J. S.、Gatsonis, C.、Epstein, A. M.(1992)。Rates of avoidable hospitalization by insurance status in Massachusetts and Maryland。JAMA，268，2388-2394。  new window
8.Blustein, J.、Hanson, K.、Shea, S.(1998)。Preventable hospitalizations and socioeconomic status。Health Affairs (Millwood)，17，177-189。  new window
9.Niti, M.、Ng, T. P.(2003)。Avoidable Hospitalization rates in Singapore, 1991-1998: assessing trends and inequities of quality in primary care。J Epidemiol Community Health，57，17-22。  new window
10.梁亞文、陳文意、林育秀、李卓倫、張曉鳳(20111000)。可避免住院研究回顧對臺灣基層醫療照護的意涵。臺灣公共衛生雜誌，30(5)，409-421。new window  延伸查詢new window
11.Guo, L.、MacDowell, M.、Levin, L.、Hornung, R. W.、Linn, S.(2001)。How are age and payors related to available hospitalization conditions?。Manag Care Q，9，33-42。  new window
12.Giuffrida, A.、Gravelle, H.、Roland, M.(1999)。Measuring quality of care with routine data: avoiding confusion between performance indicators and health outcomes。BMJ，319，94-98。  new window
13.Gill, J. M.(1997)。Can hospitalizations be avoided by having a regular source of care?。Fam Med，29，166-171。  new window
14.Pappas, G.、Hadden, W. C.、Kozak, L. J.、Fisher, G. F.(1997)。Potentially avoidable hospitalizations: inequalities in rates between US socioeconomic groups。American Journal of Public Health，87，811-816。  new window
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16.Ekeland, A. G.、Bowes, A.、Flottorp, S.(2012)。Methodologies for assessing telemedicine: a systematic review of reviews。Int J Med Inform，81，1-11。  new window
17.Wallace, D. L.、Hussain, A.、Khan, N.、Wilson, Y. T.(2012)。A systematic review of the evidence for telemedicine in burn care: with a UK perspective。Burns，38，465-480。  new window
18.Hailey, D.、Roine, R.、Ohinmaa, A.、Dennett, L.(2011)。Evidence of benefit from telerehabilitation in routine care: a systematic review。J Telemed Telecare，17，281-287。  new window
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20.Bergmo, T. S.(2010)。Economic evaluation in telemedicine: still room for improvement。J Telemed Telecare，16，229-231。  new window
21.Ekeland, A. G.、Bowes, A.、Flottorp, S.(2010)。Effectiveness of telemedicine: a systematic review of reviews。Int J Med Inform，79(11)，736-771。  new window
22.Garcia-Lizana, F.、Munoz-Mayorga, I.(2010)。Telemedicine for depression: a systematic review。Perspect Psychiatr Care，46，119-126。  new window
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24.Polisena, J.、Tran, K.、Cimon, K.、Hutton, B.、McGill, S.、Palmer, K.(2009)。Home telehealth for diabetes management: a systematic review and meta-analysis。Diabetes Obes Metab，11，913-930。  new window
25.呂如分、陳靜敏(20101200)。以系統性文獻回顧法探討成人慢性病患遠距居家照護之成效指標。長期照護雜誌，14(3)，335-346。  延伸查詢new window
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29.梁亞文、陳芬如、鄭瑛琳(20080200)。臺灣的可避免住院及其病患社經狀態。臺灣公共衛生雜誌，27(1)，81-90。new window  延伸查詢new window
研究報告
1.衛生福利部(2012)。全民健康保險重要統計資料。臺北：衛生福利部。  延伸查詢new window
2.衛生福利部(2012)。全民健康保險統計。臺北：衛生福利部。  延伸查詢new window
3.南投縣衛生局(2010)。民國99年南投縣衛生統計年報。南投：南投縣衛生局。  延伸查詢new window
圖書
1.Institute of Medicine(1993)。Access to Health Care in America。Washington, DC：National Academy Press。  new window
2.Agency for Health Research and Quality(2007)。Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions。Rockville, MD：Agency for Health Research and Quality。  new window
3.Guo, S.、Fraser, M. W.(2009)。Propensity Score Analysis: Statistical Methods and Applications。Sage Publication。  new window
4.Barro, R. J.、Sala-i-Martin, X.(2004)。Economic Growth。Boston, Massachusetts：Massachusetts Institute of Technology。  new window
5.史聖群(2014)。人情行銷：人情對臺灣銀髮族使用遠距照護系統的運作關係。臺北：臺北大學企業管理研究所。  延伸查詢new window
6.謝松哲(2009)。機構式遠距照顧服務成本效益分析--以北部護理之家為例。臺北：臺北醫學大學醫務管理研究所。  延伸查詢new window
7.劉欝鎬(2008)。偏遠地區導入遠距照護服務之研究--以竹山秀傳醫院遠距照護計畫為例。南投：南開科技大學福祉科技與服務管理研究所。  延伸查詢new window
其他
1.Foland, J.。Avoidable hospitalization: an indicator of inadequate primary care，http://www.state.ct.us/dph/OPPE/brief20001.htm。  new window
2.Connecticut Office of Health Care Assess。Preventable hospitalizations in Connecticut: assessing access to community health services 2005，http://www.ct.gov/ohca/site/default.asp。  new window
3.南投縣醫師公會。醫療院所地圖--南投縣診所地圖，http://www.nantouma.org.tw/ContentAspx/Brovvser00.aspx?isClass=2&setTable=0&type=2&areaID=3。  延伸查詢new window
圖書論文
1.劉景寬(2012)。遠距照護。長期照護理論與實務。新北市：洪葉文化。  延伸查詢new window
2.Heckman, J.、Robb, R.(1985)。Alternative methods for estimating the impact of interventions。Longitudinal Analysis of Labor Market Data。Boston, Massachusetts：Cambridge University Press。  new window
 
 
 
 
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