照護連續性與醫療利用之相關性探討

The Association between Continuity of Care and Healthcare Utilization in Taiwan

10.6288/TJPH2010-29-01-05

黃郁清(Yu-Ching Huang)；支伯生(Po-Sheng Chih)；鄭守夏(Shou-Hsia Cheng)

照護連續性 ； 醫療利用 ； 急診 ； 住院 ； continuity of care ； healthcare utilization ； emergency department visit ； hospital admission

台灣公共衛生雜誌

29卷1期（2010 / 02 / 01）

46 - 53

繁體中文

目標：瞭解照護連續性在沒有家庭醫師制度的台灣所呈現的狀況，並檢視較佳的照護連續性是否可以減少急診與住院的利用。方法：利用國家衛生研究院全民健康保險學術資料庫，自2006年抽樣歸人檔選取第一至五組總計20萬人資料為研究樣本，共有127,992人納入分析，資料庫中包含樣本的所有門診、急診與住院紀錄。本研究採用Bice與Boxerman所發展的照護連續性指標(Continuity of Care Index)，並利用負二項式迴歸模型檢視其對急診及住院利用的影響。結果：台灣照護連續性指標平均為0.31，利用負二項式迴歸模型，控制其他變項後發現，在照護連續性高中低三組樣本中，照護連續性高者，其急診次數比照護連續性低者少了50.8%，而住院次數少了38.0%，顯示照護連續性與急診及住院利用間呈現負相關。結論：本研究結果與國際文獻相似，在台灣，照護連續性似乎也有助於健康照護結果的改善，如何提高民眾就醫的照護連續性，是值得考慮的健康照護改革方向。

Objectives: To explore the current status of continuity of care in Taiwan, and to examine the association between continuity of care and emergency visits and hospitalizations. Methods: This study used the 2006 National Health Insurance research dataset obtained from the National Health Research Institutes. A total of 127,992 persons were included in the analysis. The dataset provided information about patients’ physician visits, emergency room visits and hospitalizations. We adopted the continuity of care (COC) index developed by Bice and Boxerman for this study. Negative binominal regression was used to examine the association between COC and emergency room visits and hospital admissions while related variables were controlled for in the models. Results: The average continuity of care score in Taiwan was 0.31. The results from the regression models revealed that, among the 3 COC groups, people with high COC made 50.8% fewer emergency room visits and had 38.0% fewer hospital admissions when compared with those with low COC. Conclusions: As in previous studies, our preliminary findings imply that continuity of care improves healthcare outcome. Improving continuity of care should be an important part of future healthcare reform in Taiwan.

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