可避免住院研究回顧對台灣基層醫療照護的意涵

A Literature Review of Preventable Hospitalizations: Implications for Primary Care in Taiwan

10.6288/TJPH2011-30-05-01

梁亞文(Yia-Wun Liang)；陳文意(Wen-Yi Chen)；林育秀(Yu-Hsiu Lin)；李卓倫(Jwo-Leun Lee)；張曉鳳(Hsiao-Feng Chang)

可避免住院 ； 門診敏感照護狀況 ； 基層醫療 ； Preventable hospitalization ； ambulatory care sensitive conditions ； primary care

台灣公共衛生雜誌

30卷5期（2011 / 10 / 15）

409 - 421

繁體中文

健保局採取多項措施減緩醫療支出增加，但成效有限。若能減少可避免住院醫療費用，將可舒緩健保財務惡化。本文回顧國內外研究對可避免住院的訂定原則、疾病與影響因子，期開啟國內對此議題的重現並提出建議。本文發現研究依疾病碼定義明確、住院率高、具文獻依據且可經由基層醫療提供照護等原則，訂定出11-24種可避免住院。國內外研究均發現，性別、年齡、社經地位、健康狀況、地理區域、照護連續性是顯著影響因子；國外研究另發現種族、婚姻狀況、有無保險、保險類別、基層醫師人力為顯著影響因子。未實施全民健保的國家，有無保險及保險類別是顯著因子，但實施全民健保的國家，個人社經狀況及醫療資源的影響可能凌駕保險。可避免住院可用以衡量基層醫療照護可近性，亦可監控門診照護結果品質，在台灣全民健康保險即將邁入以公平、品質、效率為核心精神的二代健保之際，建議將可避免住院列為例行收集之正式衛生統計指標，並發展台灣版的可避免住院表列。

The Bureau of National Health Insurance adopted several policies to control rising healthcare expenditures; however, the results were limited. The financial burden on National Health Insurance can be reduced by avoiding expenditures for preventable hospitalizations. This article provides a brief review of criteria for preventable hospitalizations, describes diseases associated with preventable hospitalizations, and summarizes factors associated with preventable hospitalizations in a review of the national/international literature. It concludes with our recommendations for further work and a look at what the future might hold. Criteria developed for considering the appropriateness of hospitalization include clarity in the definition and coding of diagnoses, a hospitalization rate of at least 1/10,000, the existence of prior studies, and if the hospitalization could potentially have been avoided through utilization of primary health care. We selected 11-24 ICD codes as a list of ambulatory care sensitive conditions (ACSCs). Gender, age, socioeconomic status (SES), health status, geography, and provider continuity were found to be associated with preventable hospitalizations both internationally and in Taiwan; however, race, marital status, insurance status, insurance type, and primary care provider were also found to be significant in other countries. For countries without universal insurance, insurance status and insurance type were significant predictors; however, for countries with universal insurance, SES and medical resources were significant predictors. The measurement of preventable hospitalization can be adopted to indicate both the accessibility and effectiveness of primary care. Since Second Generation National Health Insurance that focuses on equity, quality, and efficiency is now being contemplated, this study suggests that the rate of preventable hospitalizations should be considered as one of the health indicators in conjunction with Taiwan's ACSCs list.

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