請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/40494
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 吳淑瓊 | |
dc.contributor.author | Mei-Ju Chi | en |
dc.contributor.author | 紀玫如 | zh_TW |
dc.date.accessioned | 2021-06-14T16:49:16Z | - |
dc.date.available | 2010-09-11 | |
dc.date.copyright | 2008-09-11 | |
dc.date.issued | 2008 | |
dc.date.submitted | 2008-07-30 | |
dc.identifier.citation | Aday, L. A., & Andersen, R. M. (1974). A framework for the study of access to medical care. Health Services Research, 9(3), 208-220.
Aday, L. A., & Shortell, S. M. (1984). Indicators and Predictors of Health Services Utilization. New York: John Wiley & Sons. Al Snih, S., Markides, K. S., Ray, L. A., Freeman, J. L., Ostir, G. V., & Goodwin, J. S. (2006). Predictors of healthcare utilization among older Mexican Americans. Ethnicity & Disease, 16(3), 640-646. Andersen, R. M. (1968). A behavioral model of families' use of health services: Chicago, IL: Center for Health Administration studies, University of Chicago. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care:does it matter? Journal of health and social behavior, 36, 1-10. Andersen, R. M., & Newman, J. F. (1973). Societal and individual determinants of medical care utilization in the US. The Milbank Memorial Fund quarterly. Health and society, 51, 95-124. Anderson, G. F. (2003). Physician, public, and policymaker perspectives on chronic conditions. Archives of Internal Medicine, 163(4), 437-442. Anderson, G. F. (2005). Medicare and chronic conditions. New England Journal of Medicine, 353(3), 305-309. Anderson, G. F., & Horvath, J. (2002). Chronic Conditions: Making the Case for Ongoing Care. NJ: Robert Wood Johnson Foundation's Partnership for Solutions: Princeton. Anderson, G. F., & Horvath, J. (2004). Chronic Conditions: Making the Case for Ongoing Care: 2004 update. NJ: Robert Wood Johnson Foundation's Partnership for Solutions: Princeton. Anderson, G. F., & Knickman, J. R. (2001). Changing the chronic care system to meet people's needs. Health Affairs, 20(6), 146-160. Anderson, J. G. (1973). Health services utilization: framework and review. Health Services Research, 8(3), 184-199. Atchison, K. A., & Andersen, R. M. (2000). Demonstrating successful aging using the International Collaborative Study for Oral Health Outcomes. Journal of Public Health Dentistry, 60(4), 282-288. Auslander, G. K., Soskolne, V., & Ben-Shahar, I. (2005). Utilization of Health Social Work Services by Older Immigrants and Veterans in Israel. Health & Social Work, 30(3), 241-251. Baldwin, L.-M., Klabunde, C. N., Green, P., Barlow, W., & Wright, G. (2006). In search of the perfect comorbidity measure for use with administrative claims data: does it exist? Medical Care, 44(8), 745-753. Balkrishnan, R., Christensen, D. B., & Bowton, D. L. (2002). Self-reported health status, prophylactic medication use, and healthcare costs in older adults with asthma. Journal of the American Geriatrics Society, 50(5), 924-929. Barker, N. N., & Himchak, M. V. (2006). Environmental issues affecting elder abuse victims in their reception of community based services. Journal of Gerontological Social Work, 48(1-2), 233-255. Bass, D. M., & Noelker, L. S. (1987). The Influence of Family Caregivers on Elder's Use of In-Home Services: An Expanded Conceptual Framework. Journal of Health & Social Behavior, 28(2), 184-196. Bayliss, E. A., Steiner, J. F., Fernald, D. H., Crane, L. A., & Main, D. S. (2003). Descriptions of barriers to self-care by persons with comorbid chronic diseases. Annals of Family Medicine, 1(1), 15-21. Bazargan, M. (1998). Emergency departmant utilization, hospital admissions, and physician visits among elderly African American persons. Gerontologist, 38(1), 25-36. Berenson, R. A. (2002). The critical characteristics of Medicare beneficiaries and implications for Medicare reform. Washington DC.: The Robert Wood Johnson Foundation. Bergeron, E., Lavoie, A., Moore, L., Clas, D., & Rossignol, M. (2005). Comorbidity and age are both independent predictors of length of hospitalization in trauma patients. Canadian Journal of Surgery, 48(5), 361-366. Boult, C., Kane, R. L., Louis, T. A., Boult, L., & McCaffrey, D. (1994). Chronic conditions that lead to functional limitation in the elderly. Journal of Gerontology, 49(1), M28-36. Bradley, E. H., Curry, L. A., McGraw, S. A., Webster, T. R., Kasl, S. V., & Andersen, R. (2004). Intended use of informal long-term care: the role of race and ethnicity. Ethnicity & Health, 9(1), 37-54. Bradley, E. H., McGraw, S. A., Curry, L., Buckser, A., King, K. L., Kasl, S. V., et al. (2002). Expanding the Andersen model: the role of psychosocial factors in long-term care use. Health Services Research, 37(5), 1221-1242. Brand, C. A., Jones, C. T., Lowe, A. J., Nielsen, D. A., Roberts, C. A., King, B. L., et al. (2004). A transitional care service for elderly chronic disease patients at risk of readmission. Australian Health Review, 28(3), 275-284. Burnette, D., & Mui, A. C. (1999). Physician utilization by Hispanic elderly persons: national perspective. Medical Care, 37(4), 362-374. Cafferata, G. L. (1987). Marital status, living arrangements, and the use of health services by elderly persons. Journal of Gerontology, 42(6), 613-618. Chapleski, E., Lichtenberg, P. A., Dwyer, J. W., Youngblade, L. M., & Tsai, P. F. (1997). Morbidity and comorbidity among Great Lakes American Indians: predictors of functional ability. Gerontologist, 37(5), 588-597. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. Chiang, T. L. (1989). Use of health services by the elderly in the Taipei area. Taiwan i Hsueh Hui Tsa Chih - Journal of the Formosan Medical Association, 88(9), 919-925. Choi, S. (2006). Insurance status and health service utilization among newly-arrived older immigrants. Journal of Immigrant & Minority Health, 8(2), 149-161. Chou, K. L., & Chi, I. (2004). Factors associated with the use of publicly funded services by Hong Kong Chinese older adults. Social Science & Medicine, 58(6), 1025. Cohen, J. W., & Krauss, N. A. (2003). Spending and service use among people with the fifteen most costly medical conditions, 1997. Health Affairs, 22(2), 129-138. Coleman, E. A., Grothaus, L. C., Sandhu, N., & Wagner, E. H. (1999). Chronic care clinics: a randomized controlled trial of a new model of primary care for frail older adults.[see comment]. Journal of the American Geriatrics Society, 47(7), 775-783. de Groot, V., Beckerman, H., Lankhorst, G. J., & Bouter, L. M. (2003). How to measure comorbidity. a critical review of available methods.[see comment]. Journal of Clinical Epidemiology, 56(3), 221-229. DeVol, R., & Bedroussian, A. (2007). An Unhealthy America: The Economic Burden of Chronic Disease: Milken Institute. Di Bari, M., Virgillo, A., Matteuzzi, D., Inzitari, M., Mazzaglia, G., Pozzi, C., et al. (2006). Predictive validity of measures of comorbidity in older community dwellers: the Insufficienza Cardiaca negli Anziani Residenti a Dicomano Study. Journal of the American Geriatrics Society, 54(2), 210-216. Druss, B. G., Marcus, S. C., Olfson, M., Tanielian, T., Elinson, L., & Pincus, H. A. (2001). Comparing the national economic burden of five chronic conditions. Health Affairs, 20(6), 233-241. Evans, R. G., & Stoddart, G. (1990). Producing Health, consuming health care. Social Science and Medicine 31, 1347-1363. Evashwick, C., Conrad, D., & Lee, F. (1982). Factors Related to Utilization of Dental Services by the Elderly. American Journal of Public Health, 72(10), 1129-1135. Evashwick, C., Rowe, G., Diehr, P., & Branch, L. (1984). Factors explaining the use of health care services by the elderly. Health Services Research, 19(3), 357-382. Fillenbaum, G. G., Pieper, C. F., Cohen, H. J., Cornoni-Huntley, J. C., & Guralnik, J. M. (2000). Comorbidity of five chronic health conditions in elderly community residents: determinants and impact on mortality. Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 55A(2), M84-M89. Fisher, G. G., Faul, J. D., Weir, D. R., & Wallace, R. B. (2005). Documentation of chronic disease measures in the Health and Retirement Study (HRS/AHEAD). MI: Survey Reasearch Center Ann Arbor. Fishman, P., Von Korff, M., Lozano, P., & Hecht, J. (1997). Chronic care costs in managed care. Health Affairs, 16(3), 239-247. Fortin, M., Bravo, G., Hudon, C., Vanasse, A., & Lapointe, L. (2005). Prevalence of multimorbidity among adults seen in family practice. Annals of Family Medicine, 3(3), 223-228. Fortin, M., Lapointe, L., Hudon, C., Vanasse, A., Ntetu, A. L., & Maltais, D. (2004). Multimorbidity and quality of life in primary care: a systematic review. Health & Quality of Life Outcomes, 2, 51. Fried, L. P., Bandeen-Roche, K., Kasper, J. D., & Guralnik, J. M. (1999). Association of comorbidity with disability in older women: the Women's Health and Aging Study. Journal of Clinical Epidemiology, 52(1), 27-37. Friedman, B., Jiang, H. J., Elixhauser, A., & Segal, A. (2006). Hospital inpatient costs for adults with multiple chronic conditions. Medical Care Research & Review, 63(3), 327-346. Fuchs, Z., Blumstein, T., Novikov, I., Walter-Ginzburg, A., Lyanders, M., Gindin, J., et al. (1998). Morbidity, comorbidity, and their association with disability among community-dwelling oldest-old in Israel. Journals of Gerontology: Series A: Biological Sciences and Medical Sciences, 53A(6), M447-M455. Gaskin, D. J., Briesacher, B. A., Limcangco, R., & Brigantti, B. L. (2006). Exploring racial and ethnic disparities in prescription drug spending and use among Medicare beneficiaries. The American Journal Of Geriatric Pharmacotherapy, 4(2), 96-111. Gijsen, R., Hoeymans, N., Schellevis, F. G., Ruwaard, D., Satariano, W. A., & van den Bos, G. A. (2001). Causes and consequences of comorbidity: a review. Journal of Clinical Epidemiology, 54(7), 661-674. Glynn, R. J., Monane, M., Gurwitz, J. H., Choodnovskiy, I., & Avorn, J. (1999). Aging, comorbidity, and reduced rates of drug treatment for diabetes mellitus. Journal of Clinical Epidemiology, 52(8), 781-790. Greenfield, S., Apolone, G., McNeil, B. J., & Cleary, P. D. (1993). The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Medical Care, 31(2), 141-154. Guralnik, J. M. (1996). Assessing the impact of comorbidity in the older population. Annals of Epidemiology, 6(5), 376-380. Guralnik, J. M., & Kaplan, G. A. (1989). Predictors of healthy aging: prospective evidence from the Alameda County study. American Journal of Public Health, 79(6), 703-708. Guralnik, J. M., LaCroix, A. Z., Everett, D. F., & Kovar, M. G. (1989). Aging in the Eighties: The Prevalence of Comorbidity and Its Association With Disability. Washington, DC: DHHS(NCHS). Hall, S. F. (2006). A user's guide to selecting a comorbidity index for clinical research. Journal of Clinical Epidemiology, 59(8), 849-855. Henton, F. E., Hays, B. J., Walker, S. N., & Atwood, J. R. (2002). Determinants of Medicare home healthcare service use among Medicare recipients. Nursing Research, 51(6), 355-362. Himelhoch, S., Weller, W. E., Wu, A. W., Anderson, G. F., & Cooper, L. A. (2004). Chronic medical illness, depression, and use of acute medical services among Medicare beneficiaries. Medical Care, 42(6), 512-521. Hoffman, C., Rice, D., & Sung, H. Y. (1996). Persons with chronic conditions: Their prevalence and costs. JAMA, 276(18), 1473-1479. Hosmer, D. W., & Lemeshow, S. (1999). Applied survival analysis : regression modeling of time to event data New York: Wiley. Howell, S., Silberberg, M., Quinn, W. V., & Lucas, J. A. (2007). Determinants of remaining in the community after discharge: results from New Jersey's Nursing Home Transition Program. The Gerontologist, 47(4), 535-547. Hwang, W., Weller, W., Ireys, H., & Anderson, G. (2001). Out-of-pocket medical spending for care of chronic conditions. Health Affairs, 20(6), 267-278. Incalzi, R. A., Capparella, O., Gemma, A., Landi, F., Bruno, E., Di Meo, F., et al. (1997). The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. Journal of Internal Medicine, 242(4), 291-298. Ishizaki, T., Imanaka, Y., Oh, E., Kuwabara, K., Hirose, M., Hayashida, K., et al. (2004). Association of hospital resource use with comorbidity status and patient age among hip fracture patients in Japan. Health Policy, 69(2), 179-187. Janz, N. K., Champion, V. L., & Strecher, V. J. (2002). The Health Belief Model. In K. Glanz, B. K. Rimer & F. M. Lewis (Eds.), Health behavior and health education: theory, research, and practice. SF: Jossey-Bass. Johansen, H. L., Wielgosz, A. T., Nguyen, K., & Fry, R. N. (2006). Incidence, comorbidity, case fatality and readmission of hospitalized stroke patients in Canada. Canadian Journal of Cardiology, 22(1), 65-71. John, R., Kerby, D. S., & Hennessy, C. H. (2003). Patterns and impact of comorbidity and multimorbidity among community-resident American Indian elders. Gerontologist, 43(5), 649-660. Joyce, G. F., Keeler, E. B., Shang, B., & Goldman, D. P. (2005). The lifetime burden of chronic disease among the elderly. Health Affairs, 24 (Suppl 2), 18-29. Kales, H. C., Blow, F. C., Copeland, L. A., Bingham, R. C., Kammerer, E. E., & Mellow, A. M. (1999). Health care utilization by older patients with coexisting dementia and depression. American Journal of Psychiatry, 156(4), 550-556. Kane, R. L., Ouslander, J. G., & Abrass, I. B. (2004). Essentials of Clinical Geriatrics New York McGraw-Hill. Kane, R. L., Priester, R., & Totten, A. M. (2005). Meeting the challenge of chronic illness: Johns Hopkins University Press, Baltimore, MD. Keith, V. M., & Jones, W. (1990). Determinants of health services utilization among the black and white elderly. Journal of Health & Social Policy, 1(3), 73-88. Krause, C. M., Jones, C. S., Joyce, S., Kuhn, M. E. J., Curtin, K., Murphy, L. P., et al. (2006). The impact of a multidisciplinary, integrated approach on improving the health and quality of care for individuals dealing with multiple chronic conditions. American Journal of Orthopsychiatry, 76(1), 109-114. Kubrin, A. I. (1995). The Role of Health Insurance in the Use of Health Services among the Non-Elderly. Journal of Health & Social Policy, 6(4), 73-90. Kunik, M. E., Snow, A. L., Molinari, V. A., Menke, T. J., Souchek, J., Sullivan, G., et al. (2003). Health care utilization in dementia patients with psychiatric comorbidity. Gerontologist, 43(1), 86-91. Kuo, T., & Torres-Gil, F. M. (2001). Factors Affecting Utilization of Health Services and Home- and Community-Based Care Programs by Older Taiwanese in the United States. Research on Aging, 23(1), 14. Kurtz, M. E., Kurtz, J. C., Given, C. W., & Given, B. A. (2005). Utilization of services among elderly cancer patients--relationship to age, symptoms, physical functioning, comorbidity, and survival status. Ethnicity & Disease, 15(2 Suppl 2), S17-22. Landi, F., Onder, G., Cesari, M., Barillaro, C., Lattanzio, F., Carbonin, P. U., et al. (2004). Comorbidity and social factors predicted hospitalization in frail elderly patients. Journal of Clinical Epidemiology, 57(8), 832-836. Lee, Y., Choi, K., & Lee, Y. K. (2001). Association of comorbidity with depressive symptoms in community-dwelling older persons. Gerontology, 47(5), 254-262. Levine, S., Reyes, J., Schwartz, R., Schmidt, D., Schwab, T., & Leung, M. (2004). Disease management of the frail elderly population. Disease Management & Health Outcomes, 14(4), 235-244. Librero, J., Peiro, S., & Ordinana, R. (1999). Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. Journal of Clinical Epidemiology, 52(3), 171-179. Lo, A. Y., Hedley, A. J., Pei, G. K., Ong, S. G., Ho, L. M., Fielding, R., et al. (1994). Doctor-shopping in Hong Kong: implications for quality of care. International Journal for Quality in Health Care, 6(4), 371-381. Lorig, K., Hurwicz, M., & Sobel, D. (2005). A national dissemination of an evidence-based self-management program: a process evaluation study. Patient education and counseling, 59(1), 69-79. Madigan, E. A., Tullai-McGuinness, S., & Neff, D. F. (2002). Home health services research. Annual Review Of Nursing Research, 20, 267-291. Matsui, K., Goldman, L., Johnson, P. A., Kuntz, K. M., Cook, E. F., & Lee, T. H. (1996). Comorbidity as a correlate of length of stay for hospitalized patients with acute chest pain. Journal of General Internal Medicine, 11(5), 262-268. McGee, D., Cooper, R., Liao, Y., & Durazo-Arvizu, R. (1996). Patterns of comorbidity and mortality risk in blacks and whites. Annals of Epidemiology, 6(5), 381-385. McKinlay, J. B. (1972). Some approaches and problems in the study of the use of services--an overview. Journal of Health & Social Behavior, 13(2), 115-152. Mechanic, D. (1978). The patient's perspective of his illness: The study of illness behavior. In D. Mechanic (Ed.), Medical Sociology New York: Free Preso. Medicare Prescription Drug, Improvement, and Modernization Act 0f 2003, Public Law 108-173 C.F.R. (2004). Menotti, A., Mulder, I., Nissinen, A., Giampaoli, S., Feskens, E. J., & Kromhout, D. (2001). Prevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly). Journal of Clinical Epidemiology, 54(7), 680-686. Miller, B., Campbell, R. T., Davis, L., Furner, S., Giachello, A., Prohaska, T., et al. (1996). Minority use of community long-term care services: a comparative analysis. Journals of Gerontology Series B-Psychological Sciences & Social Sciences, 51(2), S70-81. Monane, M., Kanter, D. S., Glynn, R. J., & Avorn, J. (1996). Variability in length of hospitalization for stroke. The role of managed care in an elderly population. Archives of Neurology, 53(9), 875-880. Moore, A. A., Giuli, L., Gould, R., Hu, P., Zhou, K., Reuben, D., et al. (2006). Alcohol use, comorbidity, and mortality. Journal of the American Geriatrics Society, 54(5), 757-762. Moore, E. G., Rosenberg, M. W., & Fitzgibbon, S. H. (1999). Activity limitation and chronic conditions in Canada's elderly, 1986-2011. Disability and Rehabilitation, 21(5-6), 196-210. Nabalamba, A., & Millar, W. J. (2007). Going to the doctor. Health Reports: Statistics Canada, 18(1), 23-35. Patrick, D. L., Stein, J., Porta, M., Porter, C. Q., & Ricketts, T. C. (1988). Poverty, health services, and health status in rural America. Milbank Quarterly, 66, 105-136. Perkins, A. J., Kroenke, K., Unutzer, J., Katon, W., Williams, J. W., Hope, C., et al. (2004). Common comorbidity scales were similar in their ability to predict health care costs and mortality. Journal of Clinical Epidemiology, 57(10), 1040-1048. Perrin, E. C., Newacheck, P., Pless, I. B., Drotar, D., Gortmaker, S. L., Leventhal, J., et al. (1993). Issues involved in the definition and classification of chronic health conditions. Pediatrics, 91(4), 787-793. Pruchno, R. A., & McMullen, W. F. (2004). Patterns of service utilization by adults with a developmental disability: type of service makes a difference. American Journal Of Mental Retardation: AJMR, 109(5), 362-378. Rangel, M. C., Schoenbach, V. J., Hogan, V. K., & Weigle, K. A. (2002). #72-S racial/ethnic disparities in influenza vaccination in elderly adults: The role of access to care. Annals of Epidemiology, 12(7), 516. Rangel, M. C., Shoenbach, V. J., Weigle, K. A., Hogan, V. K., Strauss, R. P., & Bangdiwala, S. I. (2005). Racial and Ethnic Disparities in Influenza Vaccination Among Elderly Adults. JGIM: Journal of General Internal Medicine, 20(5), 426-431. Reisine, S. (1987). A path analysis of the utilization of dental services. Community Dentistry & Oral Epidemiology, 15(3), 119-124. Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328-335. Saag, K. G., Doebbeling, B. N., Rohrer, J. E., Kolluri, S., Peterson, R., Hermann, M. E., et al. (1998). Variation in tertiary prevention and health service utilization among the elderly: the role of urban-rural residence and supplemental insurance. Medical Care, 36(7), 965-976. Satariano, W. A., & Ragland, D. R. (1994). The effect of comorbidity on 3-year survival of women with primary breast cancer. Annals of Internal Medicine, 120(2), 104-110. Schlosberg, C. (2004). Medicare Prescription Drug, Improvement and Modernization Act and the impact on care of people with chronic illness: benefit design and implementation issues. Care Management Journals, 5(2), 113-121. Schneeweiss, S., Wang, P. S., Avorn, J., & Glynn, R. J. (2003). Improved comorbidity adjustment for predicting mortality in Medicare populations. Health Services Research, 38(4), 1103-1120. Schoenberg, N. E., Kim, H., Edwards, W., & Fleming, S. T. (2007). Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. Gerontologist, 47(4), 423-437. Schubert, C. C., Boustani, M., Callahan, C. M., Perkins, A. J., Carney, C. P., Fox, C., et al. (2006). Comorbidity profile of dementia patients in primary care: are they sicker? Journal of the American Geriatrics Society, 54(1), 104-109. Shah, M. N., Rathouz, P. J., & Chin, M. H. (2001). Emergency department utilization by noninstitutionalized elders. Academic Emergency Medicine, 8(3), 267-273. Shelton, P. (2002). Disease Management Programs: The Second Generation. Disease Management & Health Outcomes, 10(8), 461-467. Shortell, S. M. (1984). Factors associated with the use of health services. In S. J. Willians & P. R. Torrens (Eds.), Introduction to health services: A Wiley Medical Publication. Smith, S. R., & Kirking, D. M. (1999). Access and use of medications in HIV disease. Health Services Research, 34(1 Pt 1), 123-144. Starfield, B., Hankin, J., Steinwachs, D., Horn, S., Benson, P., Katz, H., et al. (1985). Utilization and morbidity: random or tandem? Pediatrics, 75(2), 241-247. Stein, J. A., Andersen, R., & Gelberg, L. (2007). Applying the gelberg-andersen behavioral model for vulnerable populations to health services utilization in homeless women. Journal Of Health Psychology, 12(5), 791-804. Struijs, J. N., Baan, C. A., Schellevis, F. G., Westert, G. P., & van den Bos, G. A. M. (2006). Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Services Research, 6, 84. Suchman, E. A. (1965). Stages of illness and medical care. Journal of Health & Human Behavior, 6(3), 114-128. Taneva, E., Bogdanova, V., & Shtereva, N. (2004). Acute coronary syndrome, comorbidity, and mortality in geriatric patients. Annals of the New York Academy of Sciences, 1019, 106-110. Thrall, J. H. (2005). Prevalence and costs of chronic disease in a health care system structured for treatment of acute illness. Radiology, 235(1), 9-12. Tsao, J. C. I., Dobalian, A., Myers, C. D., & Zeltzer, L. K. (2005). Pain and Use of Complementary and Alternative Medicine in a National Sample of Persons Living with HIV. Journal of Pain & Symptom Management, 30(5), 418-432. Tu, H. T. (2004). Rising health costs, medical debt and chronic conditions: Center for Studying Health System Change, Washington, DC. Sep 2004. van den Akker, M., Buntinx, F., & Knottnerus, J. A. (1996). Comorbidity or multimorbidity: What's in a name? A review of literature. European journal of general practice, 2(2), 65-70. van den Akker, M., Buntinx, F., Metsemakers, J. F., Roos, S., & Knottnerus, J. A. (1998). Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. Journal of Clinical Epidemiology, 51(5), 367-375. van den Akker, M., Buntinx, F., Roos, S., & Knottnerus, J. A. (2001). Problems in determining occurrence rates of multimorbidity. Journal of Clinical Epidemiology, 54(7), 675-679. van Dijk, P. T. M., Mehr, D. R., Ooms, M. E., Madsen, R., Petroski, G., Frijters, D. H., et al. (2005). Comorbidity and 1-year mortality risks in nursing home residents. Journal of the American Geriatrics Society, 53(4), 660-665. Verbrugge, L. M., Lepkowski, J. M., & Imanaka, Y. (1989). Comorbidity and its impact on disability. Milbank Quarterly, 67(3-4), 450-484. Wagner, E. H., Austin, B. T., & Von Korff, M. (1996). Improving outcomes in chronic illness. Managed Care Quarterly, 4(2), 12-25. Weiner, M., Fan, M.-Y., Johnson, B. A., Kasper, J. D., Anderson, G. F., & Fried, L. P. (2003). Predictors of health resource use by disabled older female Medicare beneficiaries living in the community. Journal of the American Geriatrics Society, 51(3), 371-379. Westert, G. P., Satariano, W. A., Schellevis, F. G., & van den Bos, G. A. (2001). Patterns of comorbidity and the use of health services in the Dutch population. European Journal of Public Health, 11(4), 365-372. Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162(20), 2269-2276. Wolinsky, F. D., Coe, R. M., Miller, D. K., Prendergast, J. M., Creel, M. J., & Chavez, M. N. (1983). Health Services Utilization among the Noninstitutionalized Elderly. Journal of Health & Social Behavior, 24(4), 325-337. Wolinsky, F. D., & Johnson, R. J. (1991). The use of health services by older adults. Journal of gerontology, 46(6), S345-S357. Yu, W., Ravelo, A., Wagner, T. H., & Barnett, P. G. (2004). The relationships among age, chronic conditions, and healthcare costs. American Journal of Managed Care, 10(12), 909-916. Yu, W., Ravelo, A., Wagner, T. H., Phibbs, C. S., Bhandari, A., Chen, S., et al. (2003). Prevalence and costs of chronic conditions in the VA health care system. Medical Care Research & Review, 60(3 Suppl), 146S-167S. Zhang, J. X., Rathouz, P. J., & Chin, M. H. (2003). Comorbidity and the concentration of healthcare expenditures in older patients with heart failure. Journal of the American Geriatrics Society, 51(4), 476-482. 于漱. (1994). 基隆市居家老人健康服務利用行為及相關因素研究. 護理雜誌, 41(3), 27-39. 中央健康保險局. (2007). http://www.nhi.gov.tw/webdata/webdata.asp?menu=&menu_id=26&webdata_id=868. (2008/03/15引用) 內政部. (2007). http://www.moi.gov.tw/stat/. (2008/03/15引用) 民國94年全民健康保險統計. (2005). 台北: 行政院衛生署。 民國94年衛生統計(二)生命統計. (2005). 行政院衛生署。 石嘉玫. (2006). 老年人糖尿病、心臟疾病、高血壓性疾病在西醫門診醫療資源耗用之研究. 高雄醫學大學醫務管理學研究所。 江東亮. (1999). 醫療保健政策--台灣經驗. 台北: 巨流。 江玲玲, 陳喬男, 曹昭懿, & 吳英黛. (2006). 物理治療介入健保系統長期使用呼吸器患者整合性照護之探討. 物理治療, 31(1), 39-45. 吳淑瓊、梁浙西、林惠生. (1993). 老人長期照護研究. 台北: 行政院衛生署委託研究報告。 李世代、范碧玉、黃麗秋. (1999). 全民健康保險慢性病ICD-9-CM分類代碼之研議. 台北: 中央健保局委託研究報告。 林四海. (2006). 台灣地區長期照護機構老人醫療利用之研究-長期照護與全民健康保險臨界服務之界定. 國立中正大學社會福利所。 林正清, 賴美淑, 徐豈庸, 張順全, & 曾芬鬱. (2005). 臺灣全民健康保險資料庫糖尿病診斷的正確性.台灣醫學會雜誌, 104(3), 157-163. 林淑錦, & 白明奇. (2006). 失智症病患主要照顧者的壓力-以家庭生態觀點論之. 長期照護雜誌, 10(4), 412-425. 張麗銀. (1995). 慢性阻塞性肺部疾病患者之因應方式與功能狀況關係之探討. 國立陽明大學臨床護理研究所。 梁煙純. (2004). 我國多重慢性病患盛行率及醫療利用分析. 國立陽明大學醫務管理研究所。 許惠娥、王維芳. (1999). 慢性阻塞性肺疾病個案低效性呼吸型態之急診室護理. 護理新象, 9(3), 40-47. 陳亮汝. (2008). 居家失能老人使用外籍監護工之相關因素分析. 台灣公共衛生雜誌, 27(1), 32-43. 陳音潔. (2001). 病患多次利用急診醫療之影響因素探討---以中部某醫學中心為例. 中國醫藥大學醫務管理學研究所。 曾曉琦. (1996). 健康狀況變化對老人醫療服務利用的影響. 國立台灣大學衛生政策與管理研究所. 廖繼鋐. (1997). 我國中老年醫療使用及對全民健保醫療費用影響之探討. 國立中正大學社會福利學系。 戴桂英、吳淑瓊、江東亮. (2006). 美國老人醫療保險急性後期照護的發展. 臺灣公共衛生雜誌, 25(5), 323-329. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/40494 | - |
dc.description.abstract | 目的:慢性病已是世界已開發國家的主要疾病型態,人口快速老化的結果使老人延續的生命卻必須伴隨慢性病所帶來的健康問題。但多數老人的慢性病問題經常不只一種,使得老人面臨多重慢性病所造成的更大的健康負擔;醫療提供面也未對多重慢性病老人提供有效的整合性照護,更可能導致醫療利用和醫療費用的急速攀升。本研究希望以全國代表性中老年人之樣本,首先瞭解全國中老年人多重慢性病以及其所罹患慢性病類型之集群型態的盛行狀況,幫助釐清目前台灣中老年人多重慢性病問題的嚴重程度;其次則是分析不同多重慢性病集群之間的中老年人之醫療利用,以瞭解不同的醫療服務需求,並提出高醫療利用風險的目標族群,提供衛生政策決策單位先針對醫療服務高利用者規劃介入計畫,以降低後續醫療利用與費用的增長,減輕健保財務負擔。
方法:本研究採用2000年行政院衛生署「全國長期照護需要評估」計畫資料,以全國50歲以上中老年人為母群體進行不等機率抽樣,並採事後加權方式使樣本具有全國中老年人代表性,第一階段樣本共計239,861人。第二階段將對樣本中有長期照護需要者進行深入的後續評估,包括身體功能、認知功能、社會支持與家庭照顧資源、心理健康、復健需求、長期照護服務使用、護理需求專業評估以及社會人口學資料等,此階段納入分析之中老年人失能樣本共計14,094人;並將上述兩階段之中老年人樣本串連2000-2002年全民健保檔,包括門診處方及治療明細檔與住院醫療費用清單明細檔,以高血壓、糖尿病、心臟病、失智症、中風、癌症、關節炎、慢性阻塞性肺病等八種中老年人常見之慢性疾病進行多重慢性病集群盛行率之描述性分析;其次套用Andersen Behavioral Model進行各種罹病集群與醫療服務使用及門診就醫行為之相關分析。 結果:全國中老年人代表性樣本中(N=239,861)有92.2%(N=221,256)在受訪後一年內有使用過至少一次的全民健保資源。在有使用過健保資源的中老年人中,有50.6%的中老年人有一種以上的慢性疾病,27.4%有兩種以上的多重慢性病,平均每人年醫療費用為30,234元。將納入分析之八種慢性病的組合方式(共有255種)分別列出後發現,僅罹患有高血壓者為所有樣本中盛行率最高者,佔7.5%;其次為僅罹患有關節炎者,佔6.2%;第三為合併有高血壓和心臟病者,佔3.4%。在前15種高盛行率之組合中,平均醫療費用最高者為合併有五種慢性病以上者,平均年醫療費用為147,351元;第二為合併有高血壓、糖尿病、心臟病及關節炎者,平均費用為89,208元;第三為合併有高血壓、糖尿病和心臟病者,平均費用為84,143元;第四為僅罹患癌症者,平均費用為82,059元。 上述研究另外發現,罹患有癌症或失智症或連續住院超過90天以上之長期住院患者,平均年醫療費用明顯提高。為避免此族群之過高費用稀釋其他慢性疾病對醫療費用的影響,後續套用Andersen Behavioral Model對失能樣本的分析,將先剔除上述三類超高醫療費用族群。 經第一階段評估後,具有長期照護需要之中老年人共有17,191人,完訪14,094名個案。而所有完訪之失能中老年人樣本中,有95.2%(N=11,617)曾在完訪後一年內使用過健保資源。有76.9%的失能中老年人有一種以上的慢性疾病,57.2%有兩種以上的多重慢性病。觀察失能中老年人主要罹患之慢性病組合(六種慢性病之組合共有63種)發現,合併有高血壓及中風者之盛行率最高,達6.2%;其次為僅罹患有關節炎者,佔5.6%;第三為僅罹患有高血壓者,佔5.4%。 失能中老年人之醫療利用方面,平均每人年醫療費用為78,623元,年門診次數為27.6次,年住院率為35.0%,平均每次住院天數為7天;年急診使用率為33.6%。考慮失能中老年人之前傾、使能及需要因素,及自變項間的交互作用後,以複迴歸比較各慢性病集群與醫療費用遞增的相關發現,對費用增加影響最大的慢性病集群為高血壓合併糖尿病(R2=0.581),其次為合併高血壓、糖尿病及中風(R2=0.578),第三為合併有高血壓、糖尿病、中風及心臟病(R2=0.577)。將所有慢性病集群與上述可能影響醫療費用之因素納入多變項分析後發現,前傾因素中,女性、教育程度較高、有偶者;使能因素中,居住偏城區、具有免部分負擔身份者;需要因素中,有身體功能依賴、任一類慢性病集群;以及中老年人的長期照護安排為「由看護照顧」者,均與醫療費用增加具有顯著相關。 失能中老年人之門診就醫行為則發現,其至基層診所看門診的比例為37.8%,亦即每100次的門診使用中,約有38次在一般基層診所看門診,其他62次則在地區醫院以上之層級使用。若以門診就醫之醫療院所數來看,平均一年會在3.75家不同的醫療院所使用門診;以門診就醫之醫師數來看,失能中老年人平均一年約看6.59位不同的醫師。依個案之就醫層級與就醫醫師數區分就醫行為固定與否,並考慮失能中老年人之前傾、使能及需要因素及自變項間的交互作用後,以邏輯斯迴歸比較各慢性病集群對就醫行為固定的發生機會。合併高血壓和中風者以及僅罹患高血壓者的固定就醫行為發生機會最高;合併有關節炎和慢性阻塞性肺病之固定就醫行為發生機會最低。當所有自變項進入迴歸模式後,和固定就醫行為有顯著相關的因素包括前傾因素中的男性、年齡較輕、教育程度較高、無偶者;使能因素中的居住偏城區、不具有免部分負擔身份者;需要因素中身體功能依賴程度越嚴重、沒有慢性病者;以及中老年人的長期照護安排為「由家人照顧」者。 結論:本研究為台灣第一篇全國中老年人多重慢性病的相關研究。面對越來越多老年人口及其伴隨的多重慢性病問題,加上有限的健保資源,我們應該開始著手規劃整合性的照護管理模式,以單一窗口提供老人多元的醫療需求。因此本研究可提供目前台灣中老年人的多重慢性病狀況以及其醫療需求相關數據,凸顯多重慢性病中老年人的問題重要性以及醫療資源耗用的嚴重性;並經由相關影響因素的分析找出高資源耗用的主要族群。 | zh_TW |
dc.description.abstract | Purpose: Co-morbidity among the elderly is caused by aging population and disease transition. These medical conditions lower quality of life for the elderly and increase their chances of becoming inactive and dysfunctional. From a social perspective, co-morbidity leads to high medical needs and costs which cause the elderly to become an economically disadvantaged group in society. Hence, this study aims to explore the medical needs of patients who have different combinations of multiple chronic diseases in order to improve care strategy for chronic patients.
Method: This study was based on a two-phase “National Long-term Care Evaluation” program of the Department of Health, Executive Yuan. Probability Proportional to Size (PPS) sampling was conducted from the national population, and over 50 years old, for each county/city, respectively. There were 239,861 people completed interviews. During the second-stage evaluation, it was found 14,094 disabled older adults completed interviews. This study collaborated the files of the 2000-2001 health insurance claims and selected 8 types of common chronic diseases among seniors, for the discussion of multiple constellations of chronic diseases, including high blood pressure, diabetes, heart disease, stroke, dementia, cancer, arthritis and chronic obstructive pulmonary disease. Results: Among 239,861 cases, 221,256 people used one of the National Health Insurance services in 2001, accounting for 92.24% of the total cases. Among the NHI users, there are 50.1% of the cases suffering from at least one chronic disease, 27.4% suffering from two types of chronic diseases and above. As a whole, the average medical expense nationwide for middle-aged and seniors is $30,234 NTD. From possible combinations of eight common chronic diseases, it is found hypertension has the highest prevalence rate, 7.5%; arthritis ranks the next (6.2%); the combination of hypertension and heart disease ranks the third (3.4%). In the 22 types of major chronic disease clusters, the average total medical expense for people who have five or more chronic diseases ranks the highest, $147,350.8 NTD; the combination of hypertension, diabetes, heart disease, and arthritis ranks the next, $89,208.3 NTD; the combination of hypertension, diabetes, and heart disease ranks the third, $84,143.0 NTD; cancer ranks the fourth, $82,058.9 NTD. According to our analysis, the cases with cancer or dementia, or long-term hospitalization were super-highly user in NHI. In order to understand the impact to medical expenditures of other common chronic diseases, we only consider the cases without the situation above. During the second-stage evaluation, it was found that 14,094 disabled older adults completed interviews, and 11,617 people (95.2%) used one of the National Health Insurance services in 2001. Among them, there are 76.9% of the cases suffering from at least one chronic disease, 57.2% suffering from co-morbidity. In the major chronic disease constellations, hypertension and stroke was the most prevalent combination (6.2%); the next was arthritis only (5.6%); and the third was hypertension only (5.4%). The average medical expense nationwide for the disabled was $78,623 NTD. The average utilization of outpatient was 27.6 times. There ware 35.0% disabled had at least one hospitalization, and the average length of stay was 7 days. There were 33.6% used at least one emergency service. Comparing with other possible combinations, the greatest impact to medical expenditures was the combination of hypertension with diabetes (R2=0.581). After controlling the predisposing, enabling, need factors and their interactions, the multiple regression showed that female, higher education, coupled, lived in town area, had social welfare, with severe disability, had at least one chronic disease and cared in home by a foreigner worker increased the total medical expenditures. Only 37.8% disabled older adults used outpatient in clinics, most of cases used outpatient in hospitals. They went to 3.75 different clinics or hospitals, and 6.59 different physicians for outpatient services per year. Comparing with possible chronic disease combinations, two combinations of hypertension with stroke and hypertension only were more likely to fix their clinics or physicians, and the combination of arthritis with COPD were more likely to shop around different hospitals and doctors. After controlling the predisposing, enabling, need factors and their interactions, the logistic regression showed that male, younger adults, higher educated, singled, lived in town area, without social welfare, more severe disability, without any chronic disease and cared in home by family members were more likely to fix their doctor-seeking behavior when they need medical services. Conclusions: With the rising aging population, and the accompanying issue of co-morbidity, policy makers in Taiwan should plan an integrated care management model in an environment with limited health insurance resources, which satisfy diverse medical needs for seniors through a single window. This study may provide statistical data concerning co-morbidity among middle-aged and seniors in Taiwan, and their medical needs. It can also present the significance of the issues with regard to seniors with co-morbidity and the exhaustion of medical resources. Through our analysis, the major population that exhausts the medical resources may be discovered. | en |
dc.description.provenance | Made available in DSpace on 2021-06-14T16:49:16Z (GMT). No. of bitstreams: 1 ntu-97-F89845110-1.pdf: 965930 bytes, checksum: e4244dba70a896a2e1787358c981816f (MD5) Previous issue date: 2008 | en |
dc.description.tableofcontents | 中文摘要 I
英文摘要 IV 第一章 前言 1 第一節 研究背景 1 第二節 研究目的 5 第二章 文獻探討 6 第一節 多重慢性病 6 第二節 多重慢性病對醫療服務利用的影響 10 第三節 多重慢性病對費用的影響 15 第四節 醫療服務利用之相關理論 19 第五節 影響醫療服務利用之相關因素 26 第六節 研究啟示 30 第三章 研究方法 32 第一節 研究架構及研究假說 32 第二節 資料來源及研究對象 34 第三節 研究變項定義與測量 36 第四節 研究設計及分析方法 40 第四章 研究結果 43 第一節 全國中老年人慢性病狀況 43 第二節 剔除超高費用者後全國中老年人慢性病狀況 62 第三節 超高費用者之醫療利用狀況 79 第四節 剔除超高費用者後全國失能中老年人慢性病狀況 83 第五節 中風失能者罹病集群、後續追蹤與照護結果影響 105 第五章 結論與討論 110 第一節 重要發現與結論 110 第二節 研究限制 118 第三節 政策與研究建議 120 參考文獻 122 | |
dc.language.iso | zh-TW | |
dc.title | 中老年人多重慢性病集群型態與醫療服務使用之相關研究 | zh_TW |
dc.title | Influence of Multiple Morbidity Combinations on Health Care Utilization of Taiwanese Older Adults | en |
dc.type | Thesis | |
dc.date.schoolyear | 96-2 | |
dc.description.degree | 博士 | |
dc.contributor.oralexamcommittee | 江東亮,戴玉慈,呂碧鴻,黃文鴻 | |
dc.subject.keyword | 多重慢性病集群形態,中老年人,醫療服務利用, | zh_TW |
dc.subject.keyword | Multiple Morbidity Combinations,Taiwanese Older Adults,Health service utilizations, | en |
dc.relation.page | 235 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2008-07-31 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 衛生政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-97-1.pdf 目前未授權公開取用 | 943.29 kB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。