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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 董鈺琪 | |
dc.contributor.author | Han-Yi Chiu | en |
dc.contributor.author | 邱翰憶 | zh_TW |
dc.date.accessioned | 2021-06-15T13:36:40Z | - |
dc.date.available | 2016-02-24 | |
dc.date.copyright | 2016-02-24 | |
dc.date.issued | 2015 | |
dc.date.submitted | 2016-01-27 | |
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Med Care 1986; 24:511-8. 47. Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care 1977; 15:347-9. 48. Chu HY, Chen CC, Cheng SH. Continuity of care, potentially inappropriate medication, and health care outcomes among the elderly: evidence from a longitudinal analysis in Taiwan. Med Care 2012; 50:1002-9. 49. OECD library. Doctors consultations per capita, 2009 and change between 2000 and 2009. Available at: http://goo.gl/wdiVML. Accessed November 11. 50. Raddish M, Horn SD, Sharkey PD. Continuity of care: is it cost effective? Am J Manag Care 1999; 5:727-34. 51. 支伯生:醫療照護連續性與急診醫療利用之相關性探討。台北市:臺灣大學衛生政策與管理研究所碩士論文,2007;65p。 52. Chen CC, Cheng SH. Better continuity of care reduces costs for diabetic patients. Am J Manag Care 2011; 17:420-7. 53. Cheng SH, Chen CC, Hou YF. A longitudinal examination of continuity of care and avoidable hospitalization: evidence from a universal coverage health care system. Arch Intern Med 2010; 170:1671-7. 54. Lin IP, Wu SC, Huang ST. Continuity of care and avoidable hospitalizations for chronic obstructive pulmonary disease (COPD). J Am Board Fam Med 2015; 28:222-30. 55. Cheng SH, Hou YF, Chen CC. Does continuity of care matter in a health care system that lacks referral arrangements? Health Policy Plan 2011; 26:157-62. 56. Lien HM, Chou SY, Liu JT. Hospital ownership and performance: evidence from stroke and cardiac treatment in Taiwan. J Health Econ 2008; 27:1208-23. 57. Blumenthal D, Mort E, Edwards J. The efficacy of primary care for vulnerable population groups. Health Serv Res 1995; 30:253-73. 58. Gill JM, Mainous AG, 3rd. The role of provider continuity in preventing hospitalizations. Arch Fam Med 1998; 7:352-7. 59. Brousseau DC, Meurer JR, Isenberg ML, Kuhn EM, Gorelick MH. Association between infant continuity of care and pediatric emergency department utilization. Pediatrics 2004; 113:738-41. 60. Flores AI, Bilker WB, Alessandrini EA. Effects of continuity of care in infancy on receipt of lead, anemia, and tuberculosis screening. Pediatrics 2008; 121:e399-406. 61. Gill JM, Mainous AG, 3rd, Nsereko M. The effect of continuity of care on emergency department use. Arch Fam Med 2000; 9:333-8. 62. Mainous AG, 3rd, Gill JM. 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 1998; 88:1539-41. 63. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992; 45:613-9. 64. Agresti A. An Introduction to Categorical Data Analysis. 2nd ed., Hoboken, NJ: Wiley-InterscienceI, 2007. 65. Katz MH, Cunningham WE, Fleishman JA, et al. Effect of case management on unmet needs and utilization of medical care and medications among HIV-infected persons. Annals of Internal Medicine 2001; 135:557-65. 66. Ezekowitz JA, Van Walraven C, McAlister FA, Armstrong PW, Kaul P. Impact of specialist follow-up in outpatients with congestive heart failure. CMAJ 2005; 172:189-94. 67. Hernandez AF, Greiner MA, Fonarow GC, et al. Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. Jama 2010; 303:1716-22. 68. 張瑋庭:照護連續性與老年慢性病患照護結果的關係-以個別醫師或醫療院所為測量基礎之比較。台北市:臺灣大學健康政策與管理研究所碩士論文,2013;92p。 69. Lambrew JM, DeFriese GH, Carey TS, Ricketts TC, Biddle AK. The effects of having a regular doctor on access to primary care. Med Care 1996; 34:138-51. 70. Stewart AL, Grumbach K, Osmond DH, Vranizan K, Komaromy M, Bindman AB. Primary care and patient perceptions of access to care. J Fam Pract 1997; 44:177-85. 71. Wasson JH, Sauvigne AE, Mogielnicki RP, et al. Continuity of outpatient medical care in elderly men. A randomized trial. JAMA 1984; 252:2413-7. 72. Gill JM. Can hospitalizations be avoided by having a regular source of care? 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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51504 | - |
dc.description.abstract | 背景:過去十年,心臟衰竭病人出院後死亡及再住院風險有增加的趨勢,因此病人需要持續性的接受門診照護。
目的:探討心臟衰竭病人出院後12個月內,門診照護連續性與照護結果及費用之相關性。 方法:本研究使用全民健康保險研究資料庫全國代表性樣本。以2007年至2011年因心臟衰竭出院,且出院後12月內門診就醫三次以上者為研究對象。依出院後12月內門診資料計算照護連續性指標(Continuity of Care Index, COCI),等分為低、中、高三組。研究以廣義估計方程式控制病患及醫院特質,探討COCI低、中、高三組對出院後12個月內照護結果及總醫療費用之相關性。 結果:本研究共納入2,927人。心臟衰竭病人出院後照護連續性較高與12個月內住院次數及再住院風險較低有關,照護連續性高與12個月內死亡風險較低有關,而照護連續性較高與總醫療費用較低有關。 結論:心臟衰竭病人出院後門診照護連續性高與降低住院次數、再住院風險、死亡風險及總醫療費用有關。 | zh_TW |
dc.description.abstract | Background:
Over the past decade, trends in mortality and readmission after discharge have increased among heart failure patients. Thus, patients need to receive consistently outpatient care. Objectives: This study was to examine the associations of continuity of outpatient care with outcomes and expenses for heart failure patients in the 12 months after discharge. Methods: This study used data from the nationwide representative sample through the National Health Insurance Research Database. Heart failure patients who were discharged from hospital be-tween 2007 and 2011 and had outpatient visits with more than three times were selected for analysis. We measured Continuity of Care Index (COCI) by using outpatient data in 12 months after discharge, and COCI scores were divided into three groups: high, medium, low. General-ized estimating equation was performed after adjustment for patient and hospital characteristics to examine the associations of outpatient continuity with 12 months outcomes and total medical expenses of post-discharge care. Results: In this study, a total of 2,927 patients were included. Higher continuity of care after discharge was associated with fewer admissions and lower risk of readmission within 12 months after discharge. High continuity of care was associated with lower risk of 12 months mortality. Higher continuity of care was associated with lower total expenses. Conclusions: Heart failure patients who had higher continuity of care after discharge is associated with fewer admissions, lower risk of readmission, decreased risk of mortality and lower total expenses. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T13:36:40Z (GMT). No. of bitstreams: 1 ntu-104-R02848031-1.pdf: 1880164 bytes, checksum: 27e7bf8534fc2a331a3e3b12be373ba6 (MD5) Previous issue date: 2015 | en |
dc.description.tableofcontents | 致謝 i
中文摘要 ii Abstract iii 目錄 iv 表目錄 vi 圖目錄 vii 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 3 第三節 研究重要性 3 第二章 文獻探討 4 第一節 心臟衰竭 4 第二節 照護連續性相關概念 8 第三節 門診照護連續性與照護結果及醫療費用之關係 15 第四節 實證研究:出院後照護連續性對心臟衰竭病人照護結果的影響 20 第五節 文獻小結 22 第三章 研究方法 23 第一節 研究架構 23 第二節 研究假說 25 第三節 研究對象 26 第四節 資料來源與處理流程 27 第五節 研究變項 30 第六節 統計分析 35 第四章 研究結果 36 第一節 樣本特徵與各變項分布情形 36 第二節 研究自變項與各變項之雙變項分析 40 第三節 研究依變項與控制變項之雙變項分析 47 第四節 研究變項與照護結果及醫療費用之多變項分析 64 第五章 討論 75 第一節 研究方法討論 75 第二節 研究結果討論 77 第三節 研究限制 79 第六章 結論與建議 80 第一節 結論 80 第二節 建議 81 參考文獻 82 | |
dc.language.iso | zh-TW | |
dc.title | 心臟衰竭病人出院後照護連續性對照護結果及醫療費用之影響 | zh_TW |
dc.title | The Effect of Continuity of Post-Discharge Care on Heart Failure Outcomes and Expenses | en |
dc.type | Thesis | |
dc.date.schoolyear | 104-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 李玉春,鄭守夏 | |
dc.subject.keyword | 心臟衰竭,照護連續性,照護結果,醫療費用, | zh_TW |
dc.subject.keyword | heart failure,continuity of care,outcomes of care,medical expenses, | en |
dc.relation.page | 89 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2016-01-27 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
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