兒童照護連續性與可避免住院之相關性研究

Abstract

研究背景與目的 「可避免住院」是一衡量基層照護可近性、品質及效率照護結果的重要指標，國外研究發現「照護連續性」為重要影響因素之一。為了解臺灣可避免住院之疾病及其影響因素，本研究目的為尋找適用於國內兒童可避免住院疾病，並探討照護連續性指標與可避免住院疾病之相關性。 研究方法 首先以問卷調查國內15位兒科相關專家，選出適合於國內兒童的可避免住院疾病。再根據全民健康保險學術研究資料庫2005年百萬承保抽樣歸人檔，研究樣本共有139,867位12歲以下兒童，以羅吉斯迴歸及負二項式迴歸分析照護連續性與照護結果的情形。 研究結果 本研究依照專家共識選入氣喘、脫水/耗竭、下呼吸道疾病、腸胃炎等共12項兒童可避免住院疾病。以Usual Provider of Care（UPC）、Continuity of Care Index（COCI）、Sequential Continuity（SECON）做為照護連續性指標，以不同面向的指標來測量病人實際的照護連續情形，結果顯示三種照護連續性指標與住院、可避免住院都呈負相關且存在劑量效應關係，意指照護連續性指標分數越高，其住院的風險越低。 結論 國內外兒童可避免住院疾病略有不同，國際疾病分類碼（ICD-9-CM）也有所差異，但照護連續性越好確實有效降低兒童住院及可避免住院，本研究未來可做為醫院提升照護品質及國家政策制定之參考。

Background: Avoid Hospitalization is a vital indicator of measuring basic healthcare performances for accessibility, quality and efficiency.Several research studies showed that it is affected by the continuity of care.The objectives of this study were to find the suitable pediatric ambulatory care sensitive conditions（ACSCs）in Taiwan, and to discuss the association between child continuity of care indicator and pediatric avoid hospitalization. Methods: We conducted a survey among 15 pediatric-related professionals,in order to choose the appropriate ACSCs for children in Taiwan.139,867 patients under age 12 were analyzed from Taiwan National Health Insurance Research Database in 2005 according to criteria decided by the survey results.Then we analyzed the data by using logistic regression and negative binominal regression models. Results: There were 12 pediatric ACSCs selected in agreement with pediatric professionals, including asthma, dehydration, lower respiratory condition and gastroenteritis. By using usual provider of care（UPC）, continuity of care index（COCI）, and sequential continuity（SECON） as the indicators for continuity of care, we inspected the actual situations for child continuity of care in different aspects. The results performed a negative correlation and a dose-response effect relationship between continuity of care and avoid hospitalization, which indicated the higher scores for continuity of care, the lower hospital admission risk. Conclusions: Although the pediatric ACSCs and the ICD-9-CM Medical Codes in Taiwan differ from those in other countries, a good child continuity of care can effectively reduce hospitalization and avoid hospitalization among children. This study can be the future direction for healthcare quality improvement in both organizational and governmental policy levels.