請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/49729完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 陳雅美(Ya-Mei Chen) | |
| dc.contributor.author | Wan-Fang Lin | en |
| dc.contributor.author | 林琬芳 | zh_TW |
| dc.date.accessioned | 2021-06-15T11:44:38Z | - |
| dc.date.available | 2026-08-12 | |
| dc.date.copyright | 2016-08-26 | |
| dc.date.issued | 2016 | |
| dc.date.submitted | 2016-08-12 | |
| dc.identifier.citation | 全民健康保險居家照護作業要點, (1997).
中央健康保險署. (2015a). 全民健康保險居家醫療照護整合計畫 中央健康保險署. (2015b). 全民健康保險特約醫事服務機構合約(特約醫院、診所、助產機構、精神復健機構、居家護理機構適用). 中央健康保險署. (2016). 全民健康保險特約醫事服務機構家數表--按分區業務組別 內政部. (2007). 我國長期照顧十年計畫- 大溫暖社會福利套案之旗艦計畫. 內政部. (2011). 中華民國 100 年身心障礙者生活狀況及各項需求評估調查報告. 朱育增, 吳肖琪, 李玉春, 賴美淑, & 譚醒朝. (2010). 探討共病測量方法於健保次級資料之應用. 臺灣公共衛生雜誌, 29(3), 191-200. 江昇達, 王勝廣, 高東煒, 方文輝, 張耀文, 高森永, & 周稚傑. (2011). 高齡患者長期住院醫療利用影響因子之探討. [Influential Factors of Medical Utilizations among Long-Stay Elderly Inpatients]. 台灣老年醫學暨老年學雜誌, 6(2), 86-104. 行政院. (2013). 長期照護服務網計畫(第一期)-102 年至 105 年」 (核定本). 行政院主計處. (2000). 89年人口及住宅普查報告. 行政院主計處. (2010). 99年人口及住宅普查報告. 行政院國家發展委員會. (2014). 中華民國人口推計（103 至 150 年）. 臺北: 行政院國家發展委員會. 護理人員法, (2015). 吳姿璇. (2011). 不同照護模式健保居家照護使用者之急診醫療利用. 國立臺北護理健康大學. 吳姿璇, 謝碧晴, 李中一, & 蘇慧芳. (2013). 健保居家照護使用者急診醫療利用. [Emergency Department Utilization by National Health Insurance Home-care Recipients]. 臺灣公共衛生雜誌, 32(1), 18-30. doi:10.6288/tjph2013-32-01-03 吳淑瓊. (2005). 人口老化與長期照護政策. [Population Aging and Long-Term Care Policy]. 國家政策季刊, 4(4), 5-24. 吳淑瓊, 梁浙西, 張明正, 林惠生, & 孟蘿拉. (1994). Utilization of Health Services among the Elderly in Taiwan. [台灣老人醫療服務之使用]. 中華公共衛生雜誌, 13(2), 168-182. doi:10.6288/cjph1994-13-02-07 吳淑瓊, & 莊坤洋. (2001). 在地老化：台灣二十一世紀長期照護的政策方向. [Aging in Place:the Direction of Taiwan Long-Term Care Policy in the 21st Century]. 臺灣公共衛生雜誌, 20(3), 192-201. doi:10.6288/tjph2001-20-03-05 李怡娟. (1997). 城鄕社區老人使用居家護理服務情形及其預測因子之探討. [Predictors of the Utilization of Home Health Care Services for the Urban/Rural Elderly]. 護理研究, 5(2), 127-136. 李昀叡. (2003). 獨立與非獨立性資料之多重比較. 李偉立. (1999). 醫院附設與獨立型護理之家住民特質與健康狀況之比較. 高雄醫學大學公共衛生學研究所學位論文, 1-129. 李愛誠. (2011). 居家護理與護理之家照護品質之探討. 亞洲大學. Available from Airiti AiritiLibrary database. (2011年) 李會珍, 楊. 杜. (2001). 居家護理服務與健保支付方式相關性之探討: 行政院衛生署. 冼鴻曦, 李英俊, 馬震中, & 盧玉強. (2012). 護理之家住民轉住院率的整體分析. [The Hospitalization Frequency of Nursing Home Residents-A Comprehensive Analysis]. 台灣老年醫學暨老年學雜誌, 7(1), 37-64. 周稚傑, 葉明功, & 游翁斌. (1999). 居家照護資源耗用之探討：健保資源使用之分析. 中華家庭醫學雜誌, 9(4), 193-199. 林秀碧, 羅萱, 謝明娟, & 葉宏明. (2001). 健保支付改採資源耗用群組後醫院附屬居家護理單位成本與損益平衡分析: 公共衛生. 林淑娟, 江蕙娟, & 王碧蘭. (2003). 護理之家住民轉住院情形及其影響因素探討. 健康促進暨衛生教育雜誌(23), 79-89. 林淑萱. (2003). 日本長期照護保險的發展經驗及其對臺灣的啟示: 社區發展季刊. 邱啟潤, 許淑敏, & 吳淑如. (2003). 居家照護病患之主要照顧者綜合性需求調查. [Needs of Home-Care Primary Caregivers]. 醫護科技學刊, 5(1), 12-25. doi:10.6563/tjhs.2003.5(1).3 紀玫如. (2008). 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. 臺灣大學. Available from Airiti AiritiLibrary database. (2008年) 范淑玲. (2004). 護理之家住民長期照護服務使用情形及其相關因素探討: 國立陽明大學社區護理研究所碩士論文. 國家衛生研究院. (2009). 2009年國民健康訪問暨藥物濫用調查. 張文瓊. (2014). 長期照護安排，醫療照護連續性與醫療服務利用. 臺灣大學. Available from Airiti AiritiLibrary database. (2014年) 張淑卿, & 吳肖琪. (2012). 居家失能老人之經濟狀態對居家護理使用及照護品質之影響. [The Impact of the Economic Status of the Disabled Elderly Dwelling at Home on the Use of Homecare and the Quality of that Care]. 臺灣公共衛生雜誌, 31(5), 446-459. doi:10.6288/tjph2012-31-05-06 張欽榮. (2014). 比較不同權屬別護理之家住民的醫療服務利用情形─全民健保資料庫研究. 臺灣大學. Available from Airiti AiritiLibrary database. (2014年) 陳怡靜. (2004). 追蹤腦中風病人之長期就醫流向及其對醫療利用之影響. 高雄醫學大學. Available from Airiti AiritiLibrary database. (2004年) 陳貞吟, 陳楚杰, 蔡明足, 沈玉卿, 周歆凱, & 翁林仲. (2008). 影響居家長期照護病患主要照顧者生活品質因素之研究. [The Research about the Factors Affecting the Quality of Life for Caregivers of Patients at Home]. 長期照護雜誌, 12(3), 267-283. 陳雪姝, 蔡淑鈴, & 黃欽印. (2009). 長期照護機構住民醫療利用分析－以中部四縣市為例. [Medical Care Utilization in long-term-care Organizations in Central Taiwan]. 臺灣公共衛生雜誌, 28(3), 175-183. doi:10.6288/tjph2009-28-03-02 陸鳳屏. (2013). 老年病況與醫療服務使用. 臺灣大學. Available from Airiti AiritiLibrary database. (2013年) 勞工保險局. (2004). 勞工保險局勞工安全衛生研究所勞保統計資料庫-城鄉分級表. 曾淑芬. (2005). 機構式長期照護服務使用之相關因素探討：社區環境與個人背景因素的分析. 臺灣大學. Available from Airiti AiritiLibrary database. (2005年) 黃金安, 賴其勛, & 胡哲生. (2006). 急診醫療服務與其它醫療服務之類別間關係. [Relationship of Utilization of Emergency Medical Services and Other Medical Services]. 臺灣公共衛生雜誌, 25(5), 384-393. doi:10.6288/tjph2006-25-05-07 黃源協. (2005). 社區長期照顧體系的建構. [Constructing Community-base Long Term Care System]. 國家政策季刊, 4(4), 41-68. 黃麗玉, 羅素英, 洪百薰, & 洪美玟. (2001). 偏遠地區衛生所辦理居家護理服務現況調查. 公共衛生, 28(3), 189-203. 楊嘉玲, & 徐亞瑛. (2001). 護理之家照護品質指標－以老年住民的觀點探討. [Indicators of Quality of Care in Nursing Homes from the Perspective of Elderly Residents]. 護理研究, 9(1), 53-64. 葉宏明, 林秀碧, 吳重慶, 黃秀雲, & 顏裕庭. (2000). 台灣居家照護的軌跡初探. [Home Care in Taiwan, Past and Future]. 秀傳醫學雜誌, 2(3), 111-115. 葉淑杏, 陳淑娟, 吳秀麗, 林束棉, & 伍玉敏. (2005). 居家護理服務成本分析--以某區域教學醫院為例. 詹弘廷, & 廖靜珠. (2015). 居家醫療與社區照顧. 熊曉芳. (2010). 失能者居家護理使用之研究. 臺灣大學. Available from Airiti AiritiLibrary database. (2010年) 劉介宇, 洪永泰, 莊義利, 陳怡如, 翁文舜, 劉季鑫, & 梁賡義. (2006). 台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究. 健康管理學刊, 4(1), 1-22. 劉慧俐, & 王鴻昌. (1999). 保險給付病患與非保險給付病患居家照顧利用因素之探討. [Comparisons of Home Care Utilizaion between Insured and Not-Insured Patients]. The Kaohsiung Journal of Medical Sciences, 15(6), 382-395. 衛生福利部. (2008). 97年護理機構服務統計量. 衛生福利部. (2013). 102年國民醫療保健支出統計. 臺北. 衛生福利部. (2014). 103年護理機構服務統計量. 賴惠玲. (1994). 美國護理之家現況及相關議題. [Nursing Home in America and the Related Issues]. 護理雜誌, 41(3), 73-78. doi:10.6224/jn.41.3.73 鍾明惠, 周稚傑, 莊明憲, & 陳永煌. (2003). 健保居家照護資源耗用者之門診, 住院費用之分析. 中華職業醫學雜誌, 10(1), 37-42. 羅鈞令, 黃小玲, 毛慧芬, 蔡宜蓉, 林惠冠, 李世代, & 張志仲. (2002). 護理之家服務現況與住民需求. [The Current Status and Needs of Residents in Nursing Home Facilities]. 職能治療學會雜誌, 20, 95-106. 顧勝敏. (2011). 台灣高齡老人的醫療服務使用情形. 中山醫學大學. Available from Airiti AiritiLibrary database. (2011年) 龔雅婷. (2005). 護理之家住民醫療資源使用、日常活動功能與存活狀況之影響因子. (碩士), 高雄醫學大學. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of health and social behavior, 1-10. Arendts, G., & Howard, K. (2010). The interface between residential aged care and the emergency department: a systematic review. Age Ageing, 39(3), 306-312. doi:10.1093/ageing/afq008 Berry, N. J., & Evans, J. M. (1985). Cost effectiveness of home health care as an alternative to inpatient care. Home Health Care Serv Q, 6(4), 11-25. Bindman, A. B., Grumbach, K., Osmond, D., Komaromy, M., Vranizan, K., Lurie, N., . . . Stewart, A. (1995). Preventable hospitalizations and access to health care. Jama, 274(4), 305-311. Blay, S. L., Fillenbaum, G. G., Andreoli, S. B., & Gastal, F. L. (2008). Equity of access to outpatient care and hospitalization among older community residents in Brazil. Medical care, 46(9), 930-937. Branch, L. G., & Goldberg, H. B. (1993). A preliminary case-mix classification system for Medicare home health clients. Med Care, 31(4), 309-321. Bryant, N. H., Candland, L., & Loewenstein, R. (1974). Comparison of care and cost outcomes for stroke patients with and without home care. Stroke, 5(1), 54-59. Chappell, N. L., Dlitt, B. H., Hollander, M. J., Miller, J. A., & McWilliam, C. (2004). Comparative costs of home care and residential care. Gerontologist, 44(3), 389-400. Condelius, A., Hallberg, I. R., & Jakobsson, U. (2010). Medical healthcare utilization as related to long-term care at home or in special accommodation. Arch Gerontol Geriatr, 51(3), 250-256. doi:10.1016/j.archger.2009.11.009 Creese, A. L., & Fielden, R. (1977). Hospital or home care for the severely disabled: a cost comparison. Br J Prev Soc Med, 31(2), 116-121. Dansky, K. H., Brannon, D., Shea, D. G., Vasey, J., & Dirani, R. (1998). Profiles of hospital, physician, and home health service use by older persons in rural areas. Gerontologist, 38(3), 320-330. Deyo, R. A., Cherkin, D. C., & Ciol, M. A. (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. Journal of clinical epidemiology, 45(6), 613-619. Donabedian, A. (1988). The quality of care: How can it be assessed? Jama, 260(12), 1743-1748. Dunlop, D. D., Manheim, L. M., Song, J., & Chang, R. W. (2002). Gender and ethnic/racial disparities in health care utilization among older adults. The Journals of Gerontology Series B: Psychological sciences and social sciences, 57(4), S221-S233. Evashwick, C. (2005). The continuum of long-term care: Cengage Learning. Fernandez-Olano, C., Hidalgo, J. D., Cerda-Diaz, R., Requena-Gallego, M., Sanchez-Castano, C., Urbistondo-Cascales, L., & Otero-Puime, A. (2006). Factors associated with health care utilization by the elderly in a public health care system. Health Policy, 75(2), 131-139. doi:10.1016/j.healthpol.2005.02.005 Fisher, G., Faul, J., Weir, D., & Wallace, R. (2005). Documentation of chronic disease measures in the Health and Retirement Study (HRS/AHEAD). Ann Arbor: University of Michigan. Fortinsky, R. H., Fenster, J. R., & Judge, J. O. (2004). Medicare and Medicaid home health and Medicaid waiver services for dually eligible older adults: Risk factors for use and correlates of expenditures. Gerontologist, 44(6), 739-749. Freedman, V. A., Martin, L. G., & Schoeni, R. F. (2002). Recent trends in disability and functioning among older adults in the United States: a systematic review. Jama, 288(24), 3137-3146. Freedman, V. A., Rogowski, J., Wickstrom, S. L., Adams, J., Marainen, J., & Escarce, J. J. (2004). Socioeconomic disparities in the use of home health services in a Medicare managed care population. Health Serv Res, 39(5), 1277-1298. Glynn, L. G., Valderas, J. M., Healy, P., Burke, E., Newell, J., Gillespie, P., & Murphy, A. W. (2011). The prevalence of multimorbidity in primary care and its effect on health care utilization and cost. Family practice, 28(5), 516-523. Godden, S., & Pollock, A. M. (2001). The use of acute hospital services by elderly residents of nursing and residential care homes. Health Soc Care Community, 9(6), 367-374. Grabowski, D. C., O'Malley, A. J., & Barhydt, N. R. (2007). The costs and potential savings associated with nursing home hospitalizations. Health Aff (Millwood), 26(6), 1753-1761. doi:10.1377/hlthaff.26.6.1753 Grabowski, D. C., Stewart, K. A., Broderick, S. M., & Coots, L. A. (2008). Predictors of nursing home hospitalization: a review of the literature. Med Care Res Rev, 65(1), 3-39. doi:10.1177/1077558707308754 Graverholt, B., Riise, T., Jamtvedt, G., Ranhoff, A. H., Kruger, K., & Nortvedt, M. W. (2011). Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Serv Res, 11, 126. doi:10.1186/1472-6963-11-126 Grumbach, K., Keane, D., & Bindman, A. (1993). Primary care and public emergency department overcrowding. Am J Public Health, 83(3), 372-378. Gruneir, A., Silver, M. J., & Rochon, P. A. (2010). Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Medical Care Research and Review. Harris, M. D. (2005). Handbook of home health care administration: Jones & Bartlett Learning. 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. Hoxie, L. O. (1996). Outcomes Measurement and Clinical Pathways. JPO: Journal of Prosthetics and Orthotics, 8(3), 93-95. Retrieved from http://journals.lww.com/jpojournal/Fulltext/1996/00830/Outcomes_Measurement_and_Clinical_Pathways_.5.aspx Huang, J.-A., Hu, W.-H., Yang, D.-Y., Weng, R.-H., & Tsai, W.-C. (2003). Analysis of emergency department utilization by elderly patients under National Health Insurance. The Kaohsiung Journal of Medical Sciences, 19(3), 113-119. Hughes, S. L., Ulasevich, A., Weaver, F. M., Henderson, W., Manheim, L., Kubal, J. D., & Bonarigo, F. (1997). Impact of home care on hospital days: a meta analysis. Health Serv Res, 32(4), 415-432. Huisman, M., Kunst, A. E., & Mackenbach, J. P. (2003). Socioeconomic inequalities in morbidity among the elderly; a European overview. Social Science & Medicine, 57(5), 861-873. Ingarfield, S. L., Finn, J. C., Jacobs, I. G., Gibson, N. P., Holman, C. D., Jelinek, G. A., & Flicker, L. (2009). Use of emergency departments by older people from residential care: a population based study. Age Ageing, 38(3), 314-318. doi:10.1093/ageing/afp022 Janz, K. (2005). All home care is not created equal--one view: dramatic growth in home health care industry creates unregulated workforce; more government oversight is needed. Geriatr Nurs, 26(1), 53-55. doi:10.1016/j.gerinurse.2004.12.008 Kane, R. A., & Kane, R. L. (1987). Long-term care: Principles, programs, and policies: Churchill Livingstone. Kempen, G. I., & Suurmeijer, T. P. (1991). Professional home care for the elderly: an application of the Andersen-Newman model in The Netherlands. Soc Sci Med, 33(9), 1081-1089. Kenney, G. M. (1993). Is access to home health care a problem in rural areas? Am J Public Health, 83(3), 412-414. Knight, S., & Tjassing, H. (1994). Health care moves to the home. World Health, 4, 413-444. Landi, F., Gambassi, G., Pola, R., Tabaccanti, S., Cavinato, T., Carbonin, P., & Bernabei, R. (1999). Impact of integrated home care services on hospital use. Journal of the American Geriatrics Society, 47(12), 1430-1434. Liu, L.-F., Tian, W.-H., & Yao, H.-P. (2012). Utilization of health care services by elderly people with National Health Insurance in Taiwan: The heterogeneous health profile approach. Health Policy, 108(2), 246-255. Mauser, E., & Miller, N. A. (1994). A profile of home health users in 1992. Health Care Financ Rev, 16(1), 17-33. McHugh, M. L. (2011). Multiple comparison analysis testing in ANOVA. Biochemia medica, 21(3), 203-209. Meret-Hanke, L. A. (2011). Effects of the program of all-inclusive care for the elderly on hospital use. Gerontologist, gnr040. Miller, B., & McFall, S. (1991). The effect of caregiver's burden on change in frail older persons' use of formal helpers. Journal of health and social behavior, 165-179. Mor, V., Intrator, O., Feng, Z., & Grabowski, D. C. (2010). The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood), 29(1), 57-64. doi:10.1377/hlthaff.2009.0629 Naylor, M. D., Brooten, D. A., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004). Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. Journal of the American Geriatrics Society, 52(5), 675-684. Nyman, J. A., Sen, A., Chan, B. Y., & Commins, P. P. (1991). Urban/rural differences in home health patients and services. Gerontologist, 31(4), 457-466. Oktay, J. S., & Volland, P. J. (1987). Foster home care for the frail elderly as an alternative to nursing home care: an experimental evaluation. Am J Public Health, 77(12), 1505-1510. Pan, S. M., Yang, J. T., & Chen, C. C. (1998). The predictors of long-term care service utilization among older Americans. Kaohsiung Journal of Medical Sciences, 14, 234-241. Pope, D., Fernandes, C. M., Bouthillette, F., & Etherington, J. (2000). Frequent users of the emergency department: a program to improve care and reduce visits. Cmaj, 162(7), 1017-1020. Porell, F. W., & Carter, M. (2005). Discretionary hospitalization of nursing home residents with and without Alzheimer's disease: a multilevel analysis. J Aging Health, 17(2), 207-238. doi:10.1177/0898264304274302 Quail, J. M., Wolfson, C., & Lippman, A. (2011). Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study. BMC Geriatr, 11, 86. doi:10.1186/1471-2318-11-86 Rosner, T. T., Namazi, K. H., & Wykle, M. L. (1988). Physician use among the old-old: Factors affecting variability. Medical care, 982-991. Sands, L. P., Xu, H., Weiner, M., Rosenman, M. B., Craig, B. A., & Thomas, J., 3rd. (2008). Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care. Med Care, 46(4), 449-453. doi:10.1097/MLR.0b013e3181621eae Segelman, M., Szydlowski, J., Kinosian, B., McNabney, M., Raziano, D. B., Eng, C., . . . Temkin–Greener, H. (2014). Hospitalizations in the Program of All‐Inclusive Care for the Elderly. Journal of the American Geriatrics Society, 62(2), 320-324. Shaughnessy, P., Schlenker, R., Brown, K., & Yslas, I. (1983). Case mix and surrogate indicators of quality of care over time in freestanding and hospital-based nursing homes in Colorado. Public Health Reports, 98(5), 486. Southern, D. A., Quan, H., & Ghali, W. A. (2004). Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Medical care, 42(4), 355-360. Strange, G. R., Chen, E. H., & Sanders, A. B. (1992). Use of emergency departments by elderly patients: projections from a multicenter data base. Annals of emergency medicine, 21(7), 819-824. Waldo, D. R., Sonnefeld, S. T., McKusick, D. R., & Arnett, R. H., 3rd. (1989). Health expenditures by age group, 1977 and 1987. Health Care Financ Rev, 10(4), 111-120. Walter‐Ginzburg, A., Chetrit, A., Medina, C., Blumstein, T., Gindin, J., & Modan, B. (2001). Physician Visits, Emergency Room Utilization, and Overnight Hospitalization in the Old‐Old in Israel: The Cross‐Sectional and Longitudinal Aging Study (CALAS). Journal of the American Geriatrics Society, 49(5), 549-556. Weissert, W. G., Cready, C. M., & Pawelak, J. E. (1988). The past and future of home-and community-based long-term care. The Milbank Quarterly, 309-388. Welch, H. G., Wennberg, D. E., & Welch, W. P. (1996). The Use of Medicare Home Health Care Services. New England Journal of Medicine, 335(5), 324-329. doi:doi:10.1056/NEJM199608013350506 Wieland, D., Lamb, V. L., Sutton, S. R., Boland, R., Clark, M., Friedman, S., . . . Eleazer, G. P. (2000). Hospitalization in the Program of All‐inclusive Care for the Elderly (PACE): Rates, Concomitants, and Predictors. Journal of the American Geriatrics Society, 48(11), 1373-1380. Wiener, J., Liu, K., & Schieber, G. (1986). Case-Mix Differences Between Hospital-Based and Freestanding Skilled Nursing Facilities: A Review of the Evidence. Medical care, 24(12), 1173-1182. Wilson, D., & Truman, C. (2005). Comparing the health services utilization of long-term-care residents, home-care recipients, and the well elderly. Can J Nurs Res, 37(4), 138-154. Wilson, D. M., & Truman, C. D. (2004). Evaluating institutionalization by comparing the use of health services before and after admission to a long-term-care facility. Eval Health Prof, 27(3), 219-236. doi:10.1177/0163278704267036 Wolinsky, F. D., & Johnson, R. J. (1991). The use of health services by older adults. Journal of Gerontology, 46(6), S345-S357. Yeh, L., & Chen, C.-H. (2003). Use of home nursing service in southern Taiwan. Home Health Care Management & Practice, 15(5), 439-448. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/49729 | - |
| dc.description.abstract | 研究背景：伴隨著快速的人口老化，老年人的醫療資源與長期照護需求逐漸增加。居家護理服務為提供疾病嚴重程度較高、有技術性護理需求的失能對象，但使用者可能因為服務模式的不同而造成醫療利用結果的差異。相較於入住機構，居住在家中可以支持老人走向在地老化的目標，且有較低的照護成本。然而我國過去的研究中並沒有針對不同服務模式其醫療利用結果差異探討，僅針對單一項長照服務的醫療利用結果進行分析。本研究希望透過比較使用居家護理服務的社區及機構老人在醫療利用結果的差異，提供未來長照政策發展不同服務模式的研究參考依據。
研究方法：本研究使用全民健康保險資料庫之2010年百萬承保歸人檔，篩選出2003至2012年間首次使用居家護理服務且連續使用3個月以上的老人作為研究對象共3117人，依健保申報的案件類別不同可分為社區(居家照護)1667人、及機構(護理之家照護、安養、養護院民之居家照護) 1450人。研究以卡方檢定、皮爾森相關係數分析、兩組樣本T檢定、單因子變異數分析進行研究變項及結果變項之雙變項分析後，再使用複羅吉斯迴歸分析與複迴歸分析進行多變項分析，比較不同長照服務模式的老人在開始使用居家護理服務3個月後的ㄧ年間門診、急診、住院之利用情形。 研究結果：在控制其他人口學因子後，社區老人每人年門診次數較機構老人少6.31次、每次門診費用多1196.9點、累積門診費用多21496點；發生急診相對風險多1.612倍、急診次數多0.41次、每次急診費用多1347.66點、累積急診費用多4586.77點；住院次數少0.21次、累積住院天數少3.44天。其餘醫療利用指標則無達統計上顯著差異。 討論：社區老人及機構老人在住院使用並無顯著差異，顯示居住在家中的照護結果並不亞於機構式照護，對於造成重症需求的住院利用結果是相似的；雖然社區老人有較高的門急診利用情形，可能表示我國居家護理服務的收案條件過於嚴格導致居家護理服務在社區中普及程度較差，且基本醫療照護不足的情況使得社區老人的醫療可近性較差。此外，本研究亦發現醫院附屬的型態對長照服務的醫療利用結果有調節作用，相較於獨立型態的居家護理單位，使用醫院附屬的居家護理單位可減少的較多的門急診利用情形；機構老人則無此保護作用。可見居家護理師若有醫院的專業照護團隊作為支持，可以有較好的照護結果。 結論與建議：本研究建議政府應重新審視居家護理服務的收案條件是否過於嚴格，應放寬收案條件使得社區中的失能老人能獲得適當的照護；現行居家護理服務應增加醫師及護理的訪視次數，以改善居家失能老人其基層醫療照護不足的問題；且未來長照政策應將居家護理及居家服務加以整合，才能發揮居家式照護的最大效益。此外，應鼓勵醫院拓展居家護理服務，可降低醫療系統的財務負擔，並且使後端的醫療資源得以有效利用。 | zh_TW |
| dc.description.abstract | Background: With a rapid aging of population, needs of medical resources and long-term cares from older adults are increasing. People who received home care nursing services have needs for skilled-nursing care. Their healthcare service utilization may be different because they were in different long-term care models, communities or institutions. Compared to institutions, living at home could support older adults aging in place with a lower cost of care. However, there was no research about comparing healthcare service utilization between those who were in different long-term care model. This research aimed to compare healthcare service utilization between older adults using home cere nursing service who were in communities and who were in institutions.
Methods: Data were extracted from 2010 National Health Insurance Claim Dataset. We examined those subjects who used home care nursing services at least 3 months during 2003-2012 and follow-up their healthcare service utilization for a year after they were first time admitted to long-term care. A total of 3117 older adults who used home care nursing services were included for analysis and the sample coud be separated 1667 communities older adults from 1450 institutions older adults. The main outcome variables examined were the use of outpatient service, emergency service, and hospitalization related services uses. The outcomes were compared between communities older adults to institutions older adults, using Chi-square test, Pearson’s correlation coefficient, two sample T-test, ANOVA, multiple logistic regression analysis and multiple linear regression analysis. Results: After controlling the demographic factors, the regression analysis showed that older adults who used home care nursing services had 6.31 fewer outpatient visits, 1196.9 points more expenditure of per outpatient visit, 21496 points more expenditure of accumulated outpatient visit, 1.612 times more risk of emergency department admission, 0.41 more emergency visits, 1347.66 points more expenditure of per emergency visit, 4586.77 points more expenditure of accumulated emergency visit, 0.21 fewer hospital admissions, 3.44 days fewer accumulated length of stay than older adults who lived in institutions in a year. Discussion: The hospitalization related service showed no significant difference between older adults who lived in communities and institutions. It indicated that the care outcomes of communities were as good as care outcomes of institutions. Though older adults who used home care nursing services living in communities had higher outpatient and emergency use, it may indicate that the inclusion criteria for older adults applying home care nursing service was too strict so that older adults living in communitis couldn’t get enough care resources. Bad accessibility to outpatient visit for older adults living at homes is another reason, too. We also found that hospital-based home care nursing agencies led to fewer outpatient and emergency use than non hospital-based home care nursing service. It could be that home care nurses who had the support from their hospitals could give better home care nursing services, and therefore their patients could show better care outcomes. Conclusion: This study suggested that the governments should reexamine the inclusion criteria for home care nursing service and increase the number of home care visits in order to improve the accessibility of outpatient visits for disabled older adults living at homes. Furthermore, future policy of long-term care should aim to integrate home nursing care and other home service so as to maximize the benefits of home care service. In addition, we encourage hospitals to expand home care nursing service in order to reduce the financial burden on the health care system and make good use of medical resources. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-15T11:44:38Z (GMT). No. of bitstreams: 1 ntu-105-R02848010-1.pdf: 2462851 bytes, checksum: b83357d4ee974eb37c71b23704763e92 (MD5) Previous issue date: 2016 | en |
| dc.description.tableofcontents | 第一章 、緒論 1
第一節、研究背景 1 第二節、研究目的 4 第二章 、文獻探討 5 第一節、居家護理及護理之家的定義 6 第二節、影響長照及醫療服務使用之相關因素 13 第三節、居家護理及護理之家的使用對醫療服務利用的影響 21 第四節、小結 28 第三章 、研究方法 29 第一節、研究架構與設計 29 第二節、研究假說 31 第三節、資料來源與研究對象 32 第四節、研究變項與操作型定義 36 第五節、統計分析方法 47 第四章 、研究結果 51 第一節、樣本基本特性及醫療利用情形之分佈 52 第二節、研究變項與依變項之雙變項分析 60 第三節、研究變項與依變項之多變項分析 86 第五章 、討論 103 第一節、研究結果與討論 104 第二節、研究限制 123 第六章、結論 124 第一節、研究結論 124 第二節、建議 126 參考文獻 128 | |
| dc.language.iso | zh-TW | |
| dc.subject | 健保資料庫 | zh_TW |
| dc.subject | 居家護理 | zh_TW |
| dc.subject | 護理之家 | zh_TW |
| dc.subject | 機構式照護 | zh_TW |
| dc.subject | 醫療服務利用 | zh_TW |
| dc.subject | nursing home | en |
| dc.subject | home care nursing service | en |
| dc.subject | National Health Insurance Dataset | en |
| dc.subject | healthcare utilization | en |
| dc.subject | institutional care | en |
| dc.title | 比較使用居家護理服務之社區及機構老人的醫療服務利用情形 | zh_TW |
| dc.title | Comparison of Health Care Utilization Between Older Adults Living in Communities and Institutions Who Received Home Care Nursing Service | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 104-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 李玉春(Yue-Chune Lee),林艷君(Yen-Chun Lin) | |
| dc.subject.keyword | 居家護理,護理之家,機構式照護,醫療服務利用,健保資料庫, | zh_TW |
| dc.subject.keyword | home care nursing service,nursing home,institutional care,healthcare utilization,National Health Insurance Dataset, | en |
| dc.relation.page | 137 | |
| dc.identifier.doi | 10.6342/NTU201602475 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2016-08-15 | |
| 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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