不同都市化程度地區可避免住院的疾病照護結果之比較

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Title:	不同都市化程度地區可避免住院的疾病照護結果之比較 Comparison of the outcomes of health care for avoidable hospitalization diseases in different urbanization areas
Authors:	胡雅萍;Ya-Ping Hu
Contributors:	公共衛生學院醫務管理學研究所碩士班
Keywords:	可避免的住院;都市化程度;氣喘;糖尿病;高血壓;avoidable hospitalization;urbanization;asthma;diabetes;hypertension
Date:	2010
Issue Date:	2010-09-29 12:05:53 (UTC+8)
Abstract:	目的：可避免的住院是一項衡量基層醫療資源可近性及預防保健適當性之指標。本研究欲探討不同都市化程度地區可避免住院的疾病照護結果之差異，以及可避免住院的疾病是否住院之影響因素。方法：本研究資料取自1997年至2007年全民康保險資料庫，以2000年至2007年中罹患氣喘(28,391人)、糖尿病(44,875人)、高血壓(77,495人)三種可避免住院的疾病之民眾為本研究對象。除描述性統計及雙變項分析外，本研究以Cox比例風險模式(Cox Proportional Hazards Model)分析探討影響可避免住院的疾病是否住院之因素。結果：氣喘、糖尿病、高血壓患者住院比例分別為3.85%、4.80%、0.76%。Cox比例風險模式分析顯示，氣喘患者65歲以上、女性、低投保金額、低都市化程度、低醫師密度、有重大傷病、共病情形嚴重、地區醫院、公立醫院及低住院市場競爭度有較高的住院風險；糖尿病患者18-34歲、男性、低投保金額、低都市化程度、有重大傷病、共病情形嚴重、區域醫院、營利醫院的住院風險較高；高血壓患者18-34歲、低投保金額、共病情形嚴重、地區醫院、營利醫院有較高的住院風險。居住於都市化程度第七級及第八級之氣喘患者住院風險分別為都市化程度第一級之1.36倍及1.20倍；居住於都市化程度第七級及第八級之糖尿病患者住院風險分別為都市化程度第一級之1.60倍及1.42倍；而居住於都市化程度第七級及第八級之高血壓患者住院風險則分別為都市化程度第一級者之1.27倍及1.08倍。結論：都市化程度較高地區相較於都市化程度較低地區對於可避免住院的疾病之照護結果較佳。 Objective: Avoidable hospitalization is the indicator to evaluate the access of primary care and the appropriateness of preventable care. Thus, the purpose of this study was to compare the outcomes of health care for avoidable hospitalization diseases in different urbanization areas and the factors associated with the hospitalization of avoidable hospitalization diseases. Methods: Data of this study were obtained from the National Health Insurance database during 1997 to 2007. The subjects of this study were the new patients suffering from asthma (N=28,391), diabetes (N=44,875), and hypertension (N=77,495) from 2000 to 2007. In addition to descriptive statistics and bivariate statistics, we used Cox proportional hazards model to analyze the factors associated with the hospitalization of avoidable hospitalization diseases. Results: We found that hospitalization rates for asthma, diabetes, and hypertension were 3.85%, 4.80%, and 0.76%, respectively. According to the Cox proportional hazards model, asthma patients who were older, female, with low premium-based salary, low urbanization level, low physician density, catastrophic illness, more comorbidities, local hospital, public hospital, and low competitive health care areas were likely to have a higher risk of hospitalization. Diabetics who were younger, male, low premium-based salary, low urbanization level, catastrophic illness, more comorbidities, regional hospital and profit hospital were likely to have a higher risk of hospitalization. Patients with hypertension who were younger, low premium-based salary, more comorbidities, local hospital and profit hospital were likely to have a higher risk of hospitalization. The risk of hospitalization for asthma patients living in the seventh degree urbanization area and the eighth degree urbanization area was 1.36 times and 1.20 times more than those living in the first degree urbanization area, respectively. The risk of hospitalization for diabetes patients living in the seventh degree urbanization area and the eighth degree urbanization area was 1.60 times and 1.42 times more than those living in the first degree urbanization area, respectively. The risk of hospitalization for hypertension patients living in the seventh degree urbanization area and the eighth degree urbanization area was 1.27 times and 1.08 times more than those living in the first degree urbanization area, respectively. Conclusion: Patients in high urbanization areas have better outcomes of health care for avoidable hospitalization diseases than those in low urbanization areas.
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