| 摘要: | 目的：非計畫性急診返診不但可能會增加急診資源的耗用並增加醫療照護成本，若是病人返診未選擇回到原醫療院所，可能有潛在的醫療疏失與法律問題之存在。本研究期望了解出院後三日內重返急診影響其重返相同醫院或不同醫院之相關因素。
方法：資料來源為「全民健康保險學術研究資料庫」之2008年百萬人承保抽樣歸人檔；自1月1日起至12月28日之有急診科別醫院的所有出院病人 (排除轉院、死亡、病危自動出院等)，且三日內有急診就醫紀錄。
結果：2008年出院人次中三日內重返急診有2,565人次，其中至相同醫院急診就醫人次為1,322人次(51.54%)，不同醫院急診就醫有1,243人次(48.46%)；病人基本人口學特質中，以年齡、重大傷病及投保區域與出院後三日內選擇至相同醫院或不同醫院急診有顯著相關，醫院因素中以醫院層級有顯著相關，疾病因素中以出院科別及出院日至急診間隔天數為影響病人出院後三日內急診至相同醫院就醫之因素。
結論：年齡越大、重大傷病、小兒科及婦產科病人，出院三日內急診較容易回到相同醫院；投保區域在高屏地區、出院醫院層級越低及出院日至急診間隔天數越少之病人，出院三日內急診較容易到不同醫院。
Background and Objective
Unplanned returning visits to emergency department after hospitalization may not only increase the consumption of emergency resources and health care costs, but also exist potential medical negligence or event legal issues if patients do not choose the original hospitals. In this study, we wish to understand the related factors which may related to patients’ returning visits to emergency department within three days after hospitalization and the difference between patients’ retuning to the original and the different hospitals.
Method
Dataset from the National Health Insurance Research Database was retrieved. All patients, from January 1 to December 28, 2008. discharged from all hospitals and returned visits to emergency department after hospitalization are included in this study. The excluding criteria are transfers, death, and automatically discharged from hospital in critical condition.
Result
In 2008, there were 2,565 patients returned visit to emergency department after hospitalization. In which, 1,322 (51.54%) patients visited the emergency in original hospitals and 1,243 (48.46%) patients visited emergency department in different hospitals. Patients’ age, disease status with seriously ill, patients’ insured areas, discharged hospital level, specialties of hospitalization, and the interval between discharge and returning visit to emergency department, are significantly related to visit the original or different hospitals’ emergency departments within three days after hospitalizatio.
Conclusion
Patients with "elder age", "seriously ill", discharged from specialties of "Pediatrics" and "Obstetrics and Gynecology" are tend to have returning visits to the original hospitals’ emergency departments within three days after hospitalization; Patients insured area in the Kaohsiung and Pingtung areas, discharged from lower hospital levels, or with shorter interval between discharge and returning visit to emergency department, are tend to have returning visits to different hospitals’ emergency departments within three days after hospitalization. |
