影響精神科住院病人再住院之醫療服務相關因子：以某一北部專科醫院為例

Service-related Factors Associated with the Risk of Readmission after Discharge from Psychiatric Hospitalization–Data from Large Psychiatric Hospital in Northern Taiwan

目的：台灣自 1995 年開始實施全民健保制度後精神疾患有增加趨勢，本研究目的在探 討精神疾病住院病人一年內再住院之發生率與影響因子。 方法：使用國家衛生研究院全民 健保住院與門診資料，串聯精神病人者就醫歸戶資料作為本研究資料來源，篩選於 2004 年 曾在某精神專科醫院出院之 789 名精神科病人作為本研究世代，以多變項邏輯迴歸檢驗分析 病人再住院之風險因子。 結果：本研究世代一年內再住院率為 27.9%，比較 14 歲（含）以 下病人，60 歲以上病人具有顯著較低之再住院風險（校正過可能性比率 [adjusted odds ratio, AOR]: 0.32; 95% 信賴區間 [confidence interval, CI]: 0.11-0.87），情緒性疾患與免支付健保部分 負擔病人具有顯著較高之再住院風險（勝算比分別為 AOR: 1.90; 95% CI: 1.07-3.35 與 AOR: 2.07; 95% CI: 1.33-3.21），病人出院後是否定期接受門診治療或社區復健則與一年內再住院風險無關。 結論：除人口學因素外，在台灣健保制度下，與醫療服務有關之政策因素與精神病 人再住院具有相關性，政策執行者應透過病人出院後之醫療資源利用來評估資源的合理分 配，而出院後轉介社區復健之個人或系統性利用情形則值得進一步評估。

Objectives:The prevalence of psychiatric disorders has gradually been in-creased since implementing Taiwan National Health Insurance (NHI) program. The study was intended to explore the incidence as well as demographic, clinical, and service-related predictors for readmission among psychiatric inpatients. Methods:Research data were retrieved from the inpatient and ambulatory care visit service claims of the Taiwan National Health Insurance Database. With a cohort study design, we included 789 inpatients discharged in 2004 from a 700-bed psy-chiatric hospital in Taiwan. With multivariate logistic regression models, we iden-tified significant predictors of readmission within one year after discharge. Results:The one-year readmission rate was estimated at 27.9%. Patients over 60 years of age had a significantly lower rate of one-year readmission than those aged ≤14 years (adjusted odds ratio: 0.32; 95% confidence interval: 0.11-0.87). Patients suffering from affective psychoses and those were exempted from co-payments, were found to have significantly higher risks (AOR = 1.90; 95% CI: 1.07-3.35 and AOR = 2.07; 95% CI: 1.33-3.21), respectively, of readmission. Patients who re-ceived scheduled ambulatory care visits or those who received access to commu-nity rehabilitation programs were not related to readmission within one year after discharge. Conclusion:In addition to demographic and clinical characteristics, the service-related factors may influence readmission under the Taiwan NHI system. Aftercare policy decision makers should assess whether medical resources avail-able for treating post-discharge psychiatric patients are maximally allocated. We suggest that further investigations focusing on individual- and system-level barri-ers to facilitating and accessing such psychiatric rehabilitation programs are warranted.