照護連續性議題的省思與未來發展方向

Re-thinking continuity of care and future directions

近年來，許多研究者利用行政資料建構照護連續性的測量指標，且多數研究發現照護連續性可改善照護結果。然而，這種量性測量能否代表照護連續性的概念，值得深思。本文以「照護連續性的概念與測量指標之發展脈絡」、「應用量化照護連續性指標的限制」，以及「病人觀點的照護連續性測量工具的發展」三部份為主軸進行文獻回顧。結果發現，研究者普遍認為照護連續性為多範疇的概念，而以行政資料為基礎的量化照護連續性指標係測量一段時間內患者看診次數集中或分散於不同看診醫師間的程度，我們認為這無法反應照護連續性多範疇的概念。此外，量化指標亦無法反應在不同照護場域與醫療環境中照護連續性的本質。最後，以病患為觀點的照護連續性測量逐漸受到重視，建議研究者可以發展病患觀點的照護連續性測量工具，並探究量化指標與各範疇病患觀點指標間的相關性，與各類照護連續性測量指標對照護結果的影響。

Along with the availability of administrative claim data in recent years, researchers have constructed claim-based continuity of care (COC) measurements and found that better COC was associated with favorable health outcomes. Can these claim-based COC measures, however, represent the concept of COC? This issue deserves investigation. This article reviews the following: (1) the evolution and implication of the concept and measurement of COC; (2) the limitation of application of claim-based quantitative measures of COC; and (3) COC measurement from the patient perspective. We found that COC was a multi-dimensional concept in previous studies; however, the claim-based COC measures describe the concentration or dispersion of physician visits among healthcare providers, and we consider that these quantitative measures might not reflect the multi-dimensional concept of COC. In addition, claim-based COC measures may not reflect the essence of care continuity in different care contexts and the medical care environment. Finally, COC measures from the patient perspective has gradually become more important. We suggest that researchers may develop measurement tools for COC from the patient perspective. Furthermore, researchers should examine the relationship between claim-based COC measures and COC measures from the patient perspective in various dimensions, and examine the effects of various COC measures on health outcomes.