照護連續性對住院醫療利用之影響

The Effects of Continuity of Care on Hospitalizations in Taiwan: Findings from a National Sample

目的：本研究旨在探討在就醫選擇自由且無完善家庭醫師制度及轉診制度的台灣全民健保情境下，民眾照護連續性性對住院醫療利用的影響。方法：本研究為一縱向研究，分析資料取自國家衛生研究院 20 萬人抽樣歸人檔，先以 2008-2009 年門診就醫資料計算照護連續性指數 (COCI)，再探討其對民眾 2010 年住院風險及住院頻率之影響。統計分析方法包含邏輯斯迴歸分析及零膨負二項式迴歸分析。結果：108,197 人的照護連續性平均值為 0.21。迴歸分析結果顯示，高照護連續性者其住院風險的勝算比為低照護連續性者的 0.79(95% CI=0.75-0.82)，高照護連續性者較低照護連續性者住院次數減少 14.5%(RR=0.855)。照護連續性顯著影響民眾住院利用的發生風險及住院次數。結論：本研究證實實施全民健康保險制度但缺乏家庭醫師制度及轉診制度的台灣，照護連續性有助降低住院醫療利用，顯示醫療政策制訂者應將提升照護連續性列為未來健康照護體系改革重要目標。

Purposes: This study aims to explore the effects of continuity of care (COC) on hospitalizations in Taiwan’s universal health care system, which lacks a comprehensive system of family physicians and effective referral mechanisms. Methods: This study is a longitudinal study, and analyzes data from 200,000 patients compiled by the National Health Research Institutes in Taiwan. The continuity of care index was calculated using data regarding outpatient doctor visits in 2008-2009, and its effect on hospitalization risk and hospitalization frequency in 2010 was examined. Multivariate logistic regression and zero-inflated negative binomial regression were performed for statistical analysis. Results: 108,197 subjects were analyzed and the average COC score in Taiwan was 0.21. The results from the regression models revealed that individuals with higher COC are less likely to suffer from hospitalization risks (OR=0.79, 95%CI=0.75-0.82) and have 14.5% fewer (RR=0.855) hospital admissions when compared with individuals with low COC. This study showed that COC was significantly associated with hospitalization risks and the number of hospital admissions. Conclusions: This study showed that COC is associated with decreased hospitalizations and hospital admissions, even in Taiwan’s universal health care system. Improving the COC is beneficial for Taiwan’s health care system.