臺灣博碩士論文加值系統

研究背景及目的：隨人口快速老化，我國面臨逐漸增加的長期照護及醫療照護需要，而長期照護需要者同時有高度的醫療需求。除了社會人口學特質、健康狀況等因素之外，公共政策制度的設計會形塑出整體長期照護安排的樣貌，進而影響醫療服務的利用。長期照護需要者有多元複雜的照護需要，故照護連續性可能對照護結果及後續醫療服務利用有重要影響。我國目前處於即將開始建立正式長期照護體系之際，應就實證資料加以分析進行瞭解長期照護安排與醫療服務利用之關係，以提供我國長期照護體系制度規劃之參考依據。本研究目的包括(1)瞭解中老年長期照護需要者之醫療服務利用情形；(2)探討長期照護安排與醫療服務利用之關係；(3)分析照護連續性與醫療服務利用之關係；(4)瞭解長期照護安排及照護連續性共同對醫療服務利用之影響；以及(5)檢視在各類長期照護安排下，醫療服務利用的影響因素之異同。
研究方法：本研究資料來源為行政院衛生署(今衛生福利部)委託國立台灣大學執行之「全國長期照護需要評估第二年計畫」問卷調查資料，並串連2002-2003年全民健康保險申報資料庫。研究樣本為(1)日常生活活動中有任何1項功能障礙，或(2)工具性日常生活活動中有5項以上因健康相關因素具功能障礙，或(3)SPMSQ量表答錯6題以上者，或(4)因個案本人罹患失智症而無法自答SPMSQ量表者。共13,110名樣本。依變項為醫療服務利用情形，包括一年內是否使用門診、年度門診次數、年度門診總金額、一年內是否使用急診、年度急診次數、年度急診總金額、一年內是否有住院、年度住院次數、年度住院總日數、年度住院總金額、一年內是否有可避免住院、年度可避免住院次數、年度可避免住院總日數、年度可避免住院總金額、以及年度醫療費用總金額。自變項為長期照護安排以及照護連續性。長期照護安排分為(1)家庭照顧者或居家/社區式服務，(2)無照顧支持者，(3)雇用全職在宅看護，(4)住機構等四類。照護連續性分數以Bice &; Boxerman提出之計算方法測量之。控制變項包括(1)前傾因素：性別、年齡、教育程度；(2)使能因素：是否免部分負擔、居住地區都市化程度、婚姻狀況。(3)需要因素：疾病複雜度、憂鬱症狀、認知功能障礙、失能程度，未滿足需求。以描述性統計量、χ2 test、ANOVA、t-test、multiple logistic regression、以及generalized linear models (GLM)等方法進行分析。
研究結果：樣本之長期照護安排為家庭照顧者或居家/社區式服務者佔60.7%，無照顧支持者有14.3%，雇用全職在宅看護者百分比為16.0%，住機構者則有8.9%。各項醫療服務利用之年度利用率及年度使用次數平均值分別為門診(94.1%，26.1次/年)、急診(32.6%，0.7次/年)、住院(36.3%，0.8次/年)，及可避免住院(17.5%，0.3次/年)；年度住院總日數及可避免住院總日數分別為12.8日及3.6日。各類長期照護安排在各項醫療服務利用達統計上之顯著差異。控制前傾、使能及需要因素等基本特質後，長期照護安排及照護連續性對各項醫療服務利用之影響達統計上之顯著意義。相較於家庭照顧者或居家/社區式服務組，無照顧支持者之住院服務利用及各項醫療費用較低，雇用全職在宅看護者之各項門診服務利用、急診機會(OR=1.17, p<0.01)、住院總金額(RR=1.11, p<0.05)、可避免住院次數(RR=1.15, p<0.05)、可避免住院總日數(RR=1.31, p<0.01)、可避免住院總金額(RR=1.27, p<0.01)，及醫療費用總金額(RR=1.18, p<0.001)都較高；住機構者則是各項門診服務利用、住院機會(OR=1.40, p<0.001)、次數(RR=1.52, p<0.001)、總日數(RR=1.74, p<0.001)、總金額(RR=1.18, p<0.01)，及可避免住院風險(OR=1.73, p<0.001)、可避免住院次數(RR=1.71, p<0.001)、可避免住院總日數(RR=1.85, p<0.001)，及可避免住院總金額(RR=1.35, p<0.01)，及醫療費用總金額(RR=1.25, p<0.001)都較高，而急診機會(OR=0.73, p<0.001)、急診次數(RR=0.63, p<0.001)、急診總金額(RR=0.67, p<0.001)較低。照護連續性的影響為照護連續性愈高，門診、急診、住院及可避免住院的使用機會和次數愈低。共同納入照護連續性之後，長期照護安排對醫療服務利用之影響仍存在，但其影響程度對雇用看護者而言在住院及可避免住院有較明顯的降低。依長期照護安排分層分析後發現，照護連續性對門診服務利用的影響在雇用全職在宅看護者最為明顯，對急診、住院、可避免住院，及醫療費用總金額的影響則是在住機構者最明顯。疾病複雜度提高醫療服務利用的作用對無照顧支持者的影響較強。失能程度對住社區者而言可能減少門診使用而增加住院服務利用，對住機構者則相反，會增加門診使用而在住院服務利用較低。
結論：長期照護安排確實對醫療服務利用有影響，整體而言雇用全職在宅看護或住機構者可能有較高的醫療服務利用。對雇用全職在宅看護者而言，照護連續性在其與醫療服務利用間之關係有部分的中介效果。各類不同的長期照護安排下，照護連續性及其他影響因素對醫療服務利用產生的作用會有所不同。本研究結果指出長期照護與醫療體系之間的聯結，受到長期照護政策之引導而形成的長期照護安排，會在醫療體系對醫療服務利用量產生顯著的影響。應加強發展多元化之居家/社區式長期照護服務，支持家庭照顧資源，以改善目前我國長期照護需要者過度依賴看護，或當家庭資源無法支持時只能接受機構式照護之選項的限制，才能提升照護品質並且有效率的提供健康照護。

Background and Objectives: With the trend of population aging, the society faces the challenge of increasing needs on long-term care and medical care. People with long-term care needs also have high demand on medical care. In addition to the factors of sociodemographic characteristics and health status, long-term care arrangement, which is shaped by policy design, could also exert influences on medical care utilization. Long-term care users usually have multiple and complex health care needs; therefore, the continuity of care could influence their health-care outcomes and subsequent medical care uses. At the present time, Taiwan is developing the formal long-term care system. It is needed to analyze experimental data to clarify the relationship between long-term care arrangement and medical care utilization, and provide this base information for system planning. The aims of this study include: 1) describing the medical care utilization of the middle-aged and older adults with long-term care needs, 2) exploring the relationship between long-term care arrangement and medical care utilization, 3) analyzing the association between continuity of care and medical care utilization, 4) examining the joint effects of long-term care arrangement and continuity of care on medical care utilization, and 5) comparing the effects of realted factors of medical care utilization among different long-term care arrangements.
Methods: The data analyzed in this study was from the 2002 interview data of the Assessment of National Long-Term Care Need in Taiwan (ANLTCNT) and 2002-2003 claims data of the National Health Insurance (NHI). To estimate the long-term care needs in Taiwan, the ANLTCNT, a two-stage nationwide survey, was first launched in 2001. Subjects who met one of the following four criteria were defined as with long-term care needs and entered the second-stage survey: 1) one or more ADLs disability; 2) five or more IADLs disabilities; 3) cognitive impairment as measured with the Short Portable Mental Status Questionnaire (SPMSQ); or 4) unable to response SPMSQ due to dementia. A total of 13,110 individuals were analyzed in this study. Dependent variables were medical care utilization of outpatient visit, emergency department (ED) visit, hospitalization, and potentially avoidable hospitalization (PAH). For each type of medical care, whether used, number of episodes, length of stay (LOS) in one year (for hospitalization and PAH), and expenditures in one year were analyzed, In addition, the total medical expenditure in one year was also included in analyses. Independent variables were long-term care arrangement and continuity of care. Long-term care arrangement was categorized as 1) family caregiver or home- and community based services (HCBS), 2) without caregiver, 3) full-time, in-home care assistant, and 4) long-term care institution. Continuity of care index was computed by applying the method proposed by Bice &; Boxerman. Control variables included 1) predisposing factors: sex, age, and educational level, 2) enabling factors: copayment exemption, level of urbanization, and marital status, and 3) need factors: morbidity burden, depressive symptom, cognitive impairment, disability level, and unmet need. Descriptive statistics, χ2 test、ANOVA、t-test、multiple logistic regression, and generalized linear models (GLM) were used in statistical analyses.
Results: Of the study samples, 60.7% were cared by family caregiver or HCBS, 14.3% had no caregiver, 16.0% hired care assistant, and 8.9% resided in institutions. The rates and numbers of using were 94.1% and 26.1 visits/year(yr) for outpatient visit, 32.6% and 0.7 visits/yr for ED visit, 36.3% and 0.8 episodes/yr for hospitalization, and 17.5% and 0.3 episodes/yr for PAH. Comparing with the family caregiver/ HCBS group, the individuals without caregiver had less hospitalization utilization and medical expenditures in all types of medical care. The care assistant group had higher utilization in outpatient and ED visits, hospitalization, and PAH, and total medical expenditure. The institution residents used more in outpatient visit, hospitalization, PAH, and total medical expenditure, but less in ED visit. Higher continuity of care was associated with lower risk and numbers of using outpatient and ED visits, hospitalization, and PAH. After controlling for continuity of care, the effects of long-term care arrangement on medical care utilization were still significant, but the magnitude of influence weakened, in particular for hospitalization and PAH. In the analyses stratified by long-term care arrangements, the effect of continuity of care on outpatient visit utilization was most significant in the care assistant group; however, the effects on ED visit, hospitalization, PAH, and total medical expenditure were more significant in the institutionalized group. The effects of morbidity burden on increased medical utilization were more relevant for those without caregiver. Higher disability was associated with lower outpatient visit and higher hospitalization utilization for the community-dwellers, but for the institution residents, the direction of effects was reverse.
Conclusions: Long-term care arrangement could affect medical care utilization, and this association is partly mediated by continuity of care. Under different long-term care arrangements, the effects of the related factors of medical care utilization might be different. The findings of this study indicate the linkage between long-term care and medical care systems. Long-term care arrangement, which is directed by long-term care policy, could greatly influence the amount of medical care utilization in medical system. To improve the quality and efficiency of health care, policy makers shoud reinforce developing diverse HCBSs to support family caregiving, and modify the trend of over-dependency on foreign care assistants and institutionalization.

目 錄
口試委員會審定書………………………………………………………i
誌謝………………………………………………………………………ii
中文摘要………………………………………………………………iii
英文摘要…………………………………………………………………vi
第一章 研究背景與研究目的…………………………………………1
第一節 研究背景………………………………………………………1
第二節 研究問題及研究目的…………………………………………6
第二章 文獻探討………………………………………………………7
第一節 長期照護需要者之醫療需要情形……………………………7
第二節 醫療服務利用之相關因素……………………………………9
第三節 長期照護服務內容及使用現況………………………………14
第四節 長期照護服務使用對醫療服務利用之影響…………………17
第五節 照護連續性與醫療服務利用之關係…………………………25
第六節 文獻探討小結…………………………………………………28
第三章 研究方法………………………………………………………30
第一節 研究架構及研究假說…………………………………………30
第二節 資料來源及研究對象…………………………………………32
第三節 研究變項及操作型定義………………………………………34
第四節 分析方法………………………………………………………39
第四章 研究結果………………………………………………………42
第一節 中老年長期照護需要者之醫療服務利用情形………………42
一、樣本基本特質及醫療服務利用之分布情形………………….42
二、基本特質與醫療服務利用之關係…………………………….44
第二節 長期照護安排與醫療服務利用之關係……………………….81
一、長期照護安排分布…………………………………………….81
二、基本特質與長期照護安排之關係…………………………….81
三、長期照護安排與醫療服務利用之關係……………………….82
第三節 照護連續性與醫療服務利用之關係………………………….96
一、照護連續性分數之分布情形及其與基本特質之關係……….96
二、照護連續性與醫療服務利用之關係………………………….96
第四節 長期照護安排及照護連續性共同對醫療服務利用
之關係……………………………………………………….107
一、長期照護安排與照護連續性之關係…………………………107
二、長期照護安排及照護連續性共同與醫療服務利用
之關係……………………………………………………….107
第五節 各類長期照護安排下的醫療服務利用影響因素………….119
一、門診服務利用之影響因素……………………………………119
二、急診服務利用之影響因素……………………………………124
三、住院服務利用之影響因素……………………………………128
四、可避免住院服務利用之影響因素……………………………134
五、醫療費用總金額之影響因素…………………………………139
第六節 研究結果小結…………………………………………………186
第五章 討論……………………………………………………………204
第一節 研究結果與討論…………………………………………….204
一、中老年長期照護需要者之基本特質及醫療服務利用
情形………………………………………………………….204
二、長期照護安排與醫療服務利用之關係………………………206
三、照護連續性與醫療服務利用之關係…………………………212
四、長期照護安排及照護連續性共同對醫療服務利用
之關係……………………………………………………….213
五、各類長期照護安排下的醫療服務利用影響因素……………215
第二節 研究限制…………………………………………………….222
第三節 結論與政策啟示…………………………………………….224
參考文獻……………………………………………………………….228
附錄…………………………………………………………………….241

圖表目錄
圖1. 研究架構………………………………………………………….31
表4.1.1.1. 樣本基本特質…………………………………………….52
表4.1.1.2. 未納入分析樣本與納入分析樣本之基本特質及長期照護安排比較…………………………………………………………………54
表4.1.1.3. 樣本醫療服務利用情形………………………………….56
表4.1.2.1.1. 基本特質與門診服務利用之關係(未校正其他因素).57
表4.1.2.1.2. 基本特質與門診服務利用之關係(多變項分析)…….59
表4.1.2.2.1. 基本特質與急診服務利用之關係(未校正其他因素).61
表4.1.2.2.2. 基本特質與急診服務利用之關係(多變項分析)…….63
表4.1.2.3.1. 基本特質與住院服務利用之關係(未校正其他因素).65
表4.1.2.3.2. 基本特質與住院服務利用之關係(多變項分析)…….68
表4.1.2.4.1. 基本特質與可避免住院服務利用之關係(未校正其他因
素)…………………………………………………………71
表4.1.2.4.2. 基本特質與可避免住院服務利用之關係(多變項分析)……………………………………………………………………………74
表4.1.2.5.1. 基本特質與醫療費用總金額之關係(未校正其他因素)……………………………………………………………………………77
表4.1.2.5.2. 基本特質與醫療費用總金額之關係(多變項分析)….79
表4.2.1. 長期照護安排情形………………………………………….87
表4.2.2. 基本特質與長期照護安排之關係………………………….88
表4.2.3.1.1. 長期照護安排與門診服務利用之關係(未校正其他因素)……………………………………………………………………….91
表4.2.3.1.2. 長期照護安排與門診服務利用之關係(多變項分析).91
表4.2.3.2.1. 長期照護安排與急診服務利用之關係(未校正其他因素)……………………………………………………………………….92
表4.2.3.2.2. 長期照護安排與急診服務利用之關係(多變項分析).92
表4.2.3.3.1. 長期照護安排與住院服務利用之關係(未校正其他因素)……………………………………………………………………….93
表4.2.3.3.2. 長期照護安排與住院服務利用之關係(多變項分析).93
表4.2.3.4.1. 長期照護安排與可避免住院服務利用之關係(未校正其他因素)………………………………………………………………….94
表4.2.3.4.2. 長期照護安排與可避免住院服務利用之關係(多變項分
析)…………………………………………………………94
表4.2.3.5.1. 長期照護安排與醫療費用總金額之關係(未校正其他因
素)…………………………………………………………95
表4.2.3.5.2. 長期照護安排與醫療費用總金額之關係(多變項分析)……………………………………………………………………………95
表4.3.1.1. 照護連續性分數分布情形………………………………100
表4.3.1.2. 基本特質與照護連續性之關係…………………………101
表4.3.2.1.1. 照護連續性與門診服務利用之關係(未校正其他因素)………………………………………………………………………….103
表4.3.2.1.2. 照護連續性與門診服務利用之關係(多變項分析)…103
表4.3.2.2.1. 照護連續性與急診服務利用之關係(未校正其他因素)………………………………………………………………………….103
表4.3.2.2.2. 照護連續性與急診服務利用之關係(多變項分析)…103
表4.3.2.3.1. 照護連續性與住院服務利用之關係(未校正其他因素)………………………………………………………………………….104
表4.3.2.3.2. 照護連續性與住院服務利用之關係(多變項分析)…104
表4.3.2.4.1. 照護連續性與可避免住院服務利用之關係(未校正其他因素)……………………………………………………………………105
表4.3.2.4.2. 照護連續性與可避免住院服務利用之關係(多變項分
析)………………………………………………………………………105
表4.3.2.5.1. 照護連續性與醫療費用總金額之關係(未校正其他因
素)……………………………………………………….106
表4.3.2.5.2. 照護連續性與醫療費用總金額之關係(多變項分析)106
表4.4.1.1. 長期照護安排與照護連續性之關係(未校正其他因素)………………………………………………………………………….113
表4.4.1.2. 長期照護安排與照護連續性之關係(多變項分析)……114
表4.4.2.1. 長期照護安排及照護連續性與門診服務利用之關係…116
表4.4.2.2. 長期照護安排及照護連續性與急診服務利用之關係…116
表4.4.2.3. 長期照護安排及照護連續性與住院服務利用之關係…117
表4.4.2.4. 長期照護安排及照護連續性與可避免住院服務利用
之關係…………………………………………………….117
表4.4.2.5. 長期照護安排及照護連續性與醫療費用總金額之關係118
表4.5.1.1. 是否使用門診之影響因素………………………………141
表4.5.1.2. 門診次數之影響因素……………………………………144
表4.5.1.3. 門診總金額之影響因素…………………………………147
表4.5.2.1. 是否使用急診之影響因素………………………………150
表4.5.2.2. 急診次數之影響因素……………………………………153
表4.5.2.3. 急診總金額之影響因素…………………………………156
表4.5.3.1. 是否有住院之影響因素…………………………………159
表4.5.3.2. 住院次數之影響因素……………………………………162
表4.5.3.3. 住院總日數之影響因素…………………………………165
表4.5.3.4. 住院總金額之影響因素…………………………………168
表4.5.4.1. 是否有可避免住院之影響因素…………………………171
表4.5.4.2. 可避免住院次數之影響因素……………………………174
表4.5.4.3. 可避免住院總日數之影響因素…………………………177
表4.5.4.4. 可避免住院總金額之影響因素…………………………180
表4.5.5.1. 醫療費用總金額之影響因素……………………………183
表4.6.1. 長期照護安排與照護連續性對醫療服務利用之影響結果
總表………………………………………………………….189
表4.6.2.1. 依長期照護安排分層分析之門診服務利用影響因素結果
總表……………………………………………………….190
表4.6.2.2. 依長期照護安排分層分析之急診服務利用影響因素結果
總表……………………………………………………….193
表4.6.2.3. 依長期照護安排分層分析之住院服務利用影響因素結果
總表……………………………………………………….196
表4.6.2.4. 依長期照護安排分層分析之可避免住院服務利用影響因素結果總表………………………………………………………….…199
表4.6.2.5. 依長期照護安排分層分析之醫療費用總金額影響因素結果總表………………………………………………………………….202

附表1-1. 長期照護安排與門診服務利用之關係(多變項分析)- 模式完整結果……………………………………………………………….241
附表1-2. 長期照護安排與急診服務利用之關係(多變項分析)- 模式完整結果……………………………………………………………….243
附表1-3. 長期照護安排與住院服務利用之關係(多變項分析)- 模式完整結果………………………………………………………….……245
附表1-4. 長期照護安排與可避免住院服務利用之關係(多變項分析)- 模式完整結果………………………………………………248
附表1-5. 長期照護安排與醫療費用總金額之關係(多變項分析)-
模式完整結果………………………………………………251
附表2-1. 照護連續性與門診服務利用之關係(多變項分析)- 模式完整結果……………….…………………………………………………253
附表2-2. 照護連續性與急診服務利用之關係(多變項分析)- 模式完整結果………………………………………………………………….255
附表2-3. 照護連續性與住院服務利用之關係(多變項分析)- 模式完整結果………………………………………………………………….257
附表2-4. 照護連續性與可避免住院服務利用之關係(多變項分析)-
模式完整結果………………………………………………260
附表2-5. 照護連續性與醫療費用總金額之關係(多變項分析)- 模式完整結果……………………………………………………………….263
附表3-1. 長期照護安排及照護連續性與門診服務利用之關係- 模式完整結果……………………………………………………………….265
附表3-2. 長期照護安排及照護連續性與急診服務利用之關係- 模式完整結果……………………………………………………………….267
附表3-3. 長期照護安排及照護連續性與住院服務利用之關係- 模式完整結果……………………………………………………………….269
附表3-4. 長期照護安排及照護連續性與可避免住院服務利用之關係-
模式完整結果………………………………………………272
附表3-5. 長期照護安排及照護連續性與醫療費用總金額之關係-
模式完整結果………………………………………………275

Agency for Healthcare Research and Quality. Appendix B. Ambulatory Care Sensitive Conditions. Available at http://archive.ahrq.gov/data/safetynet/billappb.htm Accessed at May 2, 2012.
Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36(1):1-10.
Arendts G, Howard K. The interface between residential aged care and the emergency department: a systematic review. Age Ageing. 2010;39(3):306-12.
Austin PC, Ghali WA, Tu JV. A comparison of several regression models for analysing cost of CABG surgery. Stat Med. 2003;22(17):2799-815.
Austin PC. A Comparison of statistical modeling strategies for analyzing length of stay after CABG surgery. Health Serv Outcomes Res Methodol. 2002; 3: 107-133.
Ayalon L. Intention to leave the job among live-in foreign home care workers in Israel. Home Health Care Serv Q. 2010(a);29(1):22-36.
Ayalon L. The perspectives of older care recipients, their family members, and their round-the-clock foreign home care workers regarding elder mistreatment. Aging Ment Health. 2010(b);14(4):411-5.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173-82.
Bice TW, Boxerman SB. A quantitative measure of continuity of care. Med Care. 1977;15(4):347-9.
Blackwell DL, Martinez ME, Gentleman JF, Sanmartin C, Berthelot JM. Socioeconomic status and utilization of health care services in Canada and the United States: findings from a binational health survey. Med Care. 2009 ;47(11):1136-46.
Blay SL, Fillenbaum GG, Andreoli SB, Gastal FL. Equity of access to outpatient care and hospitalization among older community residents in Brazil. Med Care. 2008;46(9):930-7.
Boult C, Hardy J. Comorbidity care models : integrated action plans for complex healthcare needs. Manasquan, NJ: Healthcare Intelligence Network, 2009.
Carpenter JS, Andrykowski MA, Wilson J, Hall LA, Rayens MK, Sachs B, Cunningham LL. Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues Ment Health Nurs. 1998;19(5):481-94.
The Centers for Medicare and Medicaid Services. Risk adjustment. https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Risk_adjustment.html. Accessed at 2012/05/06.
Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83.
Chen TJ, Chou LF, Hwang SJ. Patterns of ambulatory care utilization in Taiwan. BMC Health Serv Res. 2006;6:54.
Cheng SH, Chen CC, Hou YF. A longitudinal examination of continuity of care and avoidable hospitalization: evidence from a universal coverage health care system. Arch Intern Med. 2010;170(18):1671-7.
Chi MJ, Wu SC, Chan DC, Lee CC. Social determinants of emergency utilization associated with patterns of care. Health Policy. 2009;93(2-3):137-42.
Condelius A, Hallberg IR, Jakobsson U. Medical healthcare utilization as related to long-term care at home or in special accommodation. Arch Gerontol Geriatr. 2010;51(3):250-6.
Conroy S, Van Der Cammen T, Schols J, Van Balen R, Peteroff P, Luxton T. Medical services for older people in nursing homes--comparing services in England and the Netherlands. J Nutr Health Aging. 2009;13(6):559-63.
Corsonello A, Pedone C, Lattanzio F, Lucchetti M, Garasto S, Carbone C, Greco C, Fabbietti P, Incalzi RA. Regimen complexity and medication nonadherence in elderly patients. Ther Clin Risk Manag. 2009;5(1):209-16.
Desai MM, Lentzner HR, Weeks JD. Unmet need for personal assistance with activities of daily living among older adults. Gerontologist. 2001;41(1):82-8.
Ellencweig AY, Stark AJ, Pagliccia N, McCashin B, Tourigny A. The effect of admission to long-term care program on utilization of health services by the elderly in British Columbia. Eur J Epidemiol. 1990;6(2):175-83.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8-27.
Feng L, Yap KB, Kua EH, Ng TP. Depressive symptoms, physician visits and hospitalization among community-dwelling older adults. Int Psychogeriatr. 2009;21(3):568-75.
Fern&;aacute;ndez-Olano C, Hidalgo JD, Cerd&;aacute;-D&;iacute;az R, Requena-Gallego M, S&;aacute;nchez-Casta&;ntilde;o C, Urbistondo-Cascales L, Otero-Puime A. Factors associated with health care utilization by the elderly in a public health care system. Health Policy. 2006;75(2):131-9.
Gaugler JE, Kane RL, Kane RA, Newcomer R. Unmet care needs and key outcomes in dementia. J Am Geriatr Soc. 2005;53(12):2098-105.
Godden S, Pollock AM. The use of acute hospital services by elderly residents of nursing and residential care homes. Health Soc Care Community. 2001;9(6):367-74.
Grabowski DC. Medicare and Medicaid: conflicting incentives for long-term care. Milbank Q. 2007;85(4):579-610.
Grabowski DC, Stewart KA, Broderick SM, Coots LA. Predictors of nursing home hospitalization: a review of the literature. Med Care Res Rev. 2008;65(1):3-39.
Graverholt B, Riise T, Jamtvedt G, Ranhoff AH, Kr&;uuml;ger K, Nortvedt MW. Acute hospital admissions among nursing home residents: a population-based observational study. BMC Health Serv Res. 2011;11:126.
Gruneir A, Bell CM, Bronskill SE, Schull M, Anderson GM, Rochon PA. Frequency and pattern of emergency department visits by long-term care residents--a population-based study. J Am Geriatr Soc. 2010;58(3):510-7.
Gruneir A, Silver MJ, Rochon PA. Emergency department use by older adults: a literature review on trends, appropriateness, and consequences of unmet health care needs. Med Care Res Rev. 2011;68(2):131-55.
Gulliford M, Cowie L, Morgan M. Relational and management continuity survey in patients with multiple long-term conditions. J Health Serv Res Policy. 2011;16(2):67-74.
Gunther S, Taub N, Rogers S, Baker R. What aspects of primary care predict emergency admission rates? A cross sectional study. BMC Health Serv Res. 2013;13:11.
Ionescu-Ittu R, McCusker J, Ciampi A, Vadeboncoeur AM, Roberge D, Larouche D, Verdon J, Pineault R. Continuity of primary care and emergency department utilization among elderly people. CMAJ. 2007;177(11):1362-8.
Ingarfield SL, Finn JC, Jacobs IG, Gibson NP, Holman CD, Jelinek GA, Flicker L. Use of emergency departments by older people from residential care: a population based study. Age Ageing. 2009;38(3):314-8.
Intrator O, Grabowski DC, Zinn J, Schleinitz M, Feng Z, Miller S, Mor V. Hospitalization of nursing home residents: the effects of states'' Medicaid payment and bed-hold policies. Health Serv Res. 2007;42(4):1651-71.
Jee SH, Cabana MD. Indices for continuity of care: a systematic review of the literature. Med Care Res Rev. 2006 Apr;63(2):158-88.
KaneRA, Kane RL. Long-term care: Principles, programs, and policies. 1987; NY: Springer Publishing Co.
Kane RL, Homyak P, Bershadsky B, Flood S, Zhang H. Patterns of utilization for the Minnesota senior health options program. J Am Geriatr Soc. 2004; 52(12):2039-44.
Kristensson J, Hallberg IR, Jakobsson U. Healthcare consumption in men and women aged 65 and above in the two years preceding decision about long-term municipal care. Health Soc Care Community. 2007;15(5):474-85.
Kuzuya M, Hirakawa Y, Suzuki Y, Iwata M, Enoki H, Hasegawa J, Iguchi A. Association between unmet needs for medication support and all-cause hospitalization in community-dwelling disabled elderly people. J Am Geriatr Soc. 2008;56(5):881-6.
Le&;oacute;n-Mu&;ntilde;oz LM, L&;oacute;pez-Garc&;iacute;a E, Graciani A, Guallar-Castill&;oacute;n P, Banegas JR, Rodr&;iacute;guez-Artalejo F. Functional status and use of health care services: longitudinal study on the older adult population in Spain. Maturitas. 2007;58(4):377-86.
Li P, Kim MM, Doshi JA. Comparison of the performance of the CMS Hierarchical Condition Category (CMS-HCC) risk adjuster with the Charlson and Elixhauser comorbidity measures in predicting mortality. BMC Health Serv Res. 2010;10:245.
Long SK, King J, Coughlin TA. The implications of unmet need for future health care use: findings for a sample of disabled Medicaid beneficiaries in New York. Inquiry. 2005-2006;42(4):413-20.
Low LF, Yap M, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. 2011;11:93.
McCall N, Harlow J, Dayhoff D. Rates of hospitalization for ambulatory care sensitive conditions in the medicare+choice population. Health Care Financ Rev. 2001;22(3):127-45.
Maciejewski ML, Liu CF, Derleth A, McDonell M, Anderson S, Fihn SD. The performance of administrative and self-reported measures for risk adjustment of Veterans Affairs expenditures. Health Serv Res. 2005;40(3):887-904.
Maciejewski ML, Liu CF, Fihn SD. Performance of comorbidity, risk adjustment, and functional status measures in expenditure prediction for patients with diabetes. Diabetes Care. 2009;32(1):75-80.
Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005 May;24(3):465-88.
Menec VH, Sirski M, Attawar D, Katz A. Does continuity of care with a family physician reduce hospitalizations among older adults? J Health Serv Res Policy. 2006;11(4):196-201.
Meret-Hanke LA. Effects of the Program of All-inclusive Care for the Elderly on hospital use. Gerontologist. 2011;51(6):774-85.
Miller EA, Weissert WG. Predicting elderly people''s risk for nursing home placement, hospitalization, functional impairment, and mortality: a synthesis. Med Care Res Rev. 2000;57(3):259-97.
Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010;29(1):57-64.
Nyweide DJ. Concordance between continuity of care reported by patients and measured from administrative data. Med Care Res Rev. 2014;71(2):138-55.
Nyweide DJ, Anthony DL, Bynum JP, Strawderman RL, Weeks WB, Casalino LP, Fisher ES. Continuity of care and the risk of preventable hospitalization in older adults. JAMA Intern Med. 2013;173(20):1879-85.
Pappa E, Niakas D. Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res. 2006;6:146.
Pope GC, Kautter J, Ellis RP, Ash AS, Ayanian JZ, Lezzoni LI, Ingber MJ, Levy JM, Robst J. Risk adjustment of Medicare capitation payments using the CMS-HCC model. Health Care Financ Rev. 2004;25(4):119-41.
Quail JM, Wolfson C, Lippman A. Unmet need and psychological distress predict emergency department visits in community-dwelling elderly women: a prospective cohort study. BMC Geriatr. 2011 19;11(1):86.
Redondo-Sendino A, Guallar-Castill&;oacute;n P, Banegas JR, Rodr&;iacute;guez-Artalejo F. Gender differences in the utilization of health-care services among the older adult population of Spain. BMC Public Health. 2006;6:155.
Saultz JW. Defining and measuring interpersonal continuity of care. Ann Fam Med. 2003;1(3):134-43.
Sands LP, Wang Y, McCabe GP, Jennings K, Eng C, Covinsky KE. Rates of acute care admissions for frail older people living with met versus unmet activity of daily living needs. J Am Geriatr Soc. 2006;54(2):339-44.
Sands LP, Xu H, Weiner M, Rosenman MB, Craig BA, Thomas J 3rd. Comparison of resource utilization for Medicaid dementia patients using nursing homes versus home and community based waivers for long-term care. Med Care. 2008;46(4):449-53.
Sansone RA, Sansone LA. Doctor Shopping: A Phenomenon of Many Themes. Innovations in Clinical Neuroscience 2012; 9: 42-6.
Sato T, Takeichi M, Shirahama M, Fukui T, Gude JK. Doctor-shopping patients and users of alternative medicine among Japanese primary care patients. General Hospital Psychiatry 1995; 17: 115-25.
Sayers SL, Hanrahan N, Kutney A, Clarke SP, Reis BF, Riegel B. Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. J Am Geriatr Soc. 2007;55(10):1585-91.
Shapiro E, Tate RB, Roos NP. Do nursing homes reduce hospital use? Med Care. 1987;25(1):1-8.
Song J, Chang RW, Manheim LM, Dunlop DD. Gender differences across race/ethnicity in use of health care among Medicare-aged Americans. J Womens Health (Larchmt). 2006;15(10):1205-13.
Suominen-Taipale AL, Martelin T, Koskinen S, Holmen J, Johnsen R. Gender differences in health care use among the elderly population in areas of Norway and Finland. A cross-sectional analysis based on the HUNT study and the FINRISK Senior Survey. BMC Health Serv Res. 2006;6:110.
Teng YH, Teng JJ, Lee MY, Hsieh MH, Chen YJ, Lin JY, Lee MC. Determinants of emergency medical utilization among the elderly population in Taiwan: a national longitudinal cohort study. Arch Gerontol Geriatr. 2013; 56(2):364-9.
Uijen AA, Schers HJ, Schellevis FG, van den Bosch WJ. How unique is continuity of care? A review of continuity and related concepts. Fam Pract. 2011 Nov 1. [Epub ahead of print]
van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: a systematic and critical review. J Eval Clin Pract. 2010;16(5):947-56.
Walter-Ginzburg A, Chetrit A, Medina C, Blumstein T, Gindin J, Modan B. Physician visits, emergency room utilization, and overnight hospitalization in the old-old in Israel: the cross-sectional and longitudinal aging study (CALAS). J Am Geriatr Soc. 2001;49(5):549-56.
Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Evaluation of a diabetes management program in China demonstrated association of improved continuity of care with clinical outcomes. J Clin Epidemiol. 2008;61(9):932-9.
Weiner JP, Dobson A, Maxwell SL, Coleman K, Starfield B, Anderson GF. Risk-adjusted Medicare capitation rates using ambulatory and inpatient diagnoses. Health Care Financ Rev. 1996;17(3):77-99.
Wenger NS, Young RT. Quality indicators for continuity and coordination of care in vulnerable elders. J Am Geriatr Soc. 2007;55 Suppl 2:S285-92.
Wieland D, Lamb VL, Sutton SR, Boland R, Clark M, Friedman S, Brummel-Smith K, Eleazer GP. Hospitalization in the Program of All-Inclusive Care for the Elderly (PACE): rates, concomitants, and predictors. J Am Geriatr Soc. 2000;48(11):1373-80.
Wilson DM, Truman CD. Evaluating institutionalization by comparing the use of health services before and after admission to a long-term-care facility. Eval Health Prof. 2004;27(3):219-36.
Wilson D, Truman C. Comparing the health services utilization of long-term-care residents, home-care recipients, and the well elderly. Can J Nurs Res. 2005;37(4):138-54.
Wolinsky FD, Liu L, Miller TR, An H, Geweke JF, Kaskie B, Wright KB, Chrischilles EA, Pavlik CE, Cook EA, Ohsfeldt RL, Richardson KK, Rosenthal GE, Wallace RB. Emergency department utilization patterns among older adults. J Gerontol A Biol Sci Med Sci. 2008;63(2):204-9.
Wolinsky FD, Bentler SE, Liu L, Geweke JF, Cook EA, Obrizan M, Chrischilles EA, Wright KB, Jones MP, Rosenthal GE, Ohsfeldt RL, Wallace RB. Continuity of care with a primary care physician and mortality in older adults. J Gerontol A Biol Sci Med Sci. 2010;65(4):421-8.
Woodward CA, Boyle MH, Offord DR, Cadman DT, Links PS, Munroe-Blum H, Byrne C, Thomas H. Ontario Child Health Study: patterns of ambulatory medical care utilization and their correlates. Pediatrics. 1988;82(3 Pt 2):425-34.
Worrall G, Knight J. Continuity of care is good for elderly people with diabetes: retrospective cohort study of mortality and hospitalization. Can Fam Physician. 2011;57(1):e16-20.
Wu SC, Chuang KY, Dai YT, Lee SD, Chang HJ, Day GI, Chan HM. Expanding the role of health service providers and the health care profession in the delivery of long-term care. Taiwan Journal of Public Health. 2005; 24(3): 189-91.
江清馦：德國、荷蘭長期照護保險內容與相關法令之研究(編號：(98)028.811)。2009；台北：行政院經濟建設委員會委託研究。
行政院內政部。內政統計通報(101年底我國老人長期照顧及安養機構概況)。2012；台北：行政院內政部。
行政院內政部統計處。統計報告-重要參考指標。http://www.moi.gov.tw/stat/ 連結日期：2014/05/12。
行政院勞委會。產業及社福外籍勞工人數－按行業及國籍分－行業標準分類第八次修訂(99年以後)。2012；http://statdb.cla.gov.tw/statis/stmain.jsp?sys=220&;ym=9906&;ymt=10106&;kind=21&;type=1&;funid=q13017&;cycle=41&;outmode=0&;compmode=0&;outkind=1&;fldspc=0,3,28,2,&;cod00=1&;rdm=peiJrp9U. 引用日期：2012/07/25。
行政院勞動部。102年外籍勞工管理及運用調查。2014；http://statdb.mol.gov.tw/html/svy02/0241menu.htm 引用日期：2014/04/27。
行政院經濟建設委員會。2010年至2060年臺灣人口推計。2011；台北：行政院經濟建設委員會。
行政院經濟建設委員會。長期照護保險規劃報告。2009；台北：行政院經濟建設委員會。
行政院衛生福利部(前衛生署)。99年國民醫療保健支出統計。2011；台北：行政院衛生署。
行政院衛生福利部(前衛生署)。92年度全民健康保險醫療統計年報。2004；http://www.mohw.gov.tw/CHT/DOS/Statistic.aspx?f_list_no=312&;fod_list_no=2075 引用日期：2014/04/26。
行政院衛生福利部國民健康署(前家庭計畫研究所)。民國八十五年台灣地區中老年保健與生涯規劃調查調查報告。1999；台北：行政院衛生福利部。
行政院衛生署。長期照護十年計畫成果。2012；台北：行政院衛生署。
吳淑瓊：全國長期照護需要評估第一年計畫期末報告(計畫編號：DOH 90-MA-5L01)。2002；台北：行政院衛生署委託研究。
吳淑瓊：全國長期照護需要評估第二年計畫期末報告(計畫編號：DOH 91-MA-1031)。2003；台北：行政院衛生署委託研究。
吳淑瓊、莊坤洋、陳亮汝：建構長期照護體系先導計畫：實驗社區介入前的照護需求與自付費用。台灣公共衛生雜誌, 2004; 23: 209-220。
李玉春：長期照顧保險法制給付方式及給付項目之評估(編號：(98)024.807)。2009；台北：行政院經濟建設委員會委託研究。
紀玫如：中老年人多重慢性病集群型態與醫療服務使用之相關研究。臺灣大學衛生政策與管理研究所博士論文，2008。
張文瓊：中風病人出院後之長期照護安排。臺灣大學衛生政策與管理研究所碩士論文，2001。
張晉芬：當制度「殺人」：外籍看護在台灣的處境。2014。http://twstreetcorner.org/2014/04/21/changchinfen-2/ 引用日期：2014/04/24。
陳正芬：管理或剝削？家庭外籍看護工雇主的生存之道。台灣社會研究季刊, 2011; 85: 89-155。
曾淑芬：機構式長期照護服務使用之相關因素探討：社區環境與個人背景因素的分析。臺灣大學衛生政策與管理研究所博士論文，2005。
陳亮汝、吳淑瓊：居家失能老人使用外籍監護工之相關因素分析。台灣公共衛生雜誌，2008；27：32-43。
陳雪姝、蔡淑鈴、黃欽印：長期照護機構住民醫療利用分析—以中部四縣市為例。台灣公共衛生雜誌，2009；28：175-183。
黃郁清、支伯生、鄭守夏：照護連續性與醫療利用之相關性探討。台灣公共衛生雜誌, 2010; 29: 45-63。
楊惠真、鄭讚源、林四海、方志琳、丁增輝：不同照顧場所之中風失能老人復健照護利用及其長期照護政策意涵。健康管理學刊, 2011; 9: 1-16。
葉莉莉：我國長期照護資源供給調查(編號：(98)021.804)。2009；台北：行政院經濟建設委員會委託研究。
劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義：台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊，2006；4：1-22。
戴桂英：中風出院病人後續醫療照護之研究。臺灣大學衛生政策與管理研究所博士論文，2007。