本研究為橫斷式研究，屬次級資料庫分析，資料來源為2006年全民健康保險研究資料庫。研究目的主要在了解不同設置型態的居家照護機構其個案之醫療資源利用及併發症發生情形、與不同個案特質對療資源利用及併發症發生情形。
研究對象為該年連續12月都有使用居家照護者，共10,530名。依變項為一年內門、急、住診醫療資源利用及是否發生壓瘡、泌尿道感染及肺炎等併發症；自變項為居家照護機構設置型態及樣本之性別、年齡、Charlson Comorbidity Index、是否有重大傷病、資源耗用群組分類、案件分類等個人特質。以SAS 9.2版統計套裝軟體進行資料分析，統計方法採用以卡方檢定、獨立T檢定、Multiple regression model、Poisson regression model、logistic regression進行描述性及多變項分析。
研究結果顯示，獨立型居家照護機構及醫療院所附設居家照護機構的個案組合，在個案基本人口學特質上無差異，但在資源耗用群組、案件分類及Charlson Comorbidity Index存在差異。獨立型機構個案壓瘡的情形低於醫療院所附設型，泌尿道感染及肺炎則無顯著差異。獨立型居家照護機構個案在門診及住院醫療資源的利用上大多數高於醫療院所附設型；但在急診次數及急診總費用低於醫療院所附設型。在個案特質方面，男性、資源耗用群組照護需求高者、及案件分類在機構內照護者，併發症發生情形較高，且隨著年齡越高泌尿道感染及肺炎的發生情形越多。男性醫療資源利用情形亦高於女性，資源耗用群組第二類及第三類醫療利用情形低於第一類，第四類反之，案件分類在機構內照護者，門診及住院醫療利用情形較高於居家照護者，但急診利用則反之。
由於人口結構老化及疾病慢性化，國人對於居家護理的需求趨多，建議衛生單位在居家照護機構設置指標、照護範圍及費用給付標準應更審慎訂定及評估；而對於居家護理服務提供者，應自我進行品質監測及照護能力提升，以不負政策美意及社會大眾對於居家護理的殷切期盼。
關鍵詞：居家照護、設置型態、醫療資源利用、併發症

This study was a cross-sectional study, an analysis of secondary databases which was from National Health Insurance Research Database, 2006. Purpose of this study is to understand the relationship among type of home health care agencies, complications and medical care utilization of their clients
10,530 objects of the research group were collected which qualify of using home health care continuously for over 12 months in the study. The dependent variables were the medical care utilization of outpatient, emergency and inpatient, and whether the occurrence complications of pressure sores, urinary tract infection and pneumonia; the independent variables were patterns of the home health care agencies and samples of sex, age, Charlson Comorbidity Index, Catastrophic illness, resource utilization group classification, and classification care type of cases. The data analyzed by SAS 9.2 version statistical software and the chi-square test, independent T test, Multiple regression model, Poisson regression model, logistic regression, descriptive and multivariate analysis were adopted in statistics.
The results show that case mixes which in patterns of home health care agencies or independent hospitals affiliated home health care agencies have no difference in demographic characteristics. But there were difference exist in resource utilization groups, classification care types of case and Charlson Comorbidity Index. Pressure sore cases in independent agencies were lower than the affiliated to hospital agencies; urinary tract infection and pneumonia have no significant differences. Most of independent agencies of cases were higher than affiliated to hospital agencies in medical care utilization of outpatient and inpatient; but the total cost and visits of emergency was reverse. In characteristics of the cases, the males, high-utilization groups of medical resource, and cares by institutions which complications is higher, urinary tract infection and pneumonia with more cases from ages. The medical resources utilization in males was also higher than females. Resource utilization group II and group III in medical resources utilization were lower than the group I; but in group IV was the reverse. The cases classification in institutions which the medical care utilization of outpatient and inpatient were lower than the case classification in home, but in emergency was a reverse.
Due to the aging population and chronic diseases, the needs home health care getting more in nowadays. The study suggests the health units of the government to set indicators in the home care agency, others such as scopes and cost of care payment standards setting need more careful and evaluation. For home health care providers, the quality need to be monitored by themselves and improve healthcare ability in order to fulfill the policy of good intentions and the public's ardent desire for home care.

Key words: home health care, type of home health care, medical care utilization, complications

目錄
表 目 錄
圖 目 錄
中文摘要
ABSTRACT
第一章 緒論
第一節 研究背景與動機
第二節 研究的重要性
第三節 研究目的
第四節 研究範圍界定
第二章 文獻探討
第一節 居家照護的定義
第二節 國內居家照護機構現況
第三節 全民健康保險與居家照護
第四節 居家照護機構的管理與品質監測
第三章 研究設計與方法
第一節 研究設計與研究架構
第二節 研究假設
第三節 研究對象
第四節 研究變項及操作型定義
第五節 資料處理與統計分析
第四章 結果
第一節 樣本特質與併發症情形之描述性統計
第二節 醫療資源利用情形之描述性統計
第三節 併發症之多變項分析
第四節 醫療資源利用之多變項分析
第五章 討論
第一節 研究問題討論
第二節 醫務管理與政策討論
第六章 結論
第一節 結論
第二節 建議
第三節 研究限制
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