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研究生:洪慈慧
研究生(外文):Hung, Tszhuei
論文名稱:低收入戶急診醫療利用及其相關因素之研究
論文名稱(外文):Factors Associated with the Emergency Medical Service Utilization in Low-income People
指導教授:陳楚杰陳楚杰引用關係
指導教授(外文):Chen, Chuchieh
口試委員:林恆慶魏中仁
口試委員(外文):Lin, HerngchingWei, Zhongren
口試日期:2012-06-18
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:健康事業管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:170
中文關鍵詞:低收入戶急診急診醫療利用可避免住院
外文關鍵詞:low incomeemergency departmentemergency medical service utilizationavoidable hospitalizationpreventable hospitalization
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背景:瞭解急診醫療利用者的特性,有助於提升管理急診醫療利用之效率,文獻探討顯示,急診醫療的利用者中以低收入患者之利用率最高,亦是造成急診重複使用量最高的一群,但國內以全國性低收入戶為研究對象的急診醫療利用之研究十分有限。
目的:本研究旨在探討低收入者急診醫療利用的概況,以及與研究對象有無利用急診醫療及有無可避免住院之相關因素。
方法:本研究資料來自國家衛生研究院發行之全民健康保險研究資料庫之2005年百萬人承保抽樣歸人檔,選取2005年9,163位低收入戶為個案組,以1比4頻率匹配性別及年齡隨機選取36,652位非低收入戶為對照組,研究對象共計45,815位。使用SAS 9.3版進行資料整理與分析,比較兩組的性別、年齡層別及投保地區別等各項指標是否具有差異。此外,使用百分比同質性檢定研究對象就醫的醫事機構層級及檢傷分類是否有所差異並運用邏吉斯迴歸分析探討與研究對象有無利用急診醫療與有無可避免住院之相關因素。
結果:本研究結果顯示,個案組有2,453人曾使用過1次以上的急診醫療照護,平均每人急診利用次數為2.14次,其中以18歲以下之低收入戶孩童其急診利用次數最低,與對照組相較之下,病情多屬緊急症狀,又在醫院醫療機構就醫的人數明顯較多。在就醫診斷方面,以「徵候、症狀及診斷欠明之各種病態」、「損傷及中毒之外因補充分類」與「呼吸系統疾病」為主。其次,本研究結果發現,個案組之急診醫療利用勝算比高於對照組,其勝算比為1.616倍;獨立影響研究對象有無急診醫療利用的顯著相關因素有低收入戶與否、性別、年齡層別、投保地區別、有無物質濫用、有無重大傷病、前一年門診服務利用次數。最後,本研究結果發現,個案組之可避免住院勝算比高於對照組,其勝算比為2.235倍;獨立影響研究對象可避免住院的顯著相關因素有低收入戶與否、性別、19至35歲、56歲以上、有無物質濫用、有無重大傷病、前一年門診次數。
結論:低收入戶其急診醫療利用與可避免住院皆比非低收入戶高,故值得衛生主管機關的關注。

Background: To understand the characteristics of the patients using emergency departments was beneficial to promote and manage the efficiency in utilization of emergency medical resources. According to the results of some studies, there was a high percentage of using emergency departments by low-income, and it was considered as a group of the patients reused the emergency departments highly. However, there were few studies rarely in nationwide low-income households regarding the emergency medical service utilization in Taiwan.
Objectives: The purposes of this study were to explore the emergency medical service utilization of low-income households and found the key factors determining whether emergency departments were ever used and whether avoidable hospitalizations were ever had or not.
Methods: This study was conducted by using nationwide claims data for the year 2005 from the National Health Research Database in Taiwan to analyze the emergency medical utilization. There were 9,163 in the case group and one to four among age-matched and sex-matched subjects with cases called control group. And then, they were combined the case group with the control group, there were 45,815. SAS 9.3 Software was used to compare the diverseness between two groups about sex, age groups, areas of insured and all variables. Besides, using homogeneity of proportion tests the levels of hospitals and triage categories and logistic regression analysis was used to determine relationships among whether emergency departments were ever used and whether avoidable hospitalizations were ever had.
Result: The result of this study found there were 9,163 people in the case group who used emergency departments and the average of utilization was 2.14, especially the less 18-year-old populations were the lowest. Their conditions were urgent than the others’ and they usually went to over the level of local community hospitals. About the diagnosis, the highest first three items of emergency visits were ‘symptoms, signs, and ill-defined conditions’, ‘injury and poisoning’, ‘diseases of the respiratory system’. Secondly, we found the case group of patients in the odds ratio of using the emergency departments were higher than the others (OR = 1.616). Factors of low-income, sex, age groups, insured areas, substance abuse, catastrophic illness, visiting outpatient departments’ frequency last year and hospital admissions last year were ever used were significantly correlated with emergency service utilization. Finally, we also found the cases in the odds ratio of avoidable hospitalizations were higher (OR = 2.235) and factors of low-income, sex, 19 to 35 years old, over 56 years old, substance abuse, catastrophic illness, visiting outpatient departments’ frequency last year were significantly correlated with avoidable hospitalizations.
Conclusion: Low-income households its emergency medical utilization and preventable hospitalizations of a higher. Therefore, they’re of great worth to be concerned by the health organizations.

中文摘要----------------------------------------------------------------------I
Abstract---------------------------------------------------------------------III
目錄--------------------------------------------------------------------------VI
表目錄------------------------------------------------------------------------VIII
圖目錄------------------------------------------------------------------------X
第一章 緒論--------------------------------------------------------------------1
第一節 研究背景與動機-------------------------------------------------------1
第二節 研究目的--------------------------------------------------------------7
第三節 研究問題--------------------------------------------------------------8
第四節 研究重要性與貢獻-----------------------------------------------------9
第二章 文獻探討--------------------------------------------------------------10
第一節 低收入戶---------------------------------------------------------------10
第二節 急診醫療利用與檢傷分類------------------------------------------------15
第三節 醫療服務利用模式--------------------------------------------------------20
第四節 可避免住院及其相關因素---------------------------------------------------28
第五節 與急診醫療利用之相關因素--------------------------------------------------38
第六節 低收入戶與急診醫療利用及可避免住院之實證研究----------------------------------51
第三章 研究方法----------------------------------------------------------------59
第一節 研究設計----------------------------------------------------------------59
  第二節 選取樣本及資料處理流程------------------------------------------------63
  第三節 研究變項之操作型定義--------------------------------------------------67
  第四節 資料分析方法---------------------------------------------------------74
第四章 研究結果----------------------------------------------------------------76
第一節 樣本之基本特性、前一年醫療利用及2005年急診醫療利用之概況----------------------------76
第二節 與研究對象急診醫療利用之相關因素--------------------------------------91
第三節 與研究對象可避免住院之相關因素---------------------------------------101
第五章 討論與建議------------------------------------------------------------107
  第一節 研究方法與研究結果之討論--------------------------------------------107
  第二節 研究限制----------------------------------------------------------112
  第三節 研究建議----------------------------------------------------------115
中文文獻---------------------------------------------------------------------118
英文文獻---------------------------------------------------------------------132
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2. 薛承泰(2008)˙臺灣地區兒少貧窮:1991-2005年的趨勢研究˙臺灣社會學刊,40,89-130。
3. 薛承泰(2000)˙臺灣地區單親戶之貧窮:以1998年為例˙臺大社會工作學刊,(2),151-189。
4. 葛應欽、謝淑芬(1994)˙原住民重要死因分析˙高雄醫學科學雜誌,10(7),352 -366。
5. 賴麗珍(2005)˙屏南地區低收入戶之學童健康檢查評估˙東港安泰醫護雜誌,11(1),35-41。
6. 葛應欽、劉碧華、謝淑芬(1994)˙台灣地區原住民的健康問題˙高雄醫學科學雜誌,10(7),337-351。
7. 鄭斐芬、李景美(2002)˙屏東縣國中學生對嚼檳榔之知識、態度及嚼食行為研究˙衛生教育學報,(18),167-184。
8. 詹廖明義(2009)˙健康知能與病人安全˙醫療品質雜誌,3(2),64-66。
9. 楊美賞(2002)˙原住民婦女健康-菸酒檳榔對婦女的健康危害˙護理雜誌,49(2),29-34。
10. 葉美玉、黃松元、林世華、姜逸群(2002)˙影響臺灣阿美族青少年飲酒行為的心理社會因素˙衛生教育學報,(18),95-108。
11. 黃惠玲、張永源、莊勝發、蔡志浩、王興耀(1992)˙低收入家庭與兒童虐待研究˙高雄醫學科學雜誌,8(1),35-44。
12. 黃金安、賴其勛、胡哲生(2006)˙急診醫療服務與其它醫療服務之類別間關係˙臺灣公共衛生雜誌,25(5),384-393。
13. 陳聲平、譚光還、王德芳、蘇忠仁、謝亞芸、陳俊芳等人(2007)˙重大事件對職業身分別的急診醫療服務量的影響初探-以某區域醫院為例˙中華職業醫學雜誌,14(1),21-27。
14. 陳聲平、王德芳、佘振興、蘇忠仁、陳俊芳、楊銘欽(2008)˙醫院重大事件與急診醫療服務量相關性探討-以某區域醫院爲例˙醫務管理期刊,9(1),66-82。
15. 陳慶餘、沈友仁(1992)˙花蓮縣山地鄕原住民健康問題盛行率之初步調查˙臺灣公共衛生雜誌,11(1),13 -19。