目錄
摘 要 i
ABSTRACT ii
誌 謝 iii
目 錄 iv
表 目 錄 vi
圖 目 錄 vii
壹、緒論 1
一、研究背景與動機 1
二、研究目的 7
貳、文獻回顧 8
一、非計畫性再入院之相關因素探討 8
二、骨科之相關研究 16
三、LACE指數 26
四、查爾森共病指標 29
參、研究設計與方法 33
一、研究架構 33
二、研究對象 34
三、研究操作型定義 38
四、研究方法 42
五、實證模型 49
肆、實證分析 52
一、敘述性統計 52
二、疾病列表 55
三、t檢定與卡方檢定 58
四、LACE指數與臨界點之衡量 61
五、邏輯斯迴歸分析(Logistic Regression) 66
六、多元邏輯斯迴歸(Multinomial Logistic Regression) 78
伍、結論與建議 81
一、研究結論 81
二、研究建議 85
三、研究限制 85
參考文獻 86
一、中文文獻 86
二、英文文獻 90

表目錄
表2- 1 LACE對照表 28
表2- 2 查爾森共病對照表 31
表3- 1 第一型誤差、第二型誤差與ROC分類之關係 44
表3- 2 混淆矩陣(confusion matrix) 45
表3- 3 列聯表 47
表4- 1 敘述性統計表 54
表4- 2 骨科前5%疾病排名 57
表4- 3 t檢定與卡方檢定 60
表4- 4每個LACE分數的比率 61
表4- 5 LACE指數每個臨界點的敏感性、特異性和正確率 65
表4- 6 邏輯斯迴歸（模型一、模型二） 71
表4- 7 邏輯斯迴歸（模型三、模型四、模型五） 72
表4- 8 多元邏輯斯迴歸（模型四） 79

圖目錄
圖1-1 六十五歲老年人口占總人口數之百分比 2
圖1-2 NHE金額及占GDP比重 3
圖3-1 研究架構 33
圖3-2 資料歸戶流程圖 36
圖3-3 骨科篩選樣本圖 37
圖4- 1 骨科病患之查爾森共病17群分群 56
圖4- 2 ROC曲線 62
圖4- 3 模型一ROC曲線 75
圖4- 4 模型二ROC曲線 75
圖4- 5 模型三ROC曲線 76
圖4- 6 模型四ROC曲線 76
圖4- 7 模型五ROC曲線 77

一、中文文獻
1.江東亮，文羽苹，謝嘉容，2014， “全民健康保險制度的發展與問題 ” 台灣醫學，第18卷，第1期，頁33-42。
2.李嫈琛，張嘉蘋，李萱，吳玫容，王琪珍.，2013， “某醫學中心出院後病人非計畫性14天內再住院之流行病學特徵調查” 醫院, ，第46卷，第5期，頁14-21。
3.邱淑貞，黃素霞，盧豐華，王琪珍， 2012， “15天內非計畫性再住院原因及其相關因素之探討” 醫療品質雜誌，第6卷，第2期，頁46-53。
4.張政國，江季蓉，林玲玉，孫茂勝，吳盈瑩，2017， “驗證LACE 指數運用於各專科病人出院30 日內再住院或死亡風險評估適配度：以臺灣某醫學中心為例” 醫務管理期刊，第18卷，第4期，頁269-291。
5.謝生蘭，李金德，江秀珠，劉芹芳，2013， “經出院準備服務病人於14天非計畫性再住院之相關因素” 醫院，第46卷，第2期，頁34-44。
6.吳盈瑩，張政國，林玲玉，陳美如，江季蓉，孫茂勝，2018， “結合LACE、8P 工具及醫院整合醫學專科醫師介入創新制度降低出院後30 日內再住院率及照護費用：以某醫學中心為例” 醫務管理期刊，第19卷，第2期，頁79-98.
7.余桂霖，2012，多元迴歸分析，五南圖書出版股份有限公司，臺北市。
8.吳明隆，2011，論文寫作與量化研究，五南圖書出版股份有限公司，臺北市。
9.張紹勳，2016，Stata與高等統計分析，五南圖書出版股份有限公司，臺北市。
10.張紹勳，2018，邏輯斯迴歸及離散選擇模型—應用STaTa統計，五南圖書出版股份有限公司，臺北市。
11.內政部戶政司全球資訊網，2019，人口統計資料， https://www.ris.gov.tw/app/portal/346，查詢日期2020/4/14。
12.行政院衛生署中央健康保險局，2012，「推動及應用國際疾病分類第十版ICD-10-CM/PCS於臨床疾病分類計畫」ICD-10-CM/PCS 國際研討會， file:///D:/%E8%AB%96%E6%96%87/LACE/21975_2_8.3%E5%9C%8B%E9%9A%9B%E7%A0%94%E8%A8%8E%E6%9C%83%E5%A0%B1%E5%91%8A%E6%9B%B8.pdf，查詢日期2020/4/11。
13.高雄榮民總醫院骨科部，2020，一般骨科，https://org.vghks.gov.tw/orth/News.aspx?n=FBB5119B6B21CB22&sms=7847F2CAC4A09E87，查詢日期2020/5/13。
14.財團法人醫院評鑑暨醫療品質策進會，2017，醫院評鑑持續性監測指標操作型定義手冊，https://www.jct.org.tw/dl-190-779a2709b54f41119d768a04819ad0b3.html，查詢日期2020/5/20。
15.國家發展委員會，2014，5.高齡化時程 https://www.ndc.gov.tw/Content_List.aspx?n=695E69E28C6AC7F3，查詢日期2020/4/7。
16.國家發展委員會，2018，出生率及死亡率趨勢，https://pop-proj.ndc.gov.tw/chart.aspx?c=1&uid=61&pid=60，查詢日期2020/4/7。
17.衛生福利部，2018，107年國人死因統計結果，https://www.mohw.gov.tw/cp-16-48057-1.html，查詢日期2020/4/16。
18.衛生福利部中央健康保險署，2012，健保給付人工膝關節，讓您的「腳頭烏」不再疼痛， https://www.nhi.gov.tw/News_Content.aspx?n=FC05EB85BD57C709&sms=587F1A3D9A03E2AD&s=BD9B4A61760FEA3D，查詢日期2020/4/28。
19.衛生福利部中央健康保險署，2014，民眾篇， https://www.nhi.gov.tw/Content_List.aspx?n=07CF9A212D130832&topn=3FC7D09599D25979，查詢日期2020/5/24。
20.衛生福利部中央健康保險署，2017，什麼是分級醫療？， https://www.nhi.gov.tw/Content_List.aspx?n=9E7392780F830646&topn=0B69A546F5DF84DC，查詢日期2020/4/6。
21.衛生福利部中央健康保險署，2017b，肌肉拉傷、關節扭傷、脫臼及骨折， https://www.nhi.gov.tw/Content_List.aspx?n=895A87E39BFE961F&topn=5FE8C9FEAE863B46，查詢日期2020/5/12。
22.衛生福利部公共關係室，2008，健保自97年5月1日起部分給付特殊材料金屬對金屬介面人工髖關節，https://dep.mohw.gov.tw/pro/cp-2731-28539-120.html，查詢日期2020/5/12。
23.衛生福利部國民健康署，2008，研究顯示：五成老人有三種以上慢性病， https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=1128&pid=1949，，查詢日期2020/5/26。
24.衛生福利部國民健康署，2015，非計畫性住院案件出院後十四日以內再入院率，https://www.nhi.gov.tw/AmountInfoWeb/iDesc.aspx?rtype=2&Q5C2_ID=1078，查詢日期2020/4/29。
25.衛生福利部國民健康署，2018，2018-2019全民健康保險年報，http://www.nhi.gov.tw/resource/Webdata/2018-19%E5%85%A8%E6%B0%91%E5%81%A5%E5%BA%B7%E4%BF%9D%E9%9A%AA%E5%B9%B4%E5%A0%B1.pdf，查詢日期2020/4/10。
26.衛生福利部統計處，2018，107年度全民健康保險醫療統計年報， https://dep.mohw.gov.tw/DOS/np-4647-113.html，查詢日期2020/4/27。
27.衛生福利部統計處，2019，107年醫療機構現況及醫院醫療服務量-電子書， https://dep.mohw.gov.tw/DOS/cp-4487-49166-113.html，查詢日期2020/4/21。
 
二、英文文獻
1.Avinash, M., Rajasekaran, S., & Aiyer, S. N., 2017. “Unplanned 90-day readmissions in a specialty orthopaedic unit-A prospective analysis of consecutive 12729 admissions” , Journal of orthopaedics, Vol.14,No.2, 236-240.
2.Benbassat, J., & Taragin, M., 2000. “Hospital Readmissions as a Measure of Quality of Health Care: Advantages and Limitations” Archives of Internal Medicine, Vol. 160,No. 8, 1074-1081.
3.Bernatz, J. T., Tueting, J. L., Hetzel, S., & Anderson, P. A., 2016. “What Are the 30-day Readmission Rates Across Orthopaedic Subspecialties?” Clinical orthopaedics and related research, Vol.474 ,No. 3, 838-847.
4.Brauer, C. A., Coca-Perraillon, M., Cutler, D. M., & Rosen, A. B., 2009. “Incidence and mortality of hip fractures in the United States” JAMA, Vol. 302,No. 14, 1573-1579.
5.Canizares, M., Leroux, T., Zywiel, M., Perruccio, A., Gandhi, R., & Rampersaud, R., 2019. “Unplanned readmissions and emergency department following orthopedic surgery for osteoarthritis from 2004 to 2016 in Ontario, Canada: The impact of the changing profiles of patients and clinical care” Osteoarthritis and Cartilage, Vol.27, S34.
6.Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R., 1987. “A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.” J Chronic Dis, Vol. 40,No.5, 373-383.
7.Cheng, T., Zhang, G. Y., Liu, T., & Zhang, X. L., 2012. “A meta-analysis of percutaneous compression plate versus sliding hip screw for the management of intertrochanteric fractures of the hip” J Trauma Acute Care Surg, Vol. 72,No. 5, 1435-1443.
8.Chern, A., Greenberg, S. E., Thakore, R. V., Sathiyakumar, V., Obremskey, W. T., & Sethi, M. K., 2015. “Factors driving readmissions in tibia and femur fractures” Advances in orthopedics, Vol. 2015, 974543-974543.
9.Chiang, T. L., 1997. “Taiwan's 1995 health care reform” Health Policy, Vol. 39,No. 3, 225-239.
10.Cram, P., Lu, X., Kaboli, P. J., Vaughan-Sarrazin, M. S., Cai, X., Wolf, B. R., & Li, Y. , 2011. “Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008” JAMA, Vol. 305,No. 15, 1560-1567.
11.Deyo, R. A., Cherkin, D. C., & Ciol, M. A., 1992. “Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases” Journal of Clinical Epidemiology, Vol. 45,No. 6, 613-619.
12.Ethgen, O., Bruyère, O., Richy, F., Dardennes, C., & Reginster, J. Y., 2004. “Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature” J Bone Joint Surg Am, Vol. 86,No. 5, 963-974.
13.Fu, M. C., Young, K., Cody, E., Schairer, W. W., Demetracopoulos, C. A., & Ellis, S. J., 2017. “Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues: An Analysis of 5056 Cases” Foot & Ankle Orthopaedics, Vol. 2,No. 2, 24730114-17695254.
14.Goldberg, V. M., Buckwalter, J. A., Hayes, W. C., & Koval, K. J., 1997. “Orthopaedic challenges in an aging population” Instr Course Lect, Vol. 46,417-422.
15.Jencks, S. F., Williams, M. V., & Coleman, E. A., 2009. “Rehospitalizations among patients in the Medicare fee-for-service program” N Engl J Med, Vol. 360,No. 14, 1418-1428.
16.Joynt, K. E., & Jha, A. K., 2013. “Characteristics of Hospitals Receiving Penalties Under the Hospital Readmissions Reduction Program” JAMA, Vol. 309,No. 4, 342-343.
17.Kang, J.-H., Hsieh, M.-S., & Lin, H.-C., 2010. “Comparison of treatment outcomes following total knee arthroplasty among patients with rheumatoid arthritis and osteoarthritis: a nationwide population-based study” Rheumatology, Vol. 49,No. 7, 1409-1410.
18.Mandi, D. M., 2012. “Ankle fractures” Clin Podiatr Med Surg, Vol. 29,No. 2, 155-186, vii.
19.Martin, C. T., Gao, Y., & Pugely, A. J., 2016. “Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery” The Iowa orthopaedic journal, 36, 155-160. Vol. 36 , 155-160.
20.McCormack, R. A., Hunter, T., Ramos, N., Michels, R., Hutzler, L., & Bosco, J. A., 2012. “An analysis of causes of readmission after spine surgery” Spine (Phila Pa 1976), 37(14), 1260-1266. Vol. 37,No. 14, 1260-1266.
21.McIlvennan, C. K., Eapen, Z. J., & Allen, L. A., 2015. “Hospital readmissions reduction program” Circulation, Vol. 131,No. 20, 1769-1803.
22.Miller, D. (2019). Screening and Referral of Orthopedic Patients into Care Coordination to Decrease Readmissions. In.
23.Nacke, E., Ramos, N., Stein, S., Hutzler, L., & Bosco, J. A., 3rd., 2013. “When do readmissions for infection occur after spine and total joint procedures?” Clinical orthopaedics and related research, Vol. 47,No. 2, 569-573.
24.Nutt, J. L., & Solan, M. C. ,2017. “Ageing and orthopaedics” Orthopaedics and Trauma, Vol. 31,No. 5, 321-325.
25.Puckett, Y., 2017. “Reassessing post-hospital conditions of section 3025 hospital read missions reduction program in the affordable care act” MOJ Public Health, Vol. 5,No. 5, 176-181.
26.Pull ter Gunne, A. F., & Cohen, D. B., 2009. “Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery” Spine (Phila Pa 1976), Vol. 34,No. 13, 1422-1428.
27.Pull ter Gunne, A. F., van Laarhoven, C. J., & Cohen, D. B., 2010. “Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk” Eur Spine J, Vol. 19,No. 6, 928-988.
28.Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J.-C., . . . Ghali, W. A., 2005. “Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data” Medical care, Vol. 43,No. 11, 1130-1139.
29.Sarimo, S., Pajulammi, H., & Jämsen, E., 2020. “Process-related predictors of readmissions and mortality following hip fracture surgery: a population-based analysis” European Geriatric Medicine.
30.Schairer, W. W., Sing, D. C., Vail, T. P., & Bozic, K. J., 2014. “Causes and frequency of unplanned hospital readmission after total hip arthroplasty” Clinical orthopaedics and related research, 472(2), 464-470. Vol. 472,No. 2, 464-470.
31.Singh, J. A., Inacio, M. C. S., Namba, R. S., & Paxton, E. W., 2015. “Rheumatoid arthritis is associated with higher ninety-day hospital readmission rates compared to osteoarthritis after hip or knee arthroplasty: a cohort study” Arthritis care & research, Vol. 67,No. 5, 718-724.
32.Singh, J. A., & Yu, S. (2016). “Gout-related inpatient utilization: a study of predictors of outcomes and time trends” Arthritis research & therapy, 18, 57-57.
33.Starks, I., Wainwright, T. W., Lewis, J., Lloyd, J., & Middleton, R. G., 2014. “Older patients have the most to gain from orthopaedic enhanced recovery programmes” Age and Ageing, Vol. 43,No. 5, 642-648.
34.van Walraven, C., Dhalla, I. A., Bell, C., Etchells, E., Stiell, I. G., Zarnke, K., . . . Forster, A. J., 2010. “Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community” Canadian Medical Association Journal, Vol. 182,No. 6, 551.
35.Veronese, N., & Maggi, S,2018. “Epidemiology and social costs of hip fracture” Injury, Vol. 49,No. 8, 1458-1460.
36.Weinberg, D. S., Kraay, M. J., Fitzgerald, S. J., Sidagam, V., & Wera, G. D., 2017. “Are Readmissions After THA Preventable?” Clinical orthopaedics and related research, Vol. 475,No. 5, 1414-1423.
37.Wu, E. Q., Patel, P. A., Yu, A. P., Mody, R. R., Cahill, K. E., Tang, J., & Krishnan, E., 2008. “Disease-related and all-cause health care costs of elderly patients with gout” J Manag Care Pharm, Vol. 14,No. 2, 164-175.
38.Yian, E., Zhou, H., Schreiber, A., Sodl, J., Navarro, R., Singh, A., & Bezrukov, N., 2016. “Early Hospital Readmission and Mortality Risk after Surgical Treatment of Proximal Humerus Fractures in a Community-Based Health Care Organization” Perm J, Vol. 20,No. 1, 47-52.
39.Youden, W. J., 1950. “Index for rating diagnostic tests” Cancer, Vol. 3,No. 1, 32-35.
40.Zhu, Y., Pandya, B. J., & Choi, H. K., 2011. “Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007-2008” Arthritis Rheum, 63(10), 3136-3141. Vol. 63,No. 10, 3163-3141.
41.Agency for Healthcare Research and Quality Advancing Excellence in Health Care,2019, Readmissions and Adverse Events After Discharge, https://psnet.ahrq.gov/primer/readmissions-and-adverse-events-after-discharge (last visited on May 14, 2020).
42.Centers for Disease Control and Prevention,2010, Surgical Site Infection (SSI),https://www.cdc.gov/hai/ssi/ssi.html (last visited on May 17, 2020).
43.KAISER FAMILY FOUNDATION,2012, Effort To Curb Medicare Spending Begins With Crackdown On Hospital Readmissions, https://khn.org/news/medicare-spending-hospital-readmissions/( last visited on May 14, 2020).
44.KAISER FAMILY FOUNDATION,2013,Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions, https://khn.org/news/readmission-penalties-medicare-hospitals-year-two/( last visited on May 14, 2020).
45.United Nations,2019,Ageing, https://www.un.org/en/sections/issues-depth/ageing/(last visited on May 26, 2020).
46.U.S. Department of Health & Human Services,2014,New HHS Data Shows Major Strides Made in Patient Safety, Leading to Improved Care and Savings,https://innovation.cms.gov/files/reports/patient-safety-results.pdf(last visited on May 28, 2020).
47.World Health Organation,2008,"Preventing Chronic Diseases: A Vital Investment" Summary,https://www.who.int/chp/chronic_disease_report/part1/zh/( last visited on Apr 15, 2020).
48.World Health Organation,2015, Road Safety Global Status Report 2015,https://www.who.int/violence_injury_prevention/road_safety_status/2015/zh/(last visited on Apr 17, 2020).
49.World Health Organation,2017,10 facts about aging and health https://www.who.int/features/factfiles/ageing/zh/( last visited on Apr 19, 2020).
50.World Health Organation,2018a,Falls,https://www.who.int/news-roo/fact-sheets/detail/falls(last visited on May 22, 2020).
51.World Health Organation,2018b,Obesity and overweight, https://www.who.int/zh/news-room/fact-sheets/detail/obesity-and-overweight(last visited on Apr 17, 2020).