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題 名 | Analysis of Emergency Department Utilization by Elderly Patients under National Health Insurance=全民健康保險老人急診醫療利用分析 |
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作 者 | 黃金安; 翁瑞宏; 蔡文正; 胡為雄; 楊大羽; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 19:3 2003.03[民92.03] |
頁 次 | 頁113-120 |
分類號 | 412.56 |
關鍵詞 | 全民健康保險; 老人; 急診; 醫療利用; Emergency department; Utilization; Elderly; National health insurance; |
語 文 | 英文(English) |
中文摘要 | 長久以來老人被認為過度使用急診醫療服務,此想法在老人比例正逐年增加的台灣尤具政策制定上的意涵。本研究目的在於比較老人(65 歲以上)與非老人(15-64 歲)對於急診醫療利用的差異,從而了解老人急診醫療利用的特性。研究資料來自民國 89 年全民健康保險研究資料庫,採次級資料分析,共抽取 12 家醫學中心 519,003 筆成人(> 14 歲)急診就醫資料。研究結果顯示,老人患者佔成人急診醫療次數的 28.5%。與非老人患者比較,老人患者有較多的男性(61.6% vs 47.7%, p< 0.001)、慢性病(11.9% vs 8.0%, p< 0.001)、重大傷病(6.7% vs 4.1%, p< 0.001)、不需要部分負擔(38.5% vs 5.8%, p< 0.001)、門診高利用(28.4% vs 9.9%, p< 0.001)、病情緊急(60.0% vs. 43.7%, p< 0.001)、急診留觀時間(14.0% vs. 4.7%, p< 0.001)及每次急診就診費用(NT$ 4,814 6,046 vs 2,779 5,533, p< 0.001)。此外,老人患者耗用了 40.8% 的成人急診醫療費用。老人與非老人的急診醫療利用有明顯的差異,急診醫護人員必須熟知老人急診的特殊且複雜的臨床表現。 |
英文摘要 | Elderly persons are thought to use emergency departments (EDs) disproportionately. This phenomenon has implications for policy-making as the population of the elderly continues to increase. This study aimed to characterize national ED utilization by elderly patients ( 65 years old), compared with that by younger patients (15-64 years old). The sample was selected from the National Health Insurance Research Database for the year 2000. There were 519,003 visits to adult EDs in the 12 medical centers sampled. The study used a secondary data analysis and included 14 variables. The elderly accounted for 28.5% of all adult ED visits. Compared with younger patients, a greater proportion of elderly patients were male (61.6% vs 47.7%, p < 0.001), had chronic diseases (11.9% vs 8.0%, p < 0.001), were major cases (6.7% vs 4.1%, p < 0.001), made no co-payment (38.5% vs 5.8%, p < 0.001), were frequent users of outpatient services (28.4% vs 9.9%, p < 0.001), were higher-level emergencies (60.0% vs 43.7%, p < 0.001), had longer stays in the ED (14.0% vs 4.7%, p < 0.001), and had higher costs per visit (NT$4,814 ± 6,046 vs 2,779 ± 5,533, p < 0.001). In addition, elderly patients used 40.8% of total adult ED costs. Older patients have distinct patterns of ED use, and use emergency services at a higher rate than younger patients. ED staff should be knowledgeable about the unique and complex presentations of older ED patients. |
本系統中英文摘要資訊取自各篇刊載內容。