| Summary: | 碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === In the past there were many hospitalized quality monitoring on medical quality management, however affects the overall medical care quality and the medical system efficiency actually is primary care performance. Avoidable hospitalization is an outcome indicator used to evaluate access to primary care and primary care quality. A reduction in unnecessary hospitalization would affect quality and access. The potential cost savings associated with reducing potentially avoidable hospitalizations are substantial.
The main purposes of this research are to : (1) understand the performance of bacterial pneumonia primary care in Taiwan ; (2) describe bacterial pneumonia admission rate trends ; (3) evaluate the impact of " patient characteristic ", " hospital characteristic" and " environmental factor " on avoidable hospitalizations of bacterial pneumonia ; and (4) evaluate the different outcome of bacterial pneumonia on primary medical utilization.
Research design: this study used claim data of National Health Insurance and Department of Health from 2000 to 2002 for analysis. This study observed the outpatients of bacteria pneumonia. It was a secondary and case-control study. The study group was the outpatients of bacterial pneumonia who were hospitalized due to bacterial pneumonia and the control group was the outpatients of bacterial pneumonia who were not hospitalized due to bacterial pneumonia.
Main findings :
1. Trends :
During 2000-2002, the national admission rate of bacterial pneumonia were increased, only " Hsin Chu County " were decreased.
2. Patient characteristic :
Rate of bacterial pneumonia admission were higher for male, the person age fewer than 4 and upper 65, the patients who have chronic disease, low income, and lack compliance.
3. Hospital characteristic :
Different hospital type and hospital ownership were impact the bacterial pneumonia admission rate. Rate of bacterial pneumonia admission were higher for hospital type in medical center and regional hospital and hospital ownership in private.
4. Environmental factor :
Rate of bacterial pneumonia admission were higher in isolated island, Taipei County, Miaoli County, Nantou County, Yunlin County, and Chiayi County. About physician supply, the results were not consistent. In 2000, the physician supply had a non-significant association with avoidable hospitalizations, but in 2001 and 2002, the physician supply had a significant association with bacterial pneumonia admission rates.
5. Ambulatory medical utilization :
The control group on ambulatory care visits, drug days, antibiotic drug days, and the proportion of radiographic examination, blood examination, and sputum examination were higher than case group. The statistical result of the proportion of appropriate medical departments and emergency visits are non-significant. About the antibiotic used is significant association with bacterial pneumonia hospitalizations.
Base on above findings, this study suggests :
1. The authority can use avoidable hospitalizations of bacterial pneumonia as an indicator to evaluate primary care quality.
2. The authority should establish a good rating of hospital, family physician system, and the system of diagnose-shifting.
3. When health care providers faced high risk groups, they should be sensitive and raise awareness.
4. Health care providers should use evidence-based medicine and follow clinical guideline.
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