The Impacts of Ambulatory Care on the Avoidable Hospitalization of Asthmatic Patients in Taiwan

• Main Authors: Shin-Yi Wang, 王馨儀
• Other Authors: 薛亞聖
• Format: Others
• Language: zh-TW
• Published: 2006
• Online Access: http://ndltd.ncl.edu.tw/handle/43876205978319514512

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 94 === Objects： Asthma is the popular chronic disease in Taiwan. Emergency treatment and hospitalization about asthma can be lessened through appropriate ambulatory care. The study apply the concept of “ambulatory care sensitive conditions” and “avoidable hospitalization” to be aware of the quality of caring asthmatic patients. First of all, we want to know the frequency of acute exacerbation, hospitalization, and emergency of asthma in each year in each administration area. Secondly, we try to understand the health service utilization of asthmatic patients in outpatient departments, emergency departments, and hospital departments, and except to find out the impact of appropriate ambulatory care on the utilization of emergency care and hospitalization. Methods： In the article, we use the National Health Insurance database during 2000-2002 to analyze medical resource utilization. The asthmatic patients in the outpatient department and emergency department we are studied are 493 in ICD-9-CM code, and exclude the patients who are undergoing operations and patients whose ICD-9-CM codes are 491 or 492. In order to emphasis the asthmatic patients’ hospitalization are preventable, we identify the asthmatic patients in the hospital department strictly. The hospital asthmatic patients we are studied are 493 in ICD-9-CM code, and exclude the patients who are undergoing operations, whose ICD-9-CM codes are 491 or 492, and whose ICD-9-CM codes are ever not respiratory diseases in the medical record. The data are analyzed by using descriptive statistics, logistic regression and poisson regression analysis. The statistic software is SAS 8.0. Results： In each administration area, the frequency of acute exacerbation, hospitalization, and emergency of asthma in each year during 2000-2002 tend to increase first and then to decrease. Compared with US, the care about asthma in Taiwan is better as a whole. But there are some differences between each administration area. Age, gender, the severity of asthma, low-income family, having a fixed clinic for regular visits, hospital ownership, hospital accreditation status, and each branch of National Health Insurance Bureau are found to have significant influence on the utilization of ambulatory care, emergency care, and hospitalization. The patients who have more times in ambulatory care are more frequency of acute exacerbation, hospitalization, and emergency of asthma. The degree of adequate medical departments in ambulatory care is significant protective influence on the frequency of acute exacerbation and emergency of asthma for serious patients. Taking lung function test regularly is significant protective influence on the frequency of hospitalization only. The patients taking allergen test are more frequency of acute exacerbation and emergency of asthma significantly, but less frequency of hospitalization significantly because of asthma. The patients served by the doctor having the more amounts of outpatient visits have more effect on asthma care. Although the boundary benefit decreases, it is the positive impact. The patients treated with a long-acting beta agonist and steroid in all year have less frequency of acute exacerbation, emergency care and hospitalization because of asthma than one-third or two-thirds year significantly. Conclusions： According to the results of this study, we suggest that public health organizations apply the concept of ‘preventable hospitalization’ to monitor the outpatient care quality and medical acceptability within fixed time in each area. Public health organizations should educate asthmatic patients to manage their diseases, the time when to seek medical advice, and correct habits about taking medical treatment: for instance, having a fixed clinic for regular visits and seeking medical advice in lower-level health care organization. That can help to provide continuity care to asthmatic patients. Besides, public health organizations should educate doctors in health care organization when to test, and when to give chronic-disorder refill prescriptions to patients. After taking lung function test or taking allergen test, doctors should educate patients how to manage their disease and plan the treatment program. Patients and doctors should strive to manage the chronic disease such as asthma continually. That can improve the quality of life of asthmatic patients and increase health service utilization about asthma.