Emergency Department Utilization among Differential Care Types for National Health Insurance Home-Care Recipients

• Main Authors: Wu, Tzu-Hsuan, 吳姿璇
• Other Authors: Su, Hui-Fang
• Format: Others
• Language: zh-TW
• Published: 2011
• Online Access: http://ndltd.ncl.edu.tw/handle/75911985692914219419

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 99 === Background: As the elderly population has been growing rapidly, the need for long-term care has been increasing day by day, as well as whether the home care benefits already in place for the aging are worth studying. Currently, there is a lack of local, national and long-term evidence-based research comparing the emergency department utilization of home-care recipients and long-term care residents. Objectives: With reference to Phase I of Andersen's Behavioral Model of Health Services Utilization, investigate the emergency department utilization of home-care recipients with the National Health Insurance (NHI); compare morbidity risks from emergency department utilization among the NHI home-care users living at house, nursing home, and other long-term care facility; study predictive factors affecting the morbidity risks from emergency department utilization. Methods: A retrospective cohort study design was used. Data came from the ambulatory care visit claims (CD), the registry of ambulatory care orders (OO), and the registry for beneficiaries (ID) of the “home care specific file” in the National Health Insurance Research Database issued by the National Health Research Institutes between 1999 and 2008. The samples were the new received of NHI home-care users living at house, nursing home, and other long-term-care facility between 2000 and 2008. The frequency of NHI home-care users living at house, nursing home, and other long-term-care facility were 102,680, 27,801, and 50,246 respectively. Using the Poisson regression model, the factors affecting the emergency department utilization and the morbidity of all causes and the major system classification were predicted; three study cohorts on the morbidity of the emergency department utilization were compared. Results: The NHI home-care users living at house experienced the highest incidence density regarding circulation system diseases (441.41/103 person-year); NHI home-care users living at nursing home and other long-term-care facility experienced the highest incidence density regarding respiratory system diseases (454.49/103 person-year vs. 338.18/103 person-year). The three study cohorts all showed that higher emergency department utilization morbidity was found in male users, those aged 65 and above, Resources Utilization Group Category-4 home care consumers, major illness/injury and long-term respiratory dependent cases, cases with Charlson Comorbidity Index score 3-8, and cases with diabetes, tumor and congestive heart failure complications. The result of accessibility was inconsistent: the insured locations of NHI home-care users living at house were the urban areas, whereas, NHI home-care users living at long-term care facilities were located in the rural. The relative risk ratio of emergency department utilization and the morbidity of all causes were significantly high. Based on the multivariate Poisson regression model analysis, we found that NHI home-care users living at house experienced the highest morbidity risks from emergency department utilization on all causes, respiratory system, circulation system, and urinary & reproductive system; the next was NHI home-care users living at nursing home, and the lowest was NHI home-care users living at other long-term-care facility. Conclusions: The emergency department utilization incidence density and morbidity of NHI home-care users living at house were both higher than those users living at long-term care facility. It suggests the insufficient support of NHI home-care users living at house. The study results are worth considering for policy decision makers and caregivers related to healthcare.