A long-term evaluation of patients continued to participate in family physician integrated care plan on healthcare utilization

• Main Authors: Cheng-Ting Lin, 林千婷
• Other Authors: Nicole Huang
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/24568583377593648532

碩士 === 國立陽明大學 === 醫務管理研究所 === 104 === Background and importance National Health Insurance Administration in March 2003 began to implement "National Health Insurance Family Physician Integrated Care Program (referred to as Family Physician Program)," desired by a family physician system, providing the patient-centered medical care. Plan implementation date has expired 13 years, initially planned to close the case by the clinic on their loyalty patient family cases, in April 2010 amended plan, the Department of health care transformation by selection chronic illnesses, high medical costs and other priority needs care as patients receive text object. Health Insurance Act of 2011 amended Article 44, shall set out a family physician responsibility system, expected to reveal this plan as a basis for the implementation of the system of family responsibilities physician. In retrospect domestic research. In the study design and methods, more emphasis on the structured questionnaire, few community medical groups to discuss physician or patient awareness and perception, satisfaction, less ink to National Health Insurance Research Database, the effectiveness of long-term evaluation plan; in the object of study, mainly in family cases compared with each other and the general public, yet high medical use of high risk patients for analysis. In view of this, the present study evaluated the use of high medical high risk patients in the intervention plan, short-term and long-term effect on health care utilization, health care costs and outcomes, as amended plan future reference. Methods This study used a quasi-experimental research methods before and after the test design, research period April 2010 to March 2015, to meet the Family Physician Program to close the case of the list of objects, that is, high medical use of high-risk groups. Intervention group is continuing to participate in the program patients. The control group patients who have never participated in program. To reduce selection bias, propensity score based on patient characteristics variables to 1: 1 matching. Pre-test period is involved in the previous year, after the test period is four years after the intervention tracking, generalized estimating equations to analyze repeated measurement data, the control physicians and regional characteristics variables, and further predicted values obtained using the difference in difference analysis. Differences between the two groups were compared, differences in healthcare utilization, health care costs and outcomes, to understand the true impact of intervention. Results In medical utilization section. After the continuous intervention of the program. The number of outpatient intervention group decreased less, the number of outpatient intervention group than the control group more than 1.13 times to 1.72 times, an average of 21 times, to maintain a certain frequency and intensity of care. Are no significant differences in both the short and long-term outpatient expenses. Short-term emergency number no significant difference, but long-term intervention group presented a greater increase. Short-term emergency expenses in the intervention group increased to a lesser extent, but there was no significant difference in the long-term. Only the intervention of the second year, the number of hospitalizations in the intervention group increased to a lesser extent. In addition to the involvement of the third year, the hospital costs rise in the intervention group than the control group small NT. 666 ~ 1,378. In the outcome of care section. After the continuous intervention of the program. Intervention in the third years, the rate of emergency intervention group decreased less, but the fourth years of intervention, the intervention group increased by a big margin. In the second years of intervention, hospitalization rates in the intervention group increased to a lesser extent, but in the third year of intervention, the intervention group larger rise. In avoidable hospitalization rates, the intervention in the second years and the fourth years, there are significant effects of intervention, the intervention group compared with the control group, a small rise from 0.21% to 0.41%. Conclusions and Suggestions In conclusion, the implementation of the program in reducing hospitalization resource consumption has its influence, the Program to implement to increase the frequency and intensity of care, may through education, prevention, so that patients pay more attention to health, and then reduce unnecessary hospitalization, improve outcome. To Health Administration, emphasizes advocacy patient about the concept of family physician, and gradually expand the coverage of care object. It recommends that authorities continue to promote the program, and promote primary health care quality assessment system to ensure the quality of primary health care. To physicians and patients, indicators of avoidable hospitalization rates, in 2016 as an indicator of the program, it is desirable to encourage physicians to provide patient-centered health care. In terms of patients, it is desirable to establish the correct concept of medical treatment. To future research, In this study, subjects were divided into those who continued to participate in family physician program, never participated in the program. The patient does not receive the case has not yet been analyzed. On the future, we can explore the influencing factors of the case did not receive. Recommendations can be combined surveys, controlling for other possible influencing factors, such as marital status, level of education, so that the effectiveness evaluation more circumspect.