| Summary: | 碩士 === 長榮大學 === 醫務管理學系碩士班 === 107 === Purpose: This study explored the changes in emergent care and patients flow after accreditation of emergency hospitals in medical sub regions.
Method: The study data were selected from the National Health Insurance Research. The database is provided by the Bureau of National Health Insurance, containing all the medical claims of one million beneficiaries with the emergent care from 2010 to 2013. Base on the residence of the emergent care patients and the area of emergency hospitals transfer to 50 medical sub regions.If the two of them are in the different medical sub regions, it is defined as cross-boundary flow. In this study, acute stroke and acute myocardial infarction were studied and the medical sub regions were used as the unit of analysis. The medical sub regions with qualification-naïve but have newly accreditated emergency hospital is categorized as the experimental group (N=15) and the medical sub regions with pre-existed qualified emergency hospital as the control group (N=29). Statistical methods of t-test, chi-square test, double variable analysis, and generalized estimation equation, analyze emergent care patients flow in the accreditation of emergency hospitals from 2010 to 2013.
Result: In 2010, the rate of rtPA administration in acute stroke in the experimental group increased from 0.2% to 1.0% in 2013, and the control group was 0.4% in 2010 to 0.2% in 2013. In 2010, the proportion of acute myocardial infarction management was 43.4%. In 2013, it reduced to 38.2%, and the control group increased from 44.5% in 2010 to 48.5% in 2013. There was a significant difference between the two groups in cross-boundary emergent care; the experiment group decreased from 56.11% to 53.99%, while the control group is from 37.19 to 36.72% (p<0.0001). The experimental group is significantly higher than control group by generalized estimating equation (GEE) model (IRR1.38，P=0.015).There was a significant difference with the first two years, with 2011 lower than previous one year (IRR 0.86，P=0.002), but no vast difference between 2012(IRR 1.00) and 2013 (IRR1.02). In general, there are no significant differences during the four years. Under the interaction of groups and years, there was no statistical significance of decrease in cross-boundary flow between each year intervals in 2011 (IRR1.09, P=0.37), 2012 (IRR1.03, P=0.68), and 2013 (IRR0.9, P=0.41).
Conclusion: In the medical sub regions of the emergency hospitals, the proportion of cross- boundary flow in the districts was significantly higher. However, after the establishment of the emergency hospitals, the decline in the proportion of medical treatment across the districts was not significantly greater than that of the medical sub regions of the hospitals, but the medical sub regions such as Qishan, Beigang and Taibao did have annual lower, showing that this policy does not have comprehensive benefits. Overall, in the first year of the emergency medical grading system policy intervention, the national cross-regional medical treatment rate has been significantly reduced, indicating that this policy has spillover effects.
Keywords: accreditation of emergency hospitals; cross-boundary flow; medical
sub regions.
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