Effect of Continuity of Care on Emergency Department Utilization
Date Issued
2007
Date
2007
Author(s)
Chih, Po-Sheng
DOI
zh-TW
Abstract
Emergency department is an indispensable part of the health care delivery system.Increased emergency department utilization may contribute to emergency department
overcrowding, and may divert the scarce emergency health care resource away from those who really need them. The health care quality may therefore be jeopardized.
The reasons involved with emergency department overcrowding are multi-factorial. The continuity of care among health care system has important effect on the emergency department utilization, yet the results remained controversial in the relevant literatures.
The purpose of the study was to explore the effect of continuity of care on emergency department utilization.
The ambulatory visit file of the first 50000-person cohort database from the National Health Research Database in year 2001, 2002, and 2003 were analyzed.
Those with at least 4 ambulatory visits in year 2001 and 2002 were included in the study. The dependent variable was non-traumatic emergency visit frequency in year
2003. Continuity of care score derived from year 2001 and 2002 ambulatory visits was used as independent variable. Control variable included age, sex, residency
location, and health care need. The health care need factor were represented by comorbidity and total ambulatory visits in year 2001 and 2002. Negative binomial
regression was used in the analysis. The analysis was repeated by applying logistic regression when the dependent variable was dichotomized as whether use emergency
department or not.
In 36510 people who met the inclusion criteria, 4597(12.59%) people ever visited emergency department in year 2003. The average emergency department visits was 0.19 (SD 0.66, Max 24, Min 0). The average continuity of care score was 0.33(SD 0.22, Max 1, Min 0).
The result of negative binomial regression revealed that more emergency department visits was associated with lower continuity of care score (RR, 0.70; 95% CI 0.60, 0.81). When logistic regression was applied, the Odd Ratio of aving at least one emergency department for those with the highest continuity of care score was 0.65 (95% CI 0.56, 0.76), when those with the lowest continuity of score were
compared with.
The results of the study may provide insights for health policy makers and health care facility administrators when dealing with emergency overcrowding. Methods facilitating the continuity of care may improve emergency overcrowding.
Subjects
急診
醫療利用
照護連續性
emergency department
health care utilization
continuity of care
SDGs
Type
thesis
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