27卷1期

• Link 原著 Original Article
• 大腸直腸癌之風險預測模式與風險指標The Risk Prediction Model and Risk Index for Colorectal Cancer
• 劉易承、宋鴻樟、謝玲玲、唐瑞平、葉志清
  Yi-Cheng Liu, Fung-Chang Sung, Ling-Ling Hsieh, Rei-Ping Tang, Chih-Ching Yeh
• 大腸直腸癌 ； 風險預測模式 ； 風險指標 ； 台灣
  colorectal cancer ; risk prediction model ; risk index ; Taiwan
• 目標：國外早已有許多健康風險預測模式的研究，在台灣則不多見。大腸直腸癌（簡稱大腸癌）為台灣地區癌症十大死因的第三位，有必要建立一個預測模式或指標，以為預防大腸癌的參考。方法：本研究藉由病例對照研究(Case-control study)探討有關大腸癌的危險因子，利用多變項邏輯斯迴歸(multivariate logistic regression)建立風險預測模式，進一步將其個別危險因子的危險對比值(odds ratio, OR)轉換為風險值(risk points)，藉由加總每一個危險因子的風險值，便可求得總風險值，最後將指標分成七個風險等級。結果：在此風險預測模式中，男性與女性有顯著影響的變項各有10個和9個。女性除缺少飲酒變項，與男性相同的危險因子有族裔、職業、運動、咖啡、白肉、海鮮、蔬菜、水果和肉類烹煮方法等9個變項。依照各個變項的危險對比值，民眾只要加總各個危險因子的風險值就可以獲得個人的總風險值，再比對風險指標的區分，即可了解本身罹患大腸癌的風險程度。結論：本研究建立一個台灣地區民眾大腸癌的風險預測模式與風險指標，提供民眾一個簡單、方便的風險評估方法。進一步地，此風險預測模式與風險指標則需要藉由世代研究來確認其準確性。
  Objectives: Various prediction models or indices for cancer risk have been developed in Western countries, but no such instruments are available in Taiwan. Colorectal cancer is the third leading cause of cancer deaths in Taiwan, thus it is essential to establish a prediction model or risk index for the prevention of colorectal cancer. Methods: The risk prediction model was established by a case-control study using multivariate logistic regression. Individual odds ratios (OR) for each risk factor were transformed into a risk point. An overall risk point was calculated as an index by summing all risk points for the related risk factors. The risk index was divided into seven categories according to the distribution of the total risk points. Results: In the risk prediction models, ten and nine significant risk factors were identified for males and females, respectively. With the exception of alcohol consumption in females, nine risk factors were identical in both genders, including race. occupation, physical activity, coffee intake, and the consumption of white meat, seafood, vegetables, and fruits, and the method of cooking of meat. After checking the strata for the selected risk factors, individuals can acquire their total risk points using the sum of the risk points for each risk factor. Referring to tire level of tire risk index by matched total risk points, individuals can recognize their risk level for the development of colorectal cancer. Conclusions: This study has established a risk prediction model and risk index for colorectal cancer in Taiwan. It is a simple and convenient method to assess colorectal cancer risk for the population in Taiwan. A prospective cohort study. however, is needed to help validate the accuracy of this risk prediction model and risk index.
• 1-12
• 10.6288/TJPH2008-27-01-01

• Link 原著 Original Article
• 台灣地區12-64歲民眾跌傷之盛行率暨危險因子研究Prevalence and Risk Factors of Injurious Falls in community-dwellers Aged 12-64 in Taiwan
• 蔡益堅、葉純志、藍祚運、張粹文、洪百薰
  Yih-Jian Tsai, Chun-Chih Yeh, Tzuo-Yun Lan, Cui-Wen Chang, Baai-Shyun Hurng
• 跌傷 ； 盛行率 ； 危險因子 ； 台灣國民健康訪問調查
  injurious falls ; prevalence ; risk factors ; National Health Interview Survey Taiwan
• 目標：檢視12-64歲者及不同年齡層之跌傷盛行率暨危險因子。方法：本研究採用2005年國民健康訪問調查12-64歲者資料檔進行分析。首先描述其跌傷之時間、地點、求醫住院等流行狀況。再選年齡、性別、是否已婚／同居、自評健康、運動、視力、慢性病數目、是否需輔具等做單變項邏輯迴歸分析及卡方檢定。並針對12-24，25-44及45-64歲人口群分別建構多變項邏輯迴歸模式。結果：在完訪的18.099位12-64歲者當中有991人跌傷，盛行率5.6%；其中84人住院。年齡別跌傷盛行率雖然呈現U字形，且可能比2001年高。在12-24，25-44及45-64歲人口群之多變項邏輯迴歸模式中，女性、正向自評健康、視力清楚至非常清楚與跌傷風險降低有關；年齡層低於40-44歲、過去兩週有運動、具有至少一種慢性病及需輔具等與跌傷風險升高有關。但是否已婚/同居與跌傷風險之間並無顯著相關。結論：2005年12-64歲者年齡別跌傷盛行率呈現U字形，此與2001年研究一致；12-24，25-44及45-64歲各年齡層之跌傷危險因子不同，建議採行生命周期策略，針對各年齡層分別施行不同的跌傷研究與防制計畫。
  Objectives: To investigate the prevalence and risk factors of injurious falls across different age groups for community dwellers aged 12-64. Methods: Data analyzed were collected from the 2005 National Health Interview Survey (NHIS) in Taiwan. The characteristics of injurious falls by time/place of occurrence and their consequences are described. Uni-variate logistic regression and Chi-square (x^2) test were used to examine the association of injurious falls with: age, sex, marital status, self-perception of health, exercise, visual ability, chronic conditions, and if there was a requirement for the use of special aids and or appliances. Multivariate logistic regression models were established for age groups 12-24. 25-44 and 45-64. Results: Among 18,099 persons aged 12-64 who completed the interview, 991(5.6%) reported having injurious falls, and 84 of them received further hospitalization. The relationship between the prevalence of injurious falls and age was U-shaped. Multivariate logistic regression models for ages 12-24, 25-44 and 45-64 showed that participants who were female, had a positive self-perception of health, and had good to very good visual ability had a reduced risk of injurious falls. In contrast, respondents who were younger than 40-44, and who had souse form of exercise in the previous two weeks, as well as had at least one chronic condition, or required special aids/appliances showed an increased risk of injurious falls. Living with a spouse/partner was not significantly associated with injurious falls. Conclusions: The U-shaped relationship of the risk of injurious falls and age was in agreement with that of the preceding study. Risk factors of injurious falls varied across a variety of age groups. Our results suggest a life-cycle approach for fall related studies and prevention programs.
• 13 - 24
• 10.6288/TJPH2008-27-01-02

• Link 原著 Original Article
• 台灣地區2001年及2005年成人及兒童口腔保健行為與牙科就診原因之比較The Relationship between Oral Health Behaviors and Dental Visits among Adults and Children in Taiwan: A Transitional Comparison between 2001 and 2005
• 吳秀英、賴辛癸、張粹文、林宇旋、洪百薰、蕭美玲
  Shiow-Ing Wu, Shin-Kuei Lai, Tsui-Wen Chang, Yu-Hsuan Lin, Baai-Shyun Hurng, Mei-Ling Hsiao
• 口腔保健行為 ； 刷牙次數 ； 牙科就診原因 ； 國民健康訪問調查
  dental health behaviors ; frequency of tooth-brushing ; Reasons for dental clinic visits ; National Health Interview Survey NHIS
• 目標：本研究藉由分析比較2001年及2005年進行之「國民健康訪問暨藥物濫用調查」資料，以了解國人口腔保健行為及牙科就診原因之變化，並探討二者之關係。方法：資料來源分別為2001年及2005年「國民健康訪問暨藥物濫用調查」完訪實料，兩年度分析之總樣本數分別為劉21.571及22.087。結果：2005年國人每日至少刷2次牙的比率已達73.9%由2001年至加2005年國人口腔保健行為在每日至少潔牙2次、每日平均刷牙次數、使用口腔清潔用品之比率皆有進步，每日至少潔牙2次之比率尤以12歲以小孩進步最多，但其睡前刷牙之比率卻仍不到7成。比較這4年間之牙科就診原因之變化，12歲以上者，2005年洗牙之排序都高於200l年，另分析口腔保健行為和牙科就診原因之關係，顯示每日潔牙至少2次、有睡前刷牙、有使用牙線／棒或漱口水者其較會因預防性原因而至牙科就診，口腔保健行為不好者較不會至牙科就診。結論：雖然這4年間，國人整體口腔狀況是改進了，但是每日平均刷牙次數仍不到二次，小孩睡前刷牙比率亦不到七成，另過去一年未曾就診者，可以列為未來在社區中，公共衛生護士篩檢民眾是否需要進行口腔檢查及口腔衛生教育之指標。
  Objectives: In view of the high prevalence of dental caries in Taiwan and the paucity of representative data on oral health practices in the past, we used recent data from a population-based National Health Interview Survey (NHIS) series to analyze the change in people's oral health behaviors, reasons for dental visits, and the relationship between these two variables over a 4-year period. Methods: Comparable data were collected from two NHIS surveys conducted in 2001 and 2005, with effective sample sizes of 21,571 and 22,087, respectively. Subsequent statistical analyses of relevant variables involved cross-tabulation and logistic regression with SAS version 1.9.3. Results: The overall rate of typical toothbrushing (at least twice per day) of the entire survey population reached 73.9% in 2005. The rate of typical toothbrushing, the average frequency of toothbrushing per day, and the proportion of respondents using various dental cleaning materials all rose moderately from 2001 to 2005. Although the rate of typical toothbrushing for children under age 12 showed a noticeable improvement over the 4-year period, the proportion of children who typically brushed their teeth at bedtime remained less than 70%. Regarding the reasons for dental visits, the proportion of respondents reporting a need for scaling increased significantly between 2001 and 2005 among those over age 12 years. Analysis of the relationship between oral health behaviors and reasons for dental visits showed that frequent toothbrushing, toothbrushing at bedtime, use of dental floss, and gargling were strongly associated with the use of preventive dental services, while poor oral health practices were associated with a lower frequency of dental service use. Conclusions: Although the overall oral health behaviors of the population improved significantly from 2001 to 2005. the most recent data still show that toothbrushing habits ate less than ideal among both adults and children. We suggest that people who have not used dental services in the preceding year be identified as the highest-priority target group for the provision of dental examination or oral health education by public health nurses.
• 25 - 31
• 10.6288/TJPH2008-27-01-03

• Link 原著 Original Article
• 居家失能老人使用外籍監護工之相關因素分析Factors Associated with Hiring a Foreign Care Aide among home-dwelling Elderly
• 陳亮汝、吳淑瓊
  Liang-Ju Chen, Shwu-Chong Wu
• 長期照護服務使用 ； 外籍監護工 ； 相關因素 ； 老人
  long-term care services utilization ; foreign care aide ; associated factors ; elderly
• 目標：估算我國居家失能老人之外籍監護工使用率，並檢驗使用之相關因素，方法：以居家1.379位失能老人的調查資料為分析資料，評估其在過去一年中之外籍監護工使用率，並以Andersen Behavioral Model為分析架構，利用邏輯斯複迴歸統計方法檢驗是否使用外籍監護工之相關因素。結果：過去一年中居家失能老人之外籍監護工使用率為15.2%。控制其他變項後，使用率顯著較高者包含：女性（勝算比為2.28, 95%CI＝1.47-3.53）、教育程度越高者（勝算比為2.03, 95%CI=1.15-3.56）、家戶每人每月平均收入越高者（勝算比為1.71, 95%CI=1.07-2.72）、與子女同住者（勝算比為4.88, 95%CI=2.74-8.72）、知道居家服務者（勝算比為1.90, 95% CI=1.31-2.75）、家庭主要照顧者為媳婦者（勝算比為1.64, 95% CI=1.02-2.63）；家庭主要照顧者有專職工作者（勝算比為 1.93 ，95% CI= 1. 25-2.98）、住在三鶯地區者（勝算比為1.98, 95% CI=1.35-2.89）、身體功能重度障礙者（勝算比為11.90, 95 % CI=6.29-22.52）、診斷疾病數多者（勝算比為1.10, 95% CI=1.02-1.19）。結論：居家重度障礙者、專職就業的家庭照顧者使用率高，顯見其對外來人力協助的需求；高教育、高收入者外籍監護工使用率高，未來嬰兒潮人口即將老化，其教育程度及收入大幅改善，可能會導致外籍監護工使用率大幅提升，但國家政策又以降低外籍監護工人數為目標，兩者之問的矛盾政府應及早尋求對策，滿足其照顧需求，否則將難達到政策目標。
  Objectives: To determine the utilization of hiring a foreign care aide for the disabled elderly in the community and to understand the factors associated with such utilization, Methods: Data pertaining to 1,379 disabled over 65 years of age was collected in a baseline survey of 2 experimental communities selected for the Pilot Program for Long-Term Care Development. The Andersen Behavioral Model was used to examine the factors associated with hiring a foreign care aide in the past year among the disabled elderly. Results: Approximately 15.2% of the disabled elderly hired a foreign care aide in the past year. Multiple logistic regression showed that after controlling for other variables, those who hired a foreign care aide were likely to have the following attributes: female gender (OR=2.28, 95%CI=1.47-3.53), at least a secondary education (OR=2.03, 95%CI=l.l5-3.56), higher income (OR=l.7l, 95%CI=l.07-2.72), living with children (OR=4.88, 95%CI=2.74-8.74). living in the San-Yin area (OR=l.98, 95%CI=l.35-2.89), awareness of home care (OR=l.90, 95%CI=l.3l-2.75), living with a daughter-in-law as the caregiver (OR=l.64, 95%CI=l.02-2.63), a caregiver who works full-time(OR=l.93,95%CI=l.25-2.98), more ADL disability (OR=11.90, 95%CI=6.29-22.52), and wore diagnosed diseases (OR=1.10, 95%Cl=1.02-1.19). Conclusions: Elderly who are moderately-to-severely disabled and whose caregiver has full-time work have a higher utilization of foreign care aide. This implies that the disabled elderly need more extra-family assistance of care. Moreover, the disabled with higher education and income are more likely to hire a foreign care aide, suggesting that policy should focus on the coming trend that baby boomers will have a higher education and income. With the goal of decreasing the number of foreign care aides in Taiwan, the government should develop appropriate services in response to the needs of the disabled elderly and their family.
• 32 - 43
• 10.6288/TJPH2008-27-01-04

• Link 原著 Original Article
• 門診戒菸治療之成效及其相關因素探討The Effectiveness of Outpatient Smoking Cessation Therapy and Related Factors
• 陳宙珍、李蘭、趙坤郁
  Chou-Chen Chen, Lee-Lan Yen, Kun-Yu Chao
• 戒菸 ； 菸害防制 ； 門診治療 ； 成年人
  smoking cessation ; tobacco control ; outpatient therapy ; adult
• 目標：探討吸菸者前往門診接受戒菸治療之成效，並找出影響其戒菸成功之因素。方法：利用行政院衛生署國民健康局門診戒菸治療計畫所建置之資料庫，進行次級資料分析。研究樣本為2003年11月至2004年12月期間，前往台灣地區各合約門診接受戒菸治療，年滿18歲且被成功追蹤者共7，802人。結果：「持續六個月」及「持績一年」的持續戒菸成功率分別為l8.9%和7.9%；「六個月後」及「一年後」的點戒菸成功（指受訪時回答前一星期內沒有吸菸）的比率分別為23.0%及17.2%。多變項統計分析發現，與「持續戒菸成功」有關之因素含年齡、性別、職業等級、睡眠品質、是否運動、飲酒頻率、有無超時工作、就醫次數、吸終年數、尼古丁成癮度、過去戒菸次數、有吸菸家人數、戒菸治療次數、及戒菸治療方式。結論：影響持續戒菸成功因素，歸納「個人因素」、「環境因素」和「治療因素」三面向。建議門診醫護人員協助吸菸者戒菸時，除考量其年齡、性別、職業、生活習慣和就醫情形外，還需掌握其吸菸年數、尼古丁成癮度、曾戒菸次數、和有吸菸家人數。至於，鼓勵個案按時回診接受完整治療，及依其情況選擇適合的戒菸方法，也是幫助吸菸者戒菸成功的關鍵。
  Objectives: To investigate the effectiveness of outpatient smoking cessation interventions and factors related to success. Methods: Secondary data analysis was conducted on data provided by the Bureau of Health Promotion funded ”Smoking Cessation Therapy Project”. A total of 7,802 smokers were included in the study. Participants included those smokers aged 18 and over who participated in smoking cessation therapy at participating clinics between November 2003 and December 2004, and who completed follow up successfully. Results: The ”continuous abstinence rates” at six months and one year were 18.9% and 7.9%, respectively. The ”point abstinence rates” at six months and one year were 23.0% and 17.2%, respectively. Factors related to continuous abstinence included age, gender, occupational level, sleep quality, exercise, frequency of alcohol consumption, working overtime, number of doctor visits, number of years of smoking, degree of nicotine dependence, number of attempts to quit smoking, number of smokers in the family, number of therapy sessions, and types of smoking cessation therapy. Conclusions: Factors related to smokers' continuous abstinence can be classified into three categories: individual factors, environmental factors and therapeutic factors. Clinic staff involved in outpatient smoking cessation should tailor therapy according to patients' age, gender, occupation, lifestyle and frequency of health-care provider visits. Consideration should also be given to other smoking related factors, such as number of years smoking, degree of nicotine dependence, number of attempts to quit smoking and number of smokers in the family. It is important to encourage smokers to visit their doctor regularly and participate in all therapy sessions. To ensure success, cessation therapy should be targeted at the individual patient's needs.
• 44 - 56
• 10.6288/TJPH2008-27-01-05

• Link 原著 Original Article
• 醫師年資、醫療服務量與消化性潰瘍治療效果之相關研究The Association between Physicians' Volume, Medical Care Institutions' Volume, or Physicians' Seniority and Healthcare Outcome for Patients with Peptic Ulcer
• 王庭荃、楊長興
  Ting-Chung Wang, Chiang-Hsing Yang
• 醫事機構服務量 ； 醫師服務量 ； 醫師年資 ； 消化性潰瘍 ； 治療成效
  hospital volume ; physician volume ; physician's seniority ; peptic ulcer ; healthcare outcome
• 目標：探討醫事機構／醫師服務量與醫師年資對消化性潰瘍病患治療成效之關係。方法：研究資料為國衛院2000年至2002年健保資料庫中的醫事機構基本資料檔(HOSB)、專科醫師證書主檔(DOC)、門診處方及治療明細檔(CD)、門診處方醫令明細檔(OO)、住院醫療費用清單明細檔(DD)、以及住院醫療費用醫令清單明細檔(DO)等。樣本選取條件是：2001年間潰瘍門診患者、使用內視鏡檢與治療潰瘍相關藥物；排除的凖則是羅患胃癌、療程中死亡患者與資料錯誤樣本。採用邏輯斯迴歸模式檢視醫事機構/醫師服務量與醫師年資好消化性潰瘍病患治療成效之關係。結果：經風險校正後，機構服務量與住院率呈正相關；醫師年資與復發率。腸胃出血呈正相關；與潰瘍穿孔呈負相關。結論：消化性潰瘍至今已有發展健全的治療方式，比起這類議題在外科手術的研究，服務量與年資對於潰瘍的治療成效較無明顯的影響，應是受到這個疾病的特性影響所致：治療此疾病的技能學習難易度較低、醫師所能掌握影響治療成效的部份較外科手術少等，但服務年資較長者對於減少嚴重的併發症（潰瘍穿孔）有顯著的效果。
  Objectives: To examine the association between hospital, physician volume, or physician seniority and healthcare outcome for patients with peptic ulcer. Methods: Data used in this study are HOSB file, DOC file, CD file. OO file, DD file, and DO file obtained from the National Health Insurance Research Database (National Health Research Institutes, Taiwan) between January 1, 2000, and December 31, 2002. Inclusion criteria for sample selection were peptic ulcer outpatients in 2001 and patients treated using upper G-I panendoscopy and drugs for peptic ulcer. Exclusion criteria were patients have gastric cancer and data error. Data was analyzed using logistic regression. Results: After risk adjustment, hospital volume was negatively related to hospitalization rate. Physician's seniority was positively related to recurrence rate and hemorrhage rate, and negatively related to pyloric stenosis rate. Conclusions: Compared with other surgical studies in this issue, patient volume and physician seniority do not obviously affect peptic ulcer treatment outcome, possibly because the skills for treating peptic ulcer are easier to learn than surgery and factors affecting internal medicine healthcare outcome controlled by physician are less than surgical healthcare. Even so, physician seniority can significantly aid serious complication prevention.
• 57 - 66
• 10.6288/TJPH2008-27-01-06

• Link 原著 Original Article
• 嚼檳榔計程車司機的健康生活型態：社會脈絡觀點的初探The Health Lifestyles of Areca quid-chewing Taxi Drivers-An Exploratory Study from the Viewpoint of Social Context
• 郭淑珍、丁志音
  Shu-Chen Kuo, Chin-Yin Lew-Ting
• 計程車司機 ； 健康生活型態 ； 社會脈絡
  taxi driver ; health lifestyle ; social context
• 目標：本研究以社會脈絡觀點，探討嚼食檳榔計程車司機的健康生活型態。方法：研究者到計程車司機的排班點與休息處，藉由深度訪談、輔以觀察法，對44位嚼食檳榔的司機收集相關資料。結果：研究發現參與研究的嚼檳榔計程車司機都有抽菸，有些會每天習慣性的喝酒；檳榔、菸通常是司機工作上的「適應品」包括提神、陪伴、抒壓與穩定情緒。工作開始的儀式性作用等；酒則為工作後的放鬆品。大多數受訪司機們雖重視健康，卻幾乎不考慮戒除使用成癮物質，但是他們會從事一些正向的健康行為，以及藉由「緩衝」負向健康行為減輕對身體的傷害，來維持健康。結論：司機們雖在其工作環境脈絡下，容易形成抽菸、嚼檳榔，甚至喝酒的生活型態，但是他們也會做一些「正向」健康行為；司機們對於行為與健康之間的關係，並非一個個分開來評估，而是將他們所從事的正向、負向健康相關行為一起做整體不同的加權考量，顯見人們的生活型態是折衝於社會結構脈絡與個人行動之間所做的選擇組合。
  Objectives: This study discussed the health lifestyles of areca quid-chewing taxi drivers from the viewpoint of social context. Methods: The author visited taxi resting areas and waiting lines to collect data from 44 areca quid-chewing taxi drivers through in-depth interviews and observation. Results: All the taxi drivers participating in this study smoked and some were in the habit of drinking alcohol: areca quid and cigarettes for those taxi drivers were ”adaptors” of work that brought them more energy, helped kill time while waiting for clients, eased pressure when stuck its truck in traffic jams, and played a ritual function for getting started; alcohol was used for relaxation after work. Although most of the interviewees appreciated the value of maintaining good health, they did not consider quitting the use of addictive substances. Nevertheless, they engaged in some actions that had positive effects on their health, such as exercising, taking liver-protective supplements, going for medical check-ups, drinking tea, doing meditation, and going for massages. Additionally, they also maintained their health by ”buffering” their negative health behaviors in order to ease damage to the body. Conclusions: Although the interviewees had developed the habit of smoking, areca quid-chewing, or even drinking under the environmental context of their work, they did take some actions that had ”positive” effects on their health: the taxi drivers did not evaluate the individual effects of their various behaviors on their health, rather they took their positive and negative health behaviors into account collectively and generated weighted assessments. The results of this study clearly showed that one's lifestyle is a compromise between social structure context and individual actions and it is on this basis that people make choices.
• 67 - 80
• 10.6288/TJPH2008-27-01-07

• Link 實務 Public Health Practice
• 台灣的可避免住院及其病患社經狀態Preventable Hospitalizations in Taiwan and Patients' Socioeconomic Status
• 梁亞文、陳芬如、鄭瑛琳
  Yia-Wun Liang, Fen-Ju Chen, Ying-Lin Cheng
• 可近性 ； 門診照護敏感狀況 ； 社經地位 ； 全民健康保險
  Access ; ambulatory care sensitive conditions ; socioeconomic position ; National Health Insurance NHI
• 目標：本研究目的在瞭解我國可避免住院之現況，並探討病患人口屬性與社經地位對可避免住院之影響。方法：本研究使用2003年「全民健康保險研究資料庫」進行次級資料分析，為一橫斷性研究。可避免住院則以美國健康照護研究及品質局(AHRQ)之16項預防品質指標加以定義。統計分析方法包括：描述性統計、卡方檢定及邏輯斯迴歸。結果：2003年台灣地區可避免住院人次達38萬餘人次，以男性居多(53.6%)平均年齡48.70歲(SD=31.18)，65歲以上所佔的比率最高(47.8%)：整體可避免住院率為15.5%，其費用達132億餘元，佔全年住院醫療費用的12.40%，每人次可避免住院醫療費用達34，541元。邏輯斯迴歸分析發現，性別、年齡、職業、所得、重大傷病、山地離島地區等因素是可避免住院的正向顯著影響因子。結論：本研究結果可知每7個住院人次中即有l人次是可避免住院、顯示基層醫療服務恐有分佈不均及服務品質不佳等問題。建議衛生主管機關在制定相關政策、分配醫療資源時，應加強分級醫療之觀念及架構的落實，並引用可避免住院之概念，定期監控各區域在門診照護品質與可近性之狀況，確保醫療資源的有效利用。
  Objectives: This study aimed to explore the magnitude of ambulatory care-sensitive condition hospitalizations (ACSH) in Taiwan and identify significant individual sociodemographic characteristics associated with ACSH. Methods: Data for this study came from the 2003 National Health Insurance database. Bivariate statistical comparisons were used to test the differences between ACSH and non-ACSH groups with respect to specific sociodemographic characteristics. Logistic regression determined the relative significance of individual characteristics to ACSH. Results: Patients discharged with ACSHs were likely to be older and male. The mean age of ACSH patients was 48.70±31.18 years. Approximately 15.5% of hospitalized patients were discharged with ACSHs, which accounted for 13.2 billion patients. ACSH charges constituted 12.4% of the total hospital charges for all ages. The average cost per ACSH was $34,541. Gender, age, occupation, income, absence of a catastrophic illness, and living in a metropolitan area increased the probability of a preventable hospitalization. Conclusions: One in every seven inpatients had an ACSH, indicating that maldistribution in a primary care capacity and poor service quality may exist. Agencies seeking to enhance access to care should be familiar with and utilize the ACSH rate to evaluate the quality of the healthcare system and develop policies and programs that provide incentives to achieving a hierarchical medical care system.
• 81 - 90
• 10.6288/TJPH2008-27-01-08