Potential Effect of Integrated Care Program on MedicalUtilization of Patients Above 65 Years Old with ChronicConditions

• Main Authors: Chih-Chi Chang, 張芝綺
• Other Authors: Ming-Chin Yang
• Format: Others
• Language: zh-TW
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/64951424819435149786

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 98 === Background and objectives: Studies have shown that the prevalence of chronic diseases increased year by year, and patients with multiple chronic diseases are the most important users of our health care system. As the population aging, the prevalence of multiple chronic diseases will increase and the issue of their medical care will be more important. The purpose of this study was to understand the basic characteristics of patients 65 years old and over with chronic conditions and the potential effects of integrated care program on their medical utilization. Methods: The source of data came from claims data of the first to twenty-fifth sets of samples registry of beneficiaries of National Health Insurance of 2006 and 2007. Study sample of patients were 73,027 people of all chronic patients and, among them, 41,957 people who were loyal to a medical institution . Data were analyzed by using student’s t test, analysis of variance (ANOVA) and chi-square test. Multiple logistic regression and stepwise multiple regression were used to explore utilization and factors of patients with chronic conditions. Results: According to the definition of this research, among all the study samples, 60.5% were loyal patients who had multiple specialty visits in a medical institution, and 79.5% had overlapped drug use. On the medical expenses, the loyal patients’ average annual overlapped diagnosis fees were 1,037.90 points; and all chronic patients’ average annual overlapped diagnosis fees were 2,102.50 points, their overlapped drug cost were 13713.26 points and the overlapped drug use days per person was 35.77 days. Women had a higher percentage of loyalty to a medical institution and they also had higher total number of drug items, but the total cost of overlapped drug use was higher in male. In addition to the patients who were older than 85 years old, the avoided multiple medical diagnosis fees increased with age, and the total drugs increased with age,too. Patients with higher number of chronic conditions, the number of physician visits, and the number of medical specialists, were more likely to have multiple specialty medical treatment and overlapped drug use, and the probability of the loyalty to a medical institution was higher. The avoided diagnosis fees, the total number of drug items, the total overlapped drug costs and the total number of overlapped drug use days all increased with the increase of chronic conditions. But in all chronic patients, with the number of medical institutions increase, the probability of the overlapped drug use decreased, and the total cost of overlapped drug use and total number of overlapped drug use days were also decreased. Conclusions: The study found that, the overlapped medical utilization increased as age, number of chronic conditions and number of the physicians visit increased.