| Summary: | 碩士 === 國立臺灣大學 === 健康政策與管理研究所 === 105 === Background:
The implementation of the National Health Insurance (NHI) increased the public''s accessibility to care and freedom of choice accompanied by doctor shopping and high number of physician visits that may lead to fragmented medical care. In order to promote comprehensive, coordinated and continuous care services, the NHI Administration has implemented the Family Physician Integrated Care Program since 2003. However, there is no consensus on the effectiveness of this program yet, and no study has investigated the reason behind the fact that the program can improve continuity of care but does not improve health care outcomes.
Objectives:
The purposes of this study were to evaluate the effect of the Family Physician Integrated Care Program, to compare the patients'' health care outcomes among clinics with different levels of continuity of care, and to investigate whether patients'' continuity of care may affect the relationship of the integrated program participation and patients'' health care outcomes.
Methods:
The National Health Insurance Research Database from 2011 to 2013 was used for this study. Patients who were enrolled in the Family Physician Integrated Care Program were classified as the intervention group and those who had never participated in the program were classified as the comparison group. In order to reduce selection bias and increase the comparability between the intervention and comparison groups, we conducted propensity score matching to select proper subjects for the comparison group for analysis. Two sub-groups including patients with cardiovascular diseases and diabetes mellitus respectively were analyzed by using disease specific process-based quality measures. The negative binomial regression model and Logistic regression were used in the study.
Results:
We found that patients enrolled in the Family Physician Integrated Care Program, patients with high continuity of care scores, and clinics with higher continuity of care scores tended to have fewer potentially avoidable emergency department visits. In addition, patients'' continuity of care had modification effect on the relationship of the program participation and patients'' potentially avoidable emergency department visits. However, in the two sub-group samples, the integrated care program enrolment did not show positive effects on process-based quality measures. Except that in the diabetes sub-group, higher continuity of care at either patient or clinic level might lead to higher rate in "less medical attention for nephropathy".
Conclusions:
Compared with process-based quality indicators, the Family Physician Integrated Care Program showed significant effect on better health outcome (potentially avoidable emergency department visits). According to the findings of this study, health authority may consider modifying the quality evaluation indicators and financial incentives for the Family Physician Integrated Care Program.
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