[[alternative]]The Analysis of Factors Associated with Revisits to Emergency Department within Three Days in Taiwan.

[[abstract]]中文摘要背景：急診返診是衡量個別醫師、急診照護組織及系統績效的重要品質指標，在急診就醫人次不斷成長的今日，部分病人在短時間內重複至急診就醫，不僅增加醫療資源的耗用，其中亦隱含許多病患錯誤的就醫認知及醫療品質的問題，然而，我國急診重返相關的研究數量並不多，且以全國人口為研究對象探討急診返診的研究非常有限。目的：本研究首先探討臺灣地區2011年急診病患三天內重返急診及因相同疾病診斷類別重返急診的概況，其次，分析影響急診病患因相同疾病診斷類別三天內重返急診的相關因素。方法：本研究使用國家衛生研究院發行的全民健康保險研究資料庫2010年百萬人抽樣歸人檔資料，利用SAS 9.3統計套裝軟體進行資料處理及統計分析，首先使用描述性統計描述臺灣地區2011年急診病患三天內重返急診的就醫資料；其次，以廣義估計方程式（Generalized Estimating Equations, GEE）探討影響急診病患因相同疾病診斷類別三天內重返急診以及重返不同醫院急診的相關因素。結果：臺灣地區2011年首次急診就醫共241,435人次，急診就醫後三天內重返急診有15,531人次，三天內急診重返率為6.43%；而因相同疾病診斷類別三天內重返急診有9,475人次，重返率為3.92%，其中有4,045人次（42.69%）重返不同醫院急診。影響臺灣地區急診病患因相同疾病診斷類別三天內重返急診的因素有性別、年齡層別、疾病診斷類別、投保地區區域別以及病患就醫機構層級別。（1）在性別方面，相較於女性病患，男性病患的勝算比為1.17；（2）在年齡層別方面，相較於< 6歲，6-17歲的勝算比為1.39，18-64歲的勝算比為1.33；（3）在疾病診斷類別方面，相較於神經系統，外傷的勝算比（10.47）最高；（4）在投保地區區域別方面，相較於東部地區，北區的勝算比為1.33；（5）在病患就醫機構層級別方面，相較於醫學中心，區域醫院的勝算比為1.12。而影響臺灣地區急診病患因相同疾病診斷類別三天內重返不同醫院急診的因素有性別、年齡層別、檢傷分類級數、投保地區都市化程度、是否為低收入戶、病患就醫機構層級別及就醫機構權屬別。（1）在性別方面，相較於女性病患，男性病患的勝算比為1.21；（2）在年齡層別方面，相較於< 6歲，18-64歲的勝算比為1.41；（3）在檢傷分類級數方面，相較於檢傷分類第5級，檢傷分類第1級的勝算比為1.80，檢傷分類第2級的勝算比為1.85，檢傷分類第4級的勝算比為1.58；（4）在投保地區都市化程度方面，相較於鄉村，都市的勝算比為0.76；（5）在是否為低收入戶方面，相較於低收入戶，非低收入戶的勝算比為1.49；（6）在病患就醫機構層級別方面，相較於醫學中心，區域醫院的勝算比為0.60；（7）在病患就醫機構權屬別方面，相較於非公立醫院，公立醫院的勝算比為1.29。結論：急診病患因相同疾病診斷類別三天內重返急診率為3.92%，有42.69%的急診病患重返不同醫院急診。影響急診病患因相同疾病診斷類別三天內重返急診的相關因素為性別、年齡層別、疾病診斷類別、檢傷分類級數、投保地區區域別、投保地區都市化程度、是否為低收入戶、病患就醫機構層級別及就醫機構權屬別。[[abstract]]AbstractBACKGROUND:Return visit to emergency department (ED) is an important index to evaluate the performance of individual doctors and the whole care system of ED. The visits to ED increases in the recent decades, and some patients visit ED repeatedly in short term. It not only increases the waste of medical resources but also decreases the quality of medical services. It also indicates that most patients have wrong cognition of medical services. However, there are only a few of researches regarding return visits to ED, and the researches based on national population are much fewer in Taiwan.OBJECTIVES:First of all, we discussed the situation that patients revisit ED within 3 days and with the same diagnosis in Taiwan in 2011. Besides, we analyzed the factors resulting in repeated visiting ED.METHODS:Data will be obtained from theNational Health Insurance Research Database (NHIRD). The annual files of one million subjects randomly selected from all beneficiaries in year 2010 will be analyzed in this study.All statistic analysis was done with statistic software SAS 9.3. Firstly, we stated the data of return visits to ED within 3 days in Taiwan in 2011 by descriptive statistics. Furthermore, we discussed factors affecting return visits due to the same diagnosis categoryand revisiting different hospitals by Generalized Estimating Equations (GEE).RESULT: In 2011,there were 241,435 person-times of first visit to ED and 15,531 person-times of return visit within 3 days in Taiwan. The 3-day ED revisit rate was 6.43%. Besides, there were 9,457 person-times of return visit due to the same diagnosiscategory, and the return visit rate is 3.92%. Of the 9,457 revisits, 4,045 (42.69%) werereturned to the ED of a different hospital.In adjusted analyses, revisit to ED with the same diagnostic categorywithin 3 days was associated with gender, age, diagnostic category, insuring region, and level of hospital.The important findings of this research as following: (1) Comparedtofemale,malewas associated with a higher rate of revisited to ED, adjusted OR 1.17.(2) Comparedto the age of <6 year-old, 6 to 17year-old and 18 to 64 year-old were associated with a higher rate of revisited to ED, adjusted OR 1.39 and 1.33.(3) Comparedtothe diagnostic category of neurological system, injurieswasassociated with thehighest rate of revisited to ED, adjusted OR 10.47. (4)Comparedtothe patients who live in the eastern region of Taiwan, patients who live in thenorthern region ofTaiwanwasassociated with a higher rate of revisited to ED, adjusted OR 1.33. (5) Comparedto the patients who visited to the ED of medical center, patients who visited to the ED of regional hospital was associated with a higher rate of revisited to ED, adjusted OR 1.12. Further analysis of data, revisit to ED of a different hospital with the same diagnostic categorywithin 3 days was associated with gender, age, level of emergency triage, level of urbanization of insuring region, low-income earner, level and type of hospital.The important findings of this research as following: (1) Comparedtofemale, male was associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.21. (2) Comparedto the age of <6 year-old, 18 to 64 year-old wasassociated with a higher rate of revisited to EDof a different hospital, adjusted OR 1.41. (3) Comparedto the patients with lever 5 of Taiwan triage and acuity scale (TTAS), the patients with lever 1 of TTAS, lever 2 of TTAS and lever 4 of TTAS were associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.80, 1.85 and 1.33. (4) Comparedto the patients who live in rural areas, patients who live in urban areas was associated with a lower rate of revisited to ED of a different hospital, adjusted OR 0.76. (5)Comparedto low-income earner, patients who were not low-income earner was associated with a higher rate of revisited to EDof a different hospital, adjusted OR 1.49. (6) Comparedto the patients who visited to the ED of medical center, patients who visited to the ED of regional hospital was associated with a lower rate of revisited to ED of a different hospital, adjusted OR0.60. (7) Comparedto the patients who visited to the ED of private hospital, patients who visited to the ED of public hospital was associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.29.CONCLUSION:The 3-day ED revisit rate with the same diagnosiscategory was 3.92% , and there were 42.69% of them who returning tothe ED of a different hospitals.The factors associated with revisited to the ED with the same diagnostic categorywithin 3 days were as following: gender, age, diagnosis, level of emergency triage, insuring region, level of urbanization of insuring region, low-income earner, level and type of hospital

急診病患三天內重返急診之相關因素分析:全人口代表性資料的研究

[[abstract]]目的：探討病患、醫師及醫療機構相關特性與急診病患三天內重返急診的關係。方法：本研究使用國家衛生研究院發行之全民健康保險研究資料庫2000年百萬人歸人檔之資料，使用邏輯斯迴歸（logistic regression）探討影響急診病患三天內重返急診的相關因素，以SAS9.4統計套裝軟體進行資料整理與統計分析。結果：研究對象共計89,708位使用過急診的病患，其中4,860人（5.42%）三天內重返急診；2,879人（3.21%）因相同疾病診斷三天內重返急診，其中有1,160人（40.29%）重返不同醫院急診。男性病患、19歲以上病患、循環系統病患、消化系統病患、檢傷分類為第一、二、三級病患、區域及地區醫院病患、低度都市化病患、非公立醫院病患、低收入戶病患重返急診的機率較高。結論：影響急診病患三天內重返急診的相關因素為病患性別、病患年齡層別、疾病診斷類別、檢傷分類級數、投保地區都市化程度及機構層級別。相同疾病類別三天內重返急診者，有40.29%至不同的醫院急診，這種現象的原因值得進一步探討

Factors associated with return visits to the emergency department within three days: A population based study

[[abstract]]目的：探討病患、醫師及醫療機構相關特性與急診病患三天內重返急診的關係。方法：本研究使用國家衛生研究院發行之全民健康保險研究資料庫2000年百萬人歸人檔之資料，使用邏輯斯迴歸（logistic regression）探討影響急診病患三天內重返急診的相關因素，以SAS9.4統計套裝軟體進行資料整理與統計分析。結果：研究對象共計89,708位使用過急診的病患，其中4,860人（5.42%）三天內重返急診；2,879人（3.21%）因相同疾病診斷三天內重返急診，其中有1,160人（40.29%）重返不同醫院急診。男性病患、19歲以上病患、循環系統病患、消化系統病患、檢傷分類為第一、二、三級病患、區域及地區醫院病患、低度都市化病患、非公立醫院病患、低收入戶病患重返急診的機率較高。結論：影響急診病患三天內重返急診的相關因素為病患性別、病患年齡層別、疾病診斷類別、檢傷分類級數、投保地區都市化程度及機構層級別。相同疾病類別三天內重返急診者，有40.29%至不同的醫院急診，這種現象的原因值得進一步探討。 Objectives: We analyzed the relationship between return visits to the emergency department (ED) within three days and various characteristics associated with patients, physicians and medical institutions. Methods: The longitudinal health insurance database of one million subjects randomly selected from all beneficiaries in 2000. All ED visits in 2013 were analyzed for return visits to the ED within three days. A multivariate logistic regression analysis was utilized to evaluate the independent effect of various characteristics of return visits to the ED within three days. Results: The overall rate of return visits to the ED within three days was 5.42% (4,860/89,708). The overall rate of return visits to the ED with the same diagnosis category within three days was 3.21% (2,897/89,708). Of these 2,897 return visits, 1,160 (40.29%) returned to the ED of a different hospital. Being male, aged ＞=19, ED visits within a diagnostic category of endocrine system or circulatory system, ED visits to regional hospitals or district hospitals, ED visits with triage acuity scales one, two, or three, subjects living in areas with a low level of urbanization, subjects on welfare, and ED visits to non-public hospitals independently increased the risk of return visits to the ED within three days. Conclusions: The risk of return visits to the ED within three days was associated with demographic characteristics, diagnosis at the initial ED visit, accreditation level of the hospital, and triage acuity scale. We noted that a large proportion (40.29%) of patients with the same diagnosis category made return visits to a different hospital. The reasons for this phenomenon warrant further investigation