| 摘要: | Objectives: Quality of medical care for patients with chronic obstructive pulmonary disease (COPD), an ambulatory care sensitive condition, has been an important issue as COPD leads to a great burden to both health care system and patients. Therefore, it is important to examine whether outpatient care for COPD patients has improved over a decade, and to identify factors associated with preventable hospitalization in a universal health insurance program, which aims to improve patient outcomes and maintain a sustainable system. Methods: Individuals who were at least 40 years old and diagnosed with COPD in 2004, 2009, and 2014 were identified and their use of health services were obtained from the National Health Insurance claims database. Indicator of preventable hospitalization – COPD admission - was adopted from the Agency for Healthcare Research and Quality’s Preventable Quality Indicators. Logistic regression model was used for examining factors associated with risk of preventable hospitalization in a sample comprising of subjects randomly selected from patients of 2004, 2009, and 2014. Results: COPD admission rate was decreasing from 4.32% in 2005, 3.76% in 2010, to 3.00% in 2015. The majority of the subjects in the sample were male, living in township or rural area, and having Charlson Comorbidity Index (CCI) score higher than zero. Older age, male, living in less-urbanized area, lower income level, higher CCI score, COPD-related hospitalization history, and poorer continuity of care were associated with higher risk of COPD preventable hospitalization. Conclusions: The findings of this study indicated that the trend of COPD-specific preventable hospitalization among COPD patients was decreasing. Patient characteristics and their care-seeking pattern were found to be associated with risk of preventable hospitalization. |
