超高齡老人急診醫療利用分析

研究目的：有鑑於急診醫療費用之成長，且面臨高齡化社會之衝擊，推估超高齡老人之急診需求才可暸解如何因應。研究方法：本研究利用病患基本特性(性別、年齡)及醫療特性(就醫科別、就醫日期、停留時間、檢傷級數、入院方式、去向、住院科別及就醫主診斷(以ICD-10-CM疾病分類區分))等變項，探討超高齡老人的急診醫療利用，利用IBM SPSS Statistics 20.0統計套裝軟體進行資料處理作描述性及卡方檢定統計，研究結果：2016年至2020年間至85歲以上老年病患至急診就醫概況，85~89歲病患居多，女性就醫次數均高於男性，就醫科別以內科最多，到達方式以自入為主，檢傷級數以第三級最多數，去向則是住院與急診出院差不多。衛福部急診就醫與本研究的前三大診斷排名一致。就醫頻率大多為每人每年1~3次，大部份病患均能在6小時內離開急診。結論與建議：本研究資料為中部某醫學中心85歲以上老人的急診醫療利用分析，顯示急診醫療偏重於檢傷第三級，醫學中心的急診應以緊急醫療第一、二級為主要任務。建議可發展高齡急診、健保改革應因時制宜，並效法各國做法，如健保與醫療商業化併行、醫療儲蓄帳戶、長照保險導入商業保險、鼓勵長照由社福轉型產業化，訂定適宜台灣的措施，才是現在醫療健保環境及人民所需。本研究結果可供制定醫療服務政策參考，台灣健保改革應因時制宜，思考如何改善醫療健保浪費，以迎接超高齡化社會的來臨。

Research purposes: In view of the growth of emergency medical expenses and the impact of an aging society, it is only by estimating the emergency needs of the super-aged to understand how to respond.Methods: This study used the basic characteristics of patients (sex, age) and medical characteristics (department of medical treatment, date of medical treatment, duration of stay, level of triage, admission method, destination, inpatient department, and the diagnosis of the main doctor (by ICD- 10-CM disease classification and differentiation)) and other variables, discuss the emergency medical utilization of super-aged people, use IBM SPSS Statistics 20.0 statistical package software to process data for descriptive and chi-square test statistics.Results: From 2016 to 2020, the general situation of elderly patients over 85 years old who went to the emergency department, the majority of patients aged 85 to 89 years old, the number of medical visits by women is higher than that of men, the medical department is the most internal medicine department, and the way of arrival is mainly self-entry , the level of triage is the highest in the third level, and the destination is similar to hospitalization and emergency discharge. Ministry of Health and Welfare emergency visits were consistent with the top three diagnoses in this study. The frequency of medical treatment is mostly 1 to 3 times per person per year, and most patients can leave the emergency department within 6 hours.Conclusion and suggestion: The research data is an analysis of the emergency medical utilization of the elderly over 85 years old in a medical center in central Taiwan. It is suggested that emergency care for the elderly can be developed, and the reform of health care should be adapted to the times and follow the practices of other countries, such as the parallelization of health care and medical treatment, the introduction of medical savings accounts, long-term care insurance into commercial insurance, and encouragement of the transformation of long-term care from social welfare to industrialization. Taiwan's measures are what the current healthcare environment and people need.The results of this study can be used as a reference for the formulation of medical service policies. Taiwan's health care reform should adapt to the times and consider how to improve the waste of health care in order to meet the advent of a super-aging society.