研究背景
COVID-19疫情於2020年初迅速擴散至全世界，加上各國醫療體系中急診首當其衝，我國急診資源濫用的議題始終沒有獲得改善。近年來人口高齡化，高齡患者可能因眾多合併症而有頻繁使用急診的需求，過去有研究也指出頻繁就診是造成急診壅塞的主要原因之一且其會對醫院產生負面影響，故本研究主要探討高齡病患之急診頻繁就診情形與其風險因子。
研究方法
本研究使用南部某醫學中心急診資料庫進行回溯性研究，研究對象取自2019與2020年曾至該院急診非外傷科就診一次且大於65歲的病患，兩年度共累計40,444次就診，並依照一年內急診就診超過4次與否之定義將其分為急診頻繁用戶與非頻繁用戶，再進一步利用傾向分數配對法(Propensity Score Matching)1:1比例進行配對以降低兩組別間干擾因素的影響，並透過邏輯斯迴歸評估頻繁使用急診之風險因素，此外，藉由卡方檢定、獨立樣本t檢定及多元線性迴歸來探討兩組別於其人口學特性、急診就診狀態與入院疾病原因之關聯。
研究結果
2019及2020年兩年度高齡急診頻繁用戶的比例皆以年齡較長、男性、健保榮民、檢傷級數第三級、夏季及白天班入院為主。經由邏輯斯迴歸分析後發現，病患能自行進入急診(AOR=1.73)、入院疾病為消化系統(AOR=1.30)、泌尿生殖系統(AOR=1.65)與影響健康狀況之因素者(AOR=2.62)之急診頻繁使用的勝算比較高(p<0.05)，此外，急診頻繁用戶離院狀況需住院的勝算比較低(AOR=0.70，p<0.001)。使用多元線性迴歸結果發現，頻繁就診者其急診留置時間相較無頻繁就診者多出1.75小時。
結論
頻繁使用急診會造成醫療資源的耗用，甚至產生急診壅塞等負面影響，藉由本研究結果希望醫院及醫師端能更了解相關族群使用急診醫療之情形，並透過政策的宣導與疾病的預防，使有限的急診醫療能發揮其最大的功用，進而提升病人醫療照護品質。

Background:
With the rapid spread of the COVID-19 epidemic worldwide in early 2020, and the fact that emergency care is the first priority in national healthcare systems. The problem of emergency abuse in Taiwan has not been improved. Nowadays, the aging population is a global trend. Elderly patients may have need to use the emergency department (ED) more frequently due to numerous comorbidities. Some studies have pointed out that frequent ED visits are one of the main reasons for emergency overcrowding. That will also have a negative impact on medical institutions. Therefore, this study mainly explored the frequent ED visits and risk factors of elderly patients.
Method:
This study is a retrospective study. Data are from the emergency department database of a medical center in southern Taiwan and collects patients older than 65 years old who have visited the emergency department at least once in 2019 and 2020. A total of 40,444 visits were accumulated in the two years, and they were classified into frequent and non-frequent emergency users according to the definition of more than four ED visits in a year. The Propensity-Score-Matching (PSM) was used to reduce the influence of interfering factors in a ratio of 1:1 compared to the control group, and its risk factors were assessed by logistic regression analysis. Moreover, the association between the demographic characteristics, ED status and the cause of hospital admission of the two groups was assessed by chi-squared, independent sample t-test and multiple linear regression.
Results:
Male, veterans with health insurance, patients with the third triage level, summer and day shift entered visiting the emergency department more frequently in 2019 and 2020. Through logistic regression analysis, who entered the emergency department on their own (AOR=1.73), and the admission disease was digestive system (AOR=1.30), genitourinary system (AOR=1.65) and factors influencing health status and contact with health services (AOR=2.62) had a higher odds ratio of frequent emergency use (p<0.05). In addition, the ED frequent users who need to hospitalize have lower odds ratio (AOR=0.70, p<0.001). Through multiple linear regression analysis, the length of stay of ED frequent users was 1.75 hours longer than those non-ED frequent users.
Conclusion:
Frequent use of emergency department will cause the consumption of medical resources and even have negative effects such as emergency overcrowding. Based on the results of this study, we hope that hospitals and physicians should pay more attention to this group and their related diseases. Through policy advocacy and disease prevention, the limited amount of emergency medical care can be maximized to improve the quality of patient care.

論文審定書 i
致謝 ii
中文摘要 iii
Abstract iv
目錄 vi
圖次 viii
表次 ix
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 預期貢獻 4
第二章 文獻探討 5
第一節 台灣急診與五級檢傷之定義 5
第二節 急診頻繁就診之次數定義 6
第三節 急診頻繁就診之各國相關研究 8
第四節 COVID-19對各國急診之影響 14
第五節 文獻探討小結 20
第三章 研究方法 21
第一節 研究設計與研究架構 21
第二節 研究假說 23
第三節 研究對象與樣本 24
第四節 研究變項及編碼定義 26
第五節 資料處理與分析方法 31
第四章 研究結果 32
第一節 兩年度急診就診之概況 32
第二節 各別兩年度有無急診頻繁就診之差異 36
第三節 影響高齡患者是否頻繁使用急診之相關因素分析 48
第四節 假設驗證 62
第五章 討論 63
第一節 COVID-19疫情影響下兩年度急診就診之概況討論 63
第二節 各別兩年度急診頻繁就診之情形討論 64
第三節 急診頻繁就診之情形討論 65
第六章 結論與建議 68
第一節 結論 68
第二節 研究限制 69
第三節 建議 70
第四節 研究貢獻 71
參考文獻 72

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