目的: 本研究探討慢性阻塞性肺病(COPD)患者的科別連續性照護(Continuity of Care, COC)對醫療結果及直接成本的影響，分析不同年齡、性別、合併症指數(Charlson Comorbidity Index, CCI)與疾病嚴重程度(FEV1)在科別連續性分布上的差異，並評估高連續性照護對住院、急診及醫療成本的影響。

方法:本研究為橫斷式研究，採用回溯性研究設計，分析高雄某醫學中心的健保申報數據。研究對象為40歲以上且於2017年被新診斷的COPD患者共496人，並針對醫療資源利用情況進行為期五年的追蹤。將其連續性照護指標(COCI)分為低(COCI<0.5)、中(0.5≤COCI<1)、高(COCI=1)三組，並檢視其住院、急診的利用情形及直接醫療成本，並以t檢定、ANOVA分析、卡方分析、邏輯斯迴歸分析、負二項式迴歸分析及多元線性迴歸分析探討COPD患者其科別照護連續性與醫療結果及直接成本的相關性。

結果: 醫療結果方面，高COCI組的住院率和急診率均顯著低於低COCI組(P<0.001)，且高COCI組患者的平均住院天數與低COCI組相比顯著減少(P<0.01)。在醫療費用方面，高COCI組的平均住院費用較低COCI組的減少約28.7%(P<0.05)，平均急診費用也有顯著的降低(P<0.05)。此外，高COCI組的住院風險顯著降低(OR=0.68, P<0.05)，而急診風險也呈現顯著下降趨勢(OR=0.74, P<0.05)。

結論:本研究強調提升專科連續性對COPD患者的重要性，高科別連續性照護能顯著降低COPD患者的住院率、急診次數及醫療成本，對提升醫療資源使用效率及改善患者健康結果具有重要影響。研究結果為制定COPD的疾病管理政策及改善照護模式提供了理論基礎與實證支持。

Objective: This study investigates the impact of specialty continuity of care (COC) on healthcare outcomes and direct costs in patients with chronic obstructive pulmonary disease (COPD). It also analyzes the distribution differences in specialty continuity among patients of different ages, genders, Charlson Comorbidity Index (CCI) scores, and disease severity (FEV1), and evaluates the effects of high continuity of care on hospitalization, emergency visits, and medical costs.
Methods: This cross-sectional study adopted a retrospective design and analyzed National Health Insurance claim data from a medical center in Kaohsiung. The study included 496 COPD patients aged 40 years or older who were newly diagnosed in 2017 and followed their healthcare utilization over five years. Patients were categorized into low(COCI<0.5), medium(0.5≤COCI<1), and high(COCI=1) continuity of care groups based on their COC index(COCI). The utilization of hospitalization, emergency visits, and direct medical costs was examined. Statistical analyses, including t-tests, ANOVA, chi-square tests, logistic regression, negative binomial regression, and multiple linear regression, were used to explore the relationship between specialty COC and healthcare outcomes and direct costs.
Results: In terms of healthcare outcomes, the hospitalization and emergency visit rates in the high COC group were significantly lower than those in the low COC group (P<0.001). The average length of hospital stay was also significantly reduced in the high COC group compared to the low COC group (P<0.01). Regarding medical costs, the average hospitalization cost in the high COC group was approximately 28.7% lower than that in the low COC group (P<0.05), and the average emergency cost decreased from TWD 22,300 in the low COC group to TWD 17,800 in the high COC group (P<0.05). Additionally, the hospitalization risk in the high COC group significantly decreased (OR=0.68, P<0.05), with a similar significant downward trend in emergency visit risk (OR=0.74, P<0.05).
Conclusion: This study highlights the importance of enhancing specialty continuity of care for COPD patients. High specialty COC significantly reduces hospitalization rates, emergency visits, and medical costs, improving healthcare resource utilization efficiency and patient outcomes. The findings provide a theoretical foundation and empirical support for formulating COPD management policies and improving care models.

論文審定書 i
致 謝 ii
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 研究目的與問題 3
第二章 文獻探討 4
第一節 慢性阻塞性肺病之相關概念與流行病學 4
第二節 連續性照護之相關概念 8
第三節 連續性照護與慢性阻塞性肺病之相關研究 12
第四節 文獻小結 15
第三章 研究方法與過程 16
第一節 研究設計 16
第二節 研究對象與資料來源 17
第三節 重要變項定義 21
第四節 研究架構 25
第五節 統計分析方法 27
第四章 研究結果 29
第一節 樣本特性與變項分布情形 29
第二節 連續性照護指標與控制變項的相關性 33
第三節 研究變項與醫療照護結果之相關性分析 36
第四節 多變項分析 40
第五章 討論 55
第一節 研究結果討論 55
第二節 研究限制與建議 62
第六章 結論與建議 65
參考文獻 67
附錄 73

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