目的：
以「可避免住院」(Avoidable hospitalization)為一評估指標，來檢視台灣自全民健保實施以來，國內整體醫療體系之可避免住院在氣喘、肺炎、高血壓、糖尿病等國內較普遍的四大疾病之趨勢發展，並進一步分析探討在各地區別、醫療層級別、性別、年齡別上可避免住院之分布概況；同時也以「可避免住院」為一評量指標，用以檢視國內相關醫療機構對於承擔可事先預防的疾病之照護是否達到均衡且有效，是否滿足醫療可近性的要求，進而達到提升初級照護的醫療品質。
方法：
本研究使用中央健保局委託國衛院所統整出具全國代表性的資料庫---全民健康保險資料庫中的醫事機構基本資料檔(HOSB)及住院醫療費用清單明細檔(DD)，研究民國86年至民國93年期間，台灣的可避免住院之整體分布趨勢。
研究對象主要為住院診斷符合本研究所歸結出的可避免住院之疾病類別氣喘、肺炎、糖尿病、高血壓者，並以國際疾病分類碼(ICD-9-CM)來進行細部比對，排除不符合者。首先，根據研究問題與假設進行描述性的統計分析，並進而以卡方檢定進行各變項間與四類疾病的顯著性分析。此外，本研究以可避免住院四類疾病之有無罹患為依變項，使用羅吉士迴歸模型做深入分析。
結果：
在台灣整體八年來的可避免住院率表現上，氣喘與高血壓之可避免住院情況呈現逐年下降的趨勢，而肺炎與糖尿病之可避免住院率則呈現逐年上升的趨勢；而在可避免住院病況發生於醫療機構層級的情形方面，四類疾病皆集中於地區醫院；而在四大地理區方面，氣喘和肺炎可避免住院情況則多發生於東部；而氣喘、肺炎可避免住院情況多發生於9歲以下的男性，而在糖尿病與高血壓方面則多發生於65歲以上的女性。
結論：
本研究採用「可避免住院」為一評估指標，期望應用於檢測國內重要疾病氣喘、肺炎、糖尿病、高血壓等在可避免住院率上的趨勢表現，進而對其進行數據解讀，延伸探究此指標對於台灣整體醫療照護體系的潛在警示，並提供政府以及相關衛生決策機構對於政策制定與疾病衛教推廣的明確方向，以提供相關疾病病人於醫療照護上得到更完善的照護品質。

Objective：
The purpose of this research is (1) to find out the overall trends of the common avoidable hospitalization diseases in Taiwan since the implementation of the National Health Insurance (NHI), (2) to compare the different distributions of the common avoidable hospitalization diseases across age groups, genders, regions, and the hospital’s characters, (3) to make the related useful information and suggestions of improving avoidable hospitalizations to the policy makers, hospitals, and the general public.
Method：
Standardized rates of avoidable hospitalization from 1997 to 2004 were derived from the National Health Insurance database and the Taiwan census data. In this research, we focus on the four main diseases：Asthma, Pneumonia, Diabetes, Hypertension as the avoidable hospitalization diseases. Logistic regression and chi-squire tests are used to detect and describes trends in data.
Results：
During the 8-year research period, AHCs (Avoidable Hospitalization Conditions)of Asthma and Hypertension decline overall, conversely, AHCs of Pneumonia and Diabetes show increasing trends overall；in the hospital characters aspects, AHCs are mostly occurred in the local hospitals；from the viewpoint of the patients’ characters, AHCs of Asthma and Pneumonia are always occurred in children male, on the other hand, AHCs of Diabetes and Hypertension are always occurred in female and above 65 years old；in the regional aspect, the AHCs of Asthma and Pneumonia are comparatively higher in east Taiwan.
Conclusion：
According to the results of this research, we can find that the avoidable hospitalizations in Taiwan still need to be improved. We suggest the policy makers and the hospitals may use the 「avoidable hospitalization」as an indicator to monitor the quality of care and the outpatient care quality in Taiwan’s healthcare system. Thus can not only reduce the unnecessary expenditure, but also can offer the general public better quality of healthcare and improve their quality of life.

目錄
致謝------------------------------------------------------------------------------------------------I
摘要-----------------------------------------------------------------------------------------------II
ABSTRACT- ---------------------------------------------------------------------------------- IV
目錄--------------------------------------------------------------------------------------------- VI
表目錄-----------------------------------------------------------------------------------------VIII
圖目錄-------------------------------------------------------------------------------------------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

第二章 文獻探討-------------------------------------------------------------------------------4
第一節 可避免住院-------------------------------------------------------------------------4
第二節 可避免住院之疾病----------------------------------------------------------------8
第三節 文獻總結---------------------------------------------------------------------------11

第三章 研究方法------------------------------------------------------------------------------12
第一節 研究設計與架構------------------------------------------------------------------12
第二節 研究變項---------------------------------------------------------------------------14
第三節 研究問題---------------------------------------------------------------------------16
第四節 研究假設---------------------------------------------------------------------------18
第五節 資料來源與研究對象------------------------------------------------------------19
第六節 統計分析---------------------------------------------------------------------------20

第四章 結果------------------------------------------------------------------------------------21
第一節 台灣歷年整體可避免住院趨勢------------------------------------------------21
第二節 各類醫療機構承擔可避免住院之情況---------------------------------------23
第三節 不同地理區域特性之可避免住院率分布趨勢------------------------------36
第四節 不同病人特性之可避免住院率分布趨勢------------------------------------49
第五結 病人特性、醫院特性、地理區域、年度對可避免住院病況之影響---59
第六節 假設驗證---------------------------------------------------------------------------66

第五章 討論------------------------------------------------------------------------------------68

第六章 結論與建議---------------------------------------------------------------------------72
第一節 結論---------------------------------------------------------------------------------72
第二節 研究限制---------------------------------------------------------------------------74
第三節 研究成果對全民健保之意涵與後續研究之建議---------------------------76

參考文獻 ---------------------------------------------------------------------------------------80

附錄一 AHRQ2006年可避免住院疾病分類表---------------------------------------- 82
附錄二 Weissman et al. 1992年可避免住院疾病分類表----------------------------- 83
附錄三 Billings et al.1993年可避免住院疾病分類表-------------------------------- 84
附錄四 2005年國人十大死因統計------------------------------------------------------85

參考文獻
中文文獻
中央健康保險局，2006，http://www.nhi.gov.tw/
內政統計資訊網，2007，http://www.moi.gov.tw/stat/index.asp
王馨儀，2006，氣喘門診照護對可避免住院之影響，國立台灣大學公共衛生學院醫療機構管理研究所碩士論文。
行政院衛生署，2006，http://www.doh.gov.tw/cht/
國家衛生研究院，2006，http://www.nhri.org.tw/
衛生統計資訊網，2007，http://www.doh.gov.tw/statistic/
蘇永裕，2002，醫院長期經營效率評估，高雄醫學大學公共衛生學研究所碩士論文。
英文文獻
AHRQ website(2007), http://www.qualityindicators.ahrq.gov/index.htm.
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