Emergency department utilization by National Health Insurance home-care recipients.

Objectives: With reference to Phase I of Andersen's Behavioral Model of Health Services Utilization, the researcher investigated emergency department utilization by home-care service recipients with National Health Insurance (NHI) in Taiwan, and examined the predictive factors affecting the risks of morbidity from emergency department utilization. Methods: This design was a retrospective cohort study. Data came from the "home care specific file" in the National Health Insurance Research Database between 1999 and 2008. The subjects were 102,680 newly NHI homecare service users between 2000 and 2008. The Poisson regression model was used to predict the factors affecting emergency department utilization, morbidity from all causes, and major system classifications. Results: The NHI home-care service users experienced the highest incidence of circulatory system diseases (441.41/103 person-year). This study showed that a higher relative risk ratio for emergency department utilization and morbidity from all causes were found in male users, those aged 65 and older, those living in urban areas, Resources Utilization Group Category2-4 home care consumers, major illness/injury and long-term respiratory dependent cases, cases with a Charlson Comorbidity Index score of 3 and above, and cases with tumors, diabetes and congestive heart failure complications. Conclusions: Based on the findings of this study, the top three reasons for emergency department utilization by home-care service recipients were diseases of the circulatory, respiratory, and urinary/reproductive systems. The adjusted relative risk of emergency department utilization increased dramatically among elders, especially for diseases of the circulatory and urinary/reproductive systems. Health care providers should pay close attention to the care needs of home-care service recipients. [ABSTRACT FROM AUTHOR]