Shwu Chong Wu

Social determinants of emergency utilization associated with patterns of care

PURPOSE To investigate the emergency room (ER) utilization among disabled Taiwanese older adults with different patterns of care arrangement. METHOD A national probability sample of 13,957 disabled older adults (aged 50 and above) was recruited. Individual interview data and National Health Insurance administrative data were used to examine the effects of care arrangements on ER utilization 1 year after the baseline interview. RESULTS One-third (33.5%) of the subjects used emergency room at least once in the follow-up year. The ER utilization rates among individuals living in institutions, in home with foreigner worker, in home with informal caregiver, and in home without caregiver, were 34.5%, 43%, 32.5% and 25% respectively. After controlling for other predisposing, enabling, need factors, and healthcare services use with multivariate logistic regression model, comparing with subjects staying home with informal caregivers, those who were institutionalized were less likely to use ER services during the study year (OR=0.64, 95%CI=0.54-0.76), those who staying home cared by foreigner worker were more likely to use ER services (OR=1.16, 95%CI=1.05-1.29), and those who staying home without caregiver were less likely to use ER services (OR=0.89, 95%CI=0.78-1.01). CONCLUSIONS Disabled older adults staying at home were more likely to use ER compared to institutionalized individuals. More research is needed to identify the unmet healthcare needs and the quality of home care that may explain the high ER utilization rate.

Geographical Variations in Elderly Disability in Taiwan

&NA; Inequality in health has long been a topic of discussion. The purpose of this research was to provide estimates of the proportions of elderly who had difficulties in activities of daily living in each of the 23 administrative areas of Taiwan, and to assess if there was geographical disparity in disability across areas. A nationally representative sample of 303,545 subjects was selected for interview. Among the subjects selected for interview, 239,861 completed the survey, a completion rate of about 80%. For the purpose of this research, only those aged 65 years or older were included (N = 114,873) in the analyses. Non-standardized and standardized prevalences of disability were presented for each of the 23 administrative areas in Taiwan, and geographical distribution of elderly disability was plotted. Results show that significant difference in disability prevalence exists among administrative districts, even after adjusting for age and sex structure of the population. Moreover, the extent of gender disparity also varied from one area to another. The western region, in general, had lower disability prevalence than the eastern region. Findings imply that since disability prevalence varied significantly across administrative areas, funding for long-term care should not be allocated based on the number of elderly population in an administrative area. Areas with high prevalence should identify reasons for their high prevalence rates and implement proper interventions.

The assessment of a hospital-based care management model for long-term care services.

The purpose of this research was to assess the effectiveness of a hospital-based care management model on disabled elderly people. A before-and-after quasi- experimental design was adopted. A total of 331 disabled elderly people, residing in the Da-An District of Taipei City, participated in the study. Among them, 166 received care management, while the other 165 did not. The latter served as controls. Baseline and follow-up data collection were carried out before and after care management intervention. Logistic regression analysis was used to test the effects of care management on medical care expenditure, self-rated health, and satisfaction with long-term care arrangement. The results showed that those under care management, compared to the controls, were more likely to experience a decrease in medical care expenditure, and less likely to have a decrease in satisfaction with long-term care. The effects were statistically significant. However, there was no effect on self-rated health. The findings show that hospital-based care management is a viable option and has the potential to become an important segment in the delivery of long-term care services. More effort should be expended in its development and in the evaluation of its effectiveness.