臺灣博碩士論文加值系統

隨著交通工具不斷更新與進步，交通事故逐年增加，顏面骨折因其發生率高及重大成本支出，為全球公共衛生面臨最大挑戰之一。為因應DRG支付方式導入，瞭解顏面骨折病患醫療資源耗用情形及其影響因素，提供經營管理者建立有效的經營模式。本研究目的藉由醫學中心之顏面骨折病患醫療資源耗用情形做分析比較，以瞭解不同病患特性、外傷特性及疾病因素在醫療資源耗用上有無差異及探討醫療資源耗用是否受到病患特性、外傷特性及疾病因素的影響。
本研究為回溯性次級資料研究，以某醫學中心疾病分類資料庫及外傷登錄資料庫之出院主診斷ICD-9-CM前三碼編列為802之患者為研究樣本為主，符合分析樣本數計816筆。使用統計方法包括獨立樣本t檢定、單變量變異數分析（one-way ANOVA）及複迴歸分析（Multiple Regression）。 研究結果影響顏面骨折醫療資源耗用的因素包括：損傷嚴重度、顏面骨折型態、麻醉方式、手術次數及疾病複雜度。
最後本研究建議，醫院管理者必需針對會影響顏面骨折醫療資源耗用的因素包括：損傷嚴重度、顏面骨折型態、麻醉方式、手術次數及複雜度，建議醫院經營者應利用醫院之資料庫將上述影響因素放入迴歸預測模式，以建構自己的成本模式。針對損傷嚴重度重度以上耗用醫療資源最高的病患採取個案管理，以控制成本。針對上下顏面骨折，且入院診斷三個以上耗用醫療資源為高的病患，建立標準化作業程序(SOP)，以控制成本。

With the developing of transport, traffic accidents increases every year, because of the high incidence of facial fractures and significant costs, as one of the greatest challenge of the public health. In response to DRG payment import, understand the medical resource utilization situation for the facial fracture patients and its influencing factors, providing managers establish an effective business model. The purpose of this study analyzes the facial fracture patients consume health care resources in the Medical Center and compared the situation to do, in order to analyze the differences of medical resource utilization in the different patient’s condition, trauma characteristics and disease factors.
This study is a retrospective study of secondary data. 816 facial fracture patients are collected from Kaohsiung Chang Gung Memorial Hospital medical center disease classification information database and trauma registry database of primary ICD-9-CM diagnosis code (802). The statistical methods includes T-test, univariate analysis of variance (one-way ANOVA), multiple regression analysis (Multiple Regression).
The result showed the significantly relationship between the medical resources consumed facial fractures and the severity of injuries, facial fracture patterns, anesthesia, surgery number and complexity of the disease.
Finally, this study suggests that hospital administrators would affect facial fractures necessary for medical resource utilization factors include: the severity of injuries, facial fracture patterns, anesthesia, surgery number and complexity, the proposed hospital operators should use the hospital's database the above factors into regression prediction model to construct their own cost model. Consumption of medical resources for injury severity in patients with severe than take up case management to control costs. For the upper and lower facial fractures, and admission diagnosis of medical resources consumed three or more patients for high establishing standardized operating procedures (SOP), in order to control costs.

中文摘要 I
Abstract III
誌謝 IV
總目錄 V
表目錄 VII
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 5
第二章文獻探討 6
第一節顏面骨折 6
第二節醫療資源耗用相關因素 15
第三章研究方法 19
第一節研究架構 19
第二節研究假設 20
第三節研究對象及資料收集 21
第四節研究變項之與操作型定義 22
第五節資料分析方法 24
第四章研究結果 25
第一節樣本之描述性分析 25
第二節病患特性在醫療資源耗用之差異分析 30
第三節外傷特性在醫療資源耗用之差異分析 39
第四節疾病因素在醫療資源耗用之差異分析 44
第五節醫療資源耗用之影響因素分析 55
第五章討論 65
第六章結論與建議 69
第一節研究結論 69
第二節建議 70
第三節研究限制 71
參考文獻 72
中文部份 72
英文部份 74

中文部份
內政部統計處。內政統計年報 from http://sowf.moi.gov.tw/stat/year/list.htm
王津惠、劉懋卿、譚秀峰與田木欣(2005)。兒童頜面創傷1024例臨床分析。口腔頜面外科雜誌，15(3)，279-281。
王雅玲、黃崇謙與楊啟賢(2006)。頭部外傷原因與醫療資源耗用。北市醫學雜誌，3(11)，53-64。
余滋照、夏毅然、謝明吉與張燕清(2001)。三軍總醫院顏面骨折病例之分析。中華民國口腔顎面外科學會雜誌，12(1)，1-7。
徐啟明與趙守一(1995)。臺中榮民總醫院1987-1991年顏面部骨折調查。中華民國口腔顎面外科學會雜誌，6(2)，43-50。
張筑禎、林蕙欣、周玉婷與林志銘. (2012)。台灣未成年人口外在事故住院之醫療資源耗用與預測因子。健康管理學刊，10(1)，1-12。
蔡佳靜、鄭良信與呂宗禧(1999)。Maxillofacial Fractures - A Review of 417 Cases. 中華民國耳鼻喉科醫學雜誌，34(4)，298-303。
衛生福利部(2008)。運用創傷嚴重程度分數(Injury Severity Score, ISS)評估創傷嚴重程度. from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=3471&WD_ID=903
衛生福利部(2012)。101年死因統計年報. from http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2747
衛生福利部(2014)。重大傷病範圍. from http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=712&webdata_id=3471&WD_ID=903
顏淑婷、王志榮、應純哲、黃詩芳與沈延盛(2013)。台灣老年人口在不同外傷嚴重度之醫療資源耗用分析－以南部某醫學中心為例。寶建醫護與管理雜誌，11(2)，1-9。

英文部份
Abbas, A. K., Hefny, A. F., & Abu-Zidan, F. M. (2012). Does wearing helmets reduce motorcycle-related death? A global evaluation. Accident Analysis & Prevention, 49(0), 249-252.
Allareddy, V., Allareddy, V., & Nalliah, R. P. (2011). Epidemiology of facial fracture injuries. J Oral Maxillofac Surg, 69(10), 2613-2618.
Arabi, Y., Haddad, S., Shirawi, N., & Al Shimemeri, A. (2004). Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Critical Care, 8(5), 1-6.
Arslan, E. D., Solakoglu, A. G., Komut, E., Kavalci, C., Yilmaz, F., Karakilic, E., et al. (2014). Assessment of maxillofacial trauma in emergency department. World J Emerg Surg, 9(1), 13.
Bagheri, S. C., Dierks, E. J., Kademani, D., Holmgren, E., Bell, R. B., Hommer, L., et al. (2006). Application of a Facial Injury Severity Scale in Craniomaxillofacial Trauma. Journal of Oral and Maxillofacial Surgery, 64(3), 408-414.
Baker SP, O'Neill B, Haddon W Jr, & WB., L. (1974). The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma, 14(3), 187-189.
Brasileiro, B. F., & Passeri, L. A. (2006). Epidemiological analysis of maxillofacial fractures in Brazil: a 5-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 102(1), 28-34.
Cheema, S. A., & Amin, F. (2006). Incidence and causes of maxillofacial skeletal injuries at the Mayo Hospital in Lahore, Pakistan. Br J Oral Maxillofac Surg, 44(3), 232-234.
Dolan, K. D., Jacoby, C. G., & Smoker, W. R. K. (1984). The radiology of facial fractures. RadioGraphics, 4(4), 577-663.
Fraser, D. R., Dombrovskiy, V. Y., & Vogel, T. R. (2011). Infectious complications after vehicular trauma in the United States. Surg Infect (Larchmt), 12(4), 291-296.
Glynn, S. M., Shetty, V., Elliot-Brown, K., Leathers, R., Belin, T. R., & Wang, J. (2007). Chronic posttraumatic stress disorder after facial injury: a 1-year prospective cohort study. J Trauma, 62(2), 410-418; discussion 418.
Hogg, N. J., Stewart, T. C., Armstrong, J. E., & Girotti, M. J. (2000). Epidemiology of maxillofacial injuries at trauma hospitals in Ontario, Canada, between 1992 and 1997. J Trauma, 49(3), 425-432.
Hwang, K., & You, S. H. (2010). Analysis of facial bone fractures: An 11-year study of 2,094 patients. Indian J Plast Surg, 43(1), 42-48.
Iida, S., Kogo, M., Sugiura, T., Mima, T., & Matsuya, T. (2001). Retrospective analysis of 1502 patients with facial fractures. Int J Oral Maxillofac Surg, 30(4), 286-290.
Iida, S., & Matsuya, T. (2002). Paediatric maxillofacial fractures: their aetiological characters and fracture patterns. J Craniomaxillofac Surg, 30(4), 237-241.
Islam, S., Ahmed, M., Walton, G. M., Dinan, T. G., & Hoffman, G. R. (2010). The association between depression and anxiety disorders following facial trauma—A comparative study. Injury, 41(1), 92-96.
Karim Brohi. (2007a). Abbreviated Injury Scale (AIS) Score-Overview of the anatomical scoring tool. from http://www.trauma.org/index.php/main/article/510/
Karim Brohi. (2007b). Injury Severity Score-Overview and Desktop Calculator. from http://www.trauma.org/index.php/main/article/383/
Kim, S. H., Lee, S. H., & Cho, P. D. (2012). Analysis of 809 facial bone fractures in a pediatric and adolescent population. Arch Plast Surg, 39(6), 606-611.
Leopold, D. A. (1988). The relationship between nasal anatomy and human olfaction. Laryngoscope, 98(11), 1232-1238.
Lin, C.-M., & Li, C.-Y. (2014). Assessment of medical resource utilization for Taiwanese children hospitalized for intracranial injuries. Injury, 45(4), 690-695.
Lopes Albuquerque, C. E., Nogueira Arcanjo, F. P., Cristino-Filho, G., Mont'Alverne Lopes-Filho, A., Cesar de Almeida, P., Prado, R., et al. (2014). How Safe Is Your Motorcycle Helmet? Journal of Oral and Maxillofacial Surgery, 72(3), 542-549.
Maliska, M. C., Lima Junior, S. M., & Gil, J. N. (2009). Analysis of 185 maxillofacial fractures in the state of Santa Catarina, Brazil. Braz Oral Res, 23(3), 268-274.
Michael L.Nance. (2011). Natioanl Trauma Data Bank Annual Report 2011. Chicago, IL: American College of Surgeons, 5-6.
Motamedi, M. H. K. (2003). An assessment of maxillofacial fractures: A 5-year study of 237 patients. Journal of Oral and Maxillofacial Surgery, 61(1), 61-64.
Neter, J., Wasserman, W., & Kutner, M. H. (1990). Applied Linear Statistical Models. Third Edition, Homewood, IL: Irwin.
Nordin, R., Rahman, N. A., Rashdi, M. F., Yusoff, A., Rahman, R. A., Sulong, S., et al. (2014). Oral and maxillofacial trauma caused by road traffic accident in two university hospitals in Malaysia: A cross-sectional study. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology(0).
Psoter, K. J., Roudsari, B. S., Mack, C., Vavilala, M. S., & Jarvik, J. G. (2014). Outcomes and Resource Utilization Associated With Underage Drinking at a Level I Trauma Center. Journal of Adolescent Health, 55(2), 195-200.
Rosina, F., Alaria, P., Castelli, S., Dirindin, N., Rocca, G., Actis, G. C., et al. (1996). Effect of patient characteristics on hospital costs for cirrhosis: implications for the disease-related group (DRG) reimbursement system. Ital J Gastroenterol, 28(7), 401-405.
Saini, N. S., Rampal, V., Dewan, Y., & Grewal, S. S. (2012). Factors predicting outcome in patients with severe head injury: Multivariate analysis. The Indian Journal of Neurotrauma, 9(1), 45-48.
Schneier, A. J., Shields, B. J., Hostetler, S. G., Xiang, H., & Smith, G. A. (2006). Incidence of pediatric traumatic brain injury and associated hospital resource utilization in the United States. Pediatrics, 118(2), 483-492.
Subhashraj, K., Nandakumar, N., & Ravindran, C. (2007). Review of maxillofacial injuries in Chennai, India: A study of 2748 cases. British Journal of Oral and Maxillofacial Surgery, 45(8), 637-639.