臺灣博碩士論文加值系統

研究背景: 近年來，醫療異常事件通報與病人安全文化，逐漸受到醫院的重視。在台灣，這樣的研究仍不多。時至今日，有關醫院異常事件的成本分析，與醫院行政單位的服務成本，還未有人報告過。

研究設計: 三年期，回溯性，資料分析方式。

主要研究結果: 各類醫療不良事件(AE)，所增加的成本與增加的住院天數，以了解醫院異常事件的服務成本。

研究結果: 在研究期間(2010-2012)，總共有246,557住院病人次。其中有2000次AE，發生在1,759位住院病人。這3年期間，醫療異常事件通報比率約佔該年度住院人次的3.57% ~ 4.0%，且有逐年增加的情形。平均每一件AE，不論類別，大約需多增加新台幣115,018 ~ 584,262 元，約略相當於3,800~19,000美金 (每件AE)；住院天數方面，平均大約會延長多住23.6~25.7天。雖然醫院有管理醫療異常事件通報系統的行政單位，投入各種資源管理，但尚未能顯著降低AE發生數。不過，一些傳統上常見且比較重大的AE，例如: 院內跌倒與手術類的AE等，在研究觀察期間數目穩定，未再持續攀升。

研究結論: 住院病人若發生醫療不良事件(AE)，會增加額外醫療花費與延長住院天數。本研究所找出的有關各類AE的重要參數(如: 相關的花費與住院天數)，可以做為很有用的基礎，提供未來更多前瞻性、多中心等更大資料的研究。

Background: Incident report system and patient safety culture have gained its importance in maintaining patient safety in modern hospital. In Taiwan, only limited studies evaluated this issue. And to date, there is absence of report studying cost analysis and service cost of hospital facilities managing incident reports.

Objectives: The aim of this work is to determine the incidence of adverse events (AE) in patients admitted in a medical center in Taiwan. We also tried to identify average cost and length of stay (LOS) related to different types of AE. The service cost of hospital facilities managing AE was also studied.

Design: a 3-year (2010-2012) retrospectively, cohort study

Main Outcome Measures: Cost, LOS of each types of AE

Results: During the designated timeframe (2010-2013), a total of 246,557 inpatients were enrolled, of which 1,759 (0.71%) experienced AE. During 2010-2012, the incidence of volunteer reports was increased from 3.57% to 4.0%. After cohort-matching of department and patient age, the increased average cost per AE was mostly 115,018 to 584,262 NT dollars (around 3,800~19,000 USD). Patients with AE had an increased LOS of 23.6 to 25.7 days for different kinds of AE. In-hospital facilities managing AE did not result in major cost savings in the indicated hospital during this study period. However, some common and major types of AE, such as fallen or surgery-related AEs, were stabilized during study period.

Conclusion: AEs are associated with more costs and longer LOS for inpatients. Our work provides important information regarding cost and LOS parameters for various types of AE. This work can serve as a pilot study for further prospective, multi-center surveys for issues of AE and for measuring cost-effectiveness of managing AE.

口試委員會審定書 i
誌 謝 ii
中文摘要 iii
英文摘要 iv
圖目錄 vii
表目錄 viii
第一章 緒 論 1
1.1 研究背景 1
1.2 研究重要性和目的 2
1.3 研究範圍定義 3
1.4 研究架構及流程 4
第二章 文獻查證 6
2.1 病人安全文化介紹 6
2.1.1 異常事件通報與病人安全文化 6
2.1.2 全球異常事件通報的現況 8
2.1.3 台灣病人安全通報系統的建置與推行 10
2.3異常事件管理的介紹 15
2.3.1 異常事件的名詞解釋、定義與範圍 15
2.3.2 國際上對異常事件的成本分析研究概況 19
第三章 研究方法 22
3.1 研究對象與研究設計 22
3.2 異常事件的資料來源與收集方法 23
3.3 財務資料的來源與收集方法 24
3.4 統計分析方法 26
第四章 研究結果 27
4.1 異常事件的類別、數目與分布特性 27
4.2 醫療不良事件的分佈與成本分析: 以【跌倒事件】為例 31
4.3 醫療不良事件依類別區分的成本分析:【其他類別事件】 44
第五章 討論 52
5.1 國內外研究結果比較 52
5.1.1國外的財務數據如何? 52
5.1.2國內的事件狀況如何? 54
5.2醫療不良事件的成本分析 55
第六章 結論與建議 59
6.1結論 59
6.2建議 60
6.3研究的未來展望 61
參考文獻 63

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