跳到主要內容

臺灣博碩士論文加值系統

(18.97.14.87) 您好!臺灣時間:2025/02/09 09:40
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:周昭宏
研究生(外文):Chao-Hung Chou
論文名稱:全民健保疾病管理模式運用於氣喘病患連續性照護之成效評估---以南部某區域教學醫院為例
論文名稱(外文):Evaluation of Asthma Disease Management on Patient Continuous Care under National Health Insurance---based on a medical teaching hospital in southern Taiwan
指導教授:郝宏恕郝宏恕引用關係毛莉雯毛莉雯引用關係
指導教授(外文):Horng-Shuh HshaoLih-Wen Mau
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:公共衛生學研究所碩士在職專班
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
論文頁數:109
中文關鍵詞:連續性照護疾病管理氣喘生活品質
外文關鍵詞:continuous carelife qualityasthmadisease management
相關次數:
  • 被引用被引用:20
  • 點閱點閱:342
  • 評分評分:
  • 下載下載:58
  • 收藏至我的研究室書目清單書目收藏:7
摘要
研究目的 :
為瞭解氣喘患者在加入疾病管理前後在醫療服務利用、醫療費用耗用及相關照護品質是否有差異。
研究方法 :
本研究是以某區域教學醫院胸腔科門診之氣喘病患加入中央健保局『全民健保氣喘病醫療給付改善方案試辦計劃』個案為研究對象,分析個案在疾病管理照護前後一年之醫療服務利用、醫療費用耗用的情形,同時比較氣喘病患在疾病管理前後連續性照護的情況、生活品質改善程度以及整體照護滿意度
研究結果:
全部研究樣本總共269位,在疾病管理照護前後一年的平均門診次數分別為4.58次及8.51次、門診費用為850.86元及1640.91元;平均急診次數分別為0.28次及0.23次、平均急診費用為318.73元及183.39元、平均住院天數為1.2天及0.84天、平均住院費用為2714元及2367元。完成年度照護的有76位(28.25%),在醫療服務利用及醫療費用耗用情形與全部樣本差異的情形雷同;在醫療照護品質方面,管理照護前氣喘嚴重度輕度的有45位,中重度的有31位,管理照護後氣喘嚴重度輕度的有71位,中重度的只有5位;氣喘病患因氣喘至其他院所就醫的在疾病管理照護前有40.8%,照護後只有12.6%;生活品質方面,疾病管理前之平均總分為3.70分,管理後之平均總分為5.06分;疾病管理照護的整體滿意度達九成以上。
討論與建議:
從研究顯示疾病管理照護後之醫療利用與醫療費用是有差異的。雖然在門診次數及門診費用是增加的,但相對上可減少急症就醫的機會以及所發生的醫療費用,減少氣喘病惡化對患者所造成的傷害;另外病患的照護品質在疾病管理前後不論是在疾病嚴重度、連續性照護、以及生活品質也達到顯著的改善,而整體的照護滿意度達九成以上,反應出病患對氣喘病疾病管理模式的認可與接受度。
疾病管理照護模式在氣喘病患的照護上,的確可以降低疾病嚴重度,改善病患生活品質,對中央健保局來講,設計一個良好的疾病管理照護計畫,可以提供病患良好的照護品質,而對醫療院所來說,執行疾病管理照護計畫,更可整合院內的醫療團隊提供病患面向的照護,可達到病患、醫療、保險三贏的局面。

關鍵詞:疾病管理、 氣喘、 生活品質、 連續性照護
Research purpose:
To analyze whether asthma patients have diverse use of medical services, waste of medical resources, and care quality in one year before and after joining disease management.
Research methodology:
This research is to analyze what the disease management will bring to the asthma patients in the use of medical services, waste of medical resources. The objects of this research are the asthma patients, in certain medical teaching hospital, who have joined the “Improving Asthma Patients’ Medical Treatment on Trial” of Health Insurance. Meanwhile, this research compares the asthma patients’ life quality and continuous care quality before and after.
Research result:
There are 269 patients surveyed in this study. One year before and after the disease management, the average numbers of time of outpatient services are 4.58 and 8.51. The fees for outpatient services are 850.86 NT$ and 1640.91 NT$. The average times of emergency treatment are 0.28 and 0.23. The average fees for emergency treatment are 318.73 NT$ and 183.39 NT$. The average days of hospitalization are 1.2 and 0.84. The average fees for hospitalization are 2714 NT$ and 2367 NT$. There are 76 patients (28.25%) experiencing one-year complete care. There is no diversity in the use of medical services and waste of medical resources. In medical care quality, there are 45 and 31 patients respectively, before receiving care management, suffering from slight asthma and middle asthma. 61 patients, after receiving care management, suffer from slight asthma while only 5 patients suffer from middle asthma. 40.8% of the asthma patients seek for other hospitals for asthma before joining disease management while only 12.6% of patients left after joining the management. In life quality, the average points before are 3.70 while the average points after are 5.06. More than 90 percent of the patients are satisfied with the disease management.
Discussions and suggestions:
This study shows the diversity in the use of medical treatment and waste of medical resources after the disease management. The number of times in outpatient services and the fees increases, but the chances of emergency treatment and the fees decrease, which further prevents the asthma from getting worse and more injuries. Additional, the care quality, no matter the seriousness of asthma, life quality, and continuous care are improved. The satisfaction of 90 percent of the patients reveals their agreeing to and accepting the work of disease management on asthma patients.
Disease management indeed helps asthma and improves the patients’ life quality. To Health Insurance, a well-designed disease management plan provides patients good care quality. To hospitals, executing the plan can manage the medical teams and provide patients better care. It is a triple wins for patients, medical treatment, and insurance.


Keyword: disease management, asthma, life quality, continuous care
目錄
誌謝 I
摘要 II
Abstract III
目錄 IV
表目錄 VI
圖目錄 VIII
第一章 緒論 1
第一節 研究緣起與動機 1
第二節 研究目的 3
第三節 研究重要性 4
第四節 重要名詞解釋 6
第二章 文獻探討 7
第一節 疾病管理之意義 7
第二節 國內外氣喘病疾病管理之實證研究 15
第三節 氣喘病定義、診斷及流行病學 20
第四節 氣喘病患之醫療利用情形 25
第五節 氣喘病患生活品質 28
第三章 研究方法 34
第一節 研究設計與架構 34
第二節 研究假設 36
第三節 研究對象與資料來源 37
第四節 研究工具、研究變項與操作型定義 38
第五節 資料處理與分析 41
第四章 研究結果 42
第一節 研究樣本人口學特質 42
第二節 疾病管理前後醫療使用之情況比較 44
第三節 完成年度照護樣本疾病管理前後醫療利用之比較 49
第四節 氣喘嚴重度分佈及疾病管理前後之比較 56
第五節 參與氣喘疾病管理方案病患意見調查結果 58
第五章 討論 68
第一節 研究假設考驗 68
第二節 研究結果與文獻之比較 71
第三節 研究限制 77
第六章 結論與建議 78
第一節 結論 78
第二節 建議 79
參考文獻 81
中文部分 81
英文部分 82
附錄 87
附錄A全民健保氣喘醫療給付改善方案試辦計劃書 87
附錄B 氣喘長期照護成效研究問卷 98
1.澎萬誠:氣喘之診斷及臨床表徵,國防醫學,2000;Vol.31(4) PP.272-277。
2.劉凱申:日趨流行的慢性病-氣喘,科學月刊,1998;Vol.29(4) pp.277-282。
3.中央健保局:中央健康保險局氣喘病醫療給付改善方案試辦計劃,2001。
4.王家宏等:台北榮總醫院呼吸治療科氣喘病人講習班教材,1992。
5.陸希平、王乃弘、郝宏恕:病案管理與疾病管理;臺灣醫界,(2003),46(10):51-55。
6.黃三桂、王悅萍、錢慶文:疾病管理對糖尿病患醫療資源耗用的影響;醫務管理雜誌,(2002),3(2):35-47。
7.李玉春、黃三桂、林小嫻、蔡篤堅:建立全民健保以共同照護模式為基礎的糖尿病疾病管理計劃之先導性研究第二年計劃成果報告,行政院衛生署九十年度委託研究計劃。
8.韓揆:醫療品質管理及門診服務品質定興指標,中華民國公共衛生雜誌,1994,13:1。
9.翁慧卿:全民健保連續性完整照護氣喘病患之疾病管理模式先導研究委託報告,行政院衛生署九十一年度委託研究計劃,2002。
10.黃齡儀:氣喘連續性照護疾病管理成效評估之初探-以高屏分局為例。高雄醫學大學健康管理學院公共衛生研究所碩論文,2003。
11.行政院衛生署:氣喘診療指引,2000。
12.俞聖彥:門診氣喘病患醫療資源耗用分析-以某區健保分局資料為例。國立陽明大學醫務管理研究所碩士論文,2001。
13.陳招式:門診急性呼吸道感染及氣喘病患醫療資源耗用分析。高雄醫學大學健康科學院公共衛生研究所碩士論文,2001。
14.鄭幸宜:成人氣喘患者的壓力、因應策略與生活品質之關係。國立台灣大學醫學院護理學研究所碩士論文,1998。
15.陳美玲:血液透析病患生活品質及其相關因素之探討。國防醫學院護理學研究所碩士論文,1996。
16.張雪芬:論質計酬試辦計劃之成效初探-以肺結核疾病為例。中國醫藥學院醫務管理研究所碩士論文,2003。





英文部分
1.Allen-Ramey FC, Diettr GB, McDonald RC, Skinner EA, Steinwachs DM, Wu, Aw:Methods aimed at improving asthma care and outcomes management Acase study: Dis Manage Health Outcomes 2002;10(8):495-503.
2.Apter, A.J, Reisine, S.T, Barrows,E & ZuWallack, R.L:The influence of demographic and socioeconomic factors on health related quality of life in asthma. Journal of Allergy and Clinical Immunology 1999;103(1):72-78.
3.Armstrong EP, Langley PC:Disease management programs. American Journal of Health-System Pharmacy 1996;53:161-170.
4.Barr RG, Somers SC, Speizer FE, Camargo CA Jr:Patient factors and medication guide adherence among older women with asthma. Arch Intern Med.2002 Aug12-26;162(15):1761-1768.
5.Battleman DS, Callahan MA, Silber S, Munoz CI, Santiago L, Abularrage J, Jabbar H:Dedicated asthma center improves the Quality of care and resource utilization for pediatric asthma:a multicenter study. Acad Emerg Med 2001;8(7):709-715.
6.Blixen CE, Tilley B, Havsted S & Zoratti E:Quality of life, medication use, and health care utilization of urban african americans with asthma treated in emergency departments. Nursing Researth 1997;46(6):338-341.
7.Bousquet J, Knani J, Dhivert H, Richard A, Chicoye A, Ware JE & Michel FB:Quality of life in asthma. American Journal of Respiratory Critical Care Medicine 1994;149:371-375.
8.Braunwald E,Fanci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL:Harrisoc''s PRINCIPLES OF INTERNAL MEDICINE, 2001;Vol 1: 187-193.
9.Braunwald E,Fanci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL:Harrisoc''s PRINCIPLES OF INTERNAL MEDICINE, 2001;Vol 1: 1120-1123.
10.Braunwald E,Fanci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL:Harrisoc''s PRINCIPLES OF INTERNAL MEDICINE, 2001;Vol 1: 1125-1129.
11.British Thoracic Association:Death from asthma in two regions of England. Br Med J 1982;285(10):1251-1255.
12.Boednheimer, T:Disease management in the American market. BMJ 2000;320(7234):536-566.
13.Chan DS, Callahan CW, Moreno C:Multidisciplinary education and management program for children with asthma. Am J Health Syst Pharm 2001;58(15):1413-1417.
14.Cough BJ:Disease management:An Overview.:In Couch JB ed. The Health Care Professional''s Guide to Disease Management:Patient-Centered Care for the 21st century. Maryland:Aspen Pub 1998:1-28.
15.DMAA.Definition of disease management. Available from URL:http://www.dmaa.org/definition/htm 「Accessed 2002 Mar 26」
16.Dales RE, Kerr PE, Schweitzer I:Asthma management preceding an emergency department visit. Arch Intern Med 1992;152:2041-2044.
17.Department of Health and human service(DHHS).International Consensus Report on Diagnosis and Treatment of Asthma. Washington DC:DHHS1992.
18.Donabedian A:Explorations in Quality Assessment and Monitoring. The Definition of Quality and Approaches to its Assessment. Ann Arbor, MI:Health Administration Pr,1980:1-31.
19.Ebbinghaus S,Bahrainwala Ah:Asthma Mamagement by an Inpatient Asthma Care Team. Pediatric Nursing, May-June 2003;29(3):193-194.
20.Ferrans CE & Power MJ:Quality of life index:Development and Psychometric properties. Advance in Nursing Science 1985;8(1):15-24.
21.Ferrans CE & Power MJ:Psychometric assessment of the quality of life index. Research in Nursing & Health 1992;15(1):29-38.
22.Gibson PG, Talbot PI, Toneguzzi RC & the Population Medicine Group 91C:Self-management, autonomy, and quality of life in asthma, Chest 1995;107(4):1003-1008.
23.Greineder DK:A randomized controlled trial of a pediatric asthma outreach program. Journal of Allergy Clinical Immunology 1999;103(3):436-440.
24.Groban MD, Evans RM, Edgren B, Butt LT, Stefano AD, Feranndes DJ, Buchner DA:Clinical Benefits and Cost Reduction Associated with a Comprejhensive Asthma Managemnet Programme at a Managed Care Organisation. Dis Manage Health Outcome, 1998;4(2):93-100.
25.Hays R, Stewart AL & Ware JE:The MOS short for general health survey. Medical Care 1988;26(7):724-735.
26.Hinds C:Personal and contextual factors predicting patient reported quality of life: Exploring congruency with Betty Neumans assumptions. Journal of Advanced Nursing 1990;15(4):456-462.
27.Hoskins G, McCowan C, Neville G, Thomas GE, Smith B, Silverman s:Risks factors and costs associated with an asthma attack.Thorax 2000;55:19-24.
28.James AW:Asthma.Obsterics and Gynecology Clinica of North American.2001;28:305-328.
29.Jones PW & the Nedocromil Sodium Quality of life Stady Group:Quality of life, symptoms and pulmonary function in asthma: long-term treatment with nedocromil sodium examined in a controlled multicentre trial. European Respiratory Journal 1994;7(1):55-62.
30.Jones KP, Mullee MA, Middleton M, Chapman E & Holgatr ST:Peak flow based asthma self-management: A randomized controlled study in general practice. Thorax 1995;50:851-857.
31.Jones PW:Quality of life measurement in asthma. European Respiratory Journal 1995;8(6):885-887.
32.Juniper EF, Guyatt GH, Esptein Rs, Ferrie PJ, Jaeschke R & Hiller TK:Evaluation of impairment of health related quality of life in asthma:Development of questionnaire for use in clinical trials. Thorax 1992;47:76-83.
33.Juniper EF, Guyatt GH, Ferrie PJ,& Griffith LE:Measuring quality of life in asthma. American Review of Respiratory Disease 1339;147(4):832-838.
34.Juniper EF, Johnson PR, Borkhoff CM, Guyatt GH, Boulet LP & Haukioja A:Quality of life in asthma clinical trials:comparison of salmeterol and salbutamol. American Journal of Respiratory Critical Care Medicine 1995;151(1):66-70.
35.Kevin BW, Sullivan Phd, Chistopher S, Lyttle MS:Trends in the cost of illness for asthma in the United States,1985-1994 2000;106:494-499.
36.Kelly CS, Morrow AL, Shults J, Nakas N, Strop GL, Adelman RD:Pediatrics 2000;105(5):1029-1035.
37.Krahn MD, Berka C, Langoid P, Detsky AS:Direct and indirect costs of asthma in canada 1990. Can Med Assoc J 1996;154:821-831.
38.Leidy NK & Cough C:Psychometric performance of the asthma quality of life questionnaire in a US sample. Qualuty of life Research 1998;7:127-134.
39.Love MM, Mainous AG 3rd, Talbert JC, Hager GL:Continuity of care and the physician-patient relationship:the importance of continuity for adult patients with asthma. J Fam Pract 2000 Nov;49(11):998-1004.
40.Markson LE, Vollmer WM, Fitterman L, O''Connor E, Narayanan S, Berger M, Buist AS:Insight into patient dissatisfaction with asthma treatment. Arch Intern Med 2001;161(3):379-384.
41.Marks GB, Dunn SM & Woolcock AJ:A scale for the measurement of qlality of life in adults with asthma. Journal of Clinical Epidemiology 1991;45(5):461-472.
42.Mcdowell I &Newell C:Measurement health :A Guide to rating scales and questionnaires(2nd Ed) 1996, New Yoyk:Oxford.
43.Mastes G, Hall SE, Phillips M, Boldy D:Outcomes Measurement for Asthma Following Acute Presentation to an Emergency Department. Asutralian Health Review.2001;24(3):53-60.
44.McCormack RE:Disease state managemnet in Managed Care. In:Couch JB ed. The Health Care Profession''s Guide to Disease Management: Patient-Centered Cars for the 21st Century. Maryland: Aspen Pub 1998:191-222.
45.Mc Glynn, EA:Six challenges in measuring the quality of health care.Health Affairs 1997;16(3):7-21.
46.Meeberg GA:quality of life: A concept analysis. Journal of Advanced Nursing 1993;18(1):32-38.
47.National institutes of Health(NIH):National Education Program/Expert Panel Report 2:Guilelines for the Diagnosis and Management of Asthma. Publication No,97-4501 NIH, Bethesda MD, 1997.
48.Quirk FH & Jones PW:Patient''s perception of distress due to symptoms and effects of asthma on daily living and an investigation of possible influential factord. Clinical Science 1990;79:17-21.
49.Radzwill, MA:Integration of case and disease managemnet –Who and How? Disease Management And Health Outcomes 2002;10(5):277-289.
50.Redinhardt UW, Cheng MT:The〝Quality〞of health care from an economic viewpoint, Internattional Conerence on the Quality of Health 1998,Taipei, Taiwan, R.O.C.
51.Redinhardt UW, Cheng MT:The 〝Quality〞of health care from an economic viewpoint. Internattional Conerence on the Quality of Health 1998.
52.Richards JM & hemstreet MP:Measures of life quality, role performance, and functional status in asthma research. American Journal of Respiratory Critical Care Medicine 1994;149(2)531-539.
53.Ronchetti R, Indinnimeo L, Bonci E, Corrias A, Evans D, Hinid-Alexander M, Midulla F, Pulejo R, Villa MP:Italian study Group on Asthma Self-Management Programes:Asthma self-management programes in a population of Italian children:A multicentric study Eur Respir J 1997;10:1248-1253.
54.Rubinfeld R, Dunt DR,McClure BG:Do patients understand asthma? A community survey of asthma knowledge. Med J Aust 1998;149:26-30.
55.Rutten-van M, Custers F, Dooslaer EK, Jansen CC, Heurman L, Smeet JJ, Bommer AM & Raaijmakers JA:Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. European Respiratory Journal 1995;8(6);888-898.
56.Shi L, Singh DA:Delivering Health Care in American, 2st ed. Gaithersburg Mayland:An aspen publication, 2001;501-507.
57.Smith DH, Malone DC, LWSON ka, Okamoto LJ, Battista C, Saunder WB:A national estimate of the economic costs of asthma. Am J Respir Crit Care Med 1997;156:787-793.
58.Spilker B:Quality of life and pharmacoeconomics in clinical trials.1996; Philadelphia: Lippincott.
59.Stanford R, Mclaughlin T, Okamoto J:The costs of asthma in the emergency department and hospital, Am J Respir Crit Case Med.1999;160:211-215.
60.Stroupe KT, Gaskins D, Murray MD:Health-care costs of inner-city patients with asthma. Am J Asthma.1999;36:645-655.


61.Sullivan SD, Weiss KB, Lynn H, Mitchell H, Kattan M, Gergen PJ, Evans R:The cost-effectiveness of an inner-city asthma intervention for children. J Allergy Clin Immunal 2002;110(4):576-581.
62.Thoonen BP, Schermer TR, Van Den Boom G, Moleme J, Folgering H, Akkermans RP, Grol R, Van Weel C, Van Schayck CP:Self-management of asthma in general practice,asthma control and quality of life:a randomised controlled trial. Thorax 2003 Jan;58(1):30-36.
63.Todd WE,Nash D:Disease Management:A System Approach to improving Patient Outcomes. Chicago:American Hospital Publishing Inc.1996。
64.Weiss KB, Wagener DK:Chsmging Patterns of asthma mortality:identifying target populations at high risk. JAMA190;264:1683-1687.
65.Weiss KB,Gergen PJ, Hodgson TA:An economic evaluation of of asthma in the United States. N Eng; J Med 1992;326:862-866.
66.Wilson SR,Scamagas P, German D, Hughes GW, Lulla S, Coss S, Chardon L, Thomas RG, Norma SS, Stancavage FB, Arsham GM:A controlled trial of two forms of self-management. The American Journal of Medicine 1993;94(6):564-576.
67.Wolf FM, Guevare JP, Grum CM, Clark NM, Cates CJ:Educational interventions for asthma in children(Cochrane Review). Cochrane Database Syst Rev 2003;(1):CD00326.
68.Zitter M:A new paradigm in health care delivery:Disease Management. Approach to Improving Patient Outcomes.1997;American Hospital Publishing, Chicago,P5.
69.Zhan L:Quality of life:Conceptual and measurement issues. Journal of Advanced Nursing 1992;17(3):795-800.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top