臺灣博碩士論文加值系統

本研究旨在探討台灣地區目前新生兒聽力篩檢的現況，及可能影響篩檢績效的相關情形及其預測力，另外並探討出生人數多寡、篩檢計劃實施的長短和篩檢步驟的不同與篩檢績效之間是否有差異存在。
本研究以自編的「台灣地區新生兒聽力篩檢現況調查表」和「聽力師問卷」，對39家提供自願性新生兒聽力篩檢的醫院進行調查，共回收30份問卷，回收率77%，研究結果摘述如下：
一、主要負責新生兒聽力篩檢計劃的科別為「小兒科」(50%)，平均一年的新生兒出生人數以「1001至2000人」的醫院最多(37%)。平均新生兒聽力篩檢計劃實施年數以「2.01至3年」最多(40%)，實施負責聽力篩檢的人員以「技術員」最多(40%)。篩檢步驟以「出院前用OAE篩檢，出院後以OAE+ABR複檢」最多(53%)，篩檢費用以500元為最多醫院採用(44%)，而有60%的醫院沒有使用早期通報系統來通報聽力損失的嬰幼兒。
二、篩檢績效：篩檢率以「46~75%」為最多，出院前轉介率以「<10%」最多，複診回診率和轉介率、確定永久性聽損年齡、聽能輔具配戴和接受早療的年齡都以「未統計」居多。與JCIH(2000)目標比較結果，只有3%的醫院達到「>95%」的篩檢率，有67%的醫院之出院前轉介率符合國際可接受標準「<10%」。有統計資料的醫院在複診回診率上有47%達到JCIH(2000)「>70%」的目標，複診轉介率有23%的醫院符合「<=4%」的標準。確定永久性聽力損失的平均年齡在「3-6個月」，及聽能輔具配戴的平均年齡在「7-12個月」，皆與國內兩大早療機構個案資料穩合，接受早療的平均年齡為「3-6個月」則與早療機構的「10個月」不穩合。
三、醫院出生人數的不同、篩檢計劃實施的長短和篩檢步驟的不同與台灣地區新生兒聽力篩檢績效無關聯(P>.05)。
四、30家醫院在篩檢實施現況中的得分屬「尚可」者(75%以上符合描述)，多與出院前轉介率的題項有關，搣鞳u不佳」者(25%符合描述)，則與通報系統的利用及定期召開相關會議討論篩檢結果有關。
五、可能影響篩檢績效的因素與7項篩檢績效之相關達顯著(p<.05)，其中以影響門診複診因素與篩檢率有較佳的正向關係。
六、多元迴歸分析的結果顯示「可能影響門診複診的因素」可以預測門 診回診率，「可能影響篩檢率的因素」可以預測「門診轉介率」，「可能影響聽損鑑定、輔具配置和介入年齡的因素」可以有效預測聽損鑑定、輔具配置和介入年齡，另外，「整體行政支持和管理因素」也可預測聽損鑑定年齡。

This study is aimed to investigate the status of newborn hearing screening program in Taiwan during 2002~2004. The study reports the results of the questionnaires of 30 hospitals regarding to the characteristics of newborn hearing screening, follow-up and referral system among each process in NHS program. It also investigates the relationship between factors that might affect NHS effectiveness and screening performances, and formulate a multiple regression analysis equation in estimating the hearing screening performance. This survey establishes a baseline assessment of current newborn hearing screening program in Taiwan; it provides an outcome measurement tool for the successful newborn hearing screening program.
Research results are as follows:
1.The majority of the in-charged department is the pediatrics department. Most hospitals have 1001~2000 newborns per year. NHS program is established around 2.01~3years and newborn hearing screenings are performed by technicians mostly. The majority of screening protocol is using OAE before discharge and combined protocol (OAE/ABR) for outpatient screening. The cost of screening is about NT$500 per baby. Government’s referral system is not used by 60% of hospitals to referral hearing loss infant.
2.Screening rates are between 46~75%. The referral rates prior to discharge are <10%. There is only 47% hospitals achieved the outpatient returning rate of JCIH goal, and only 23% hospitals reached the JCIH target for outpatient referral rate. Results of this survey indicate that only 7% of the hospitals reported the average age of confirmation of hearing loss to be within the first 3 months of life. Both ages of hearing aid fitting and intervention didn’t meet the target of JCIH 2000.
3.No significant correlations among birth numbers, the years of establishing NHS programs, screening protocol and screening performances.
4.High correlations are observed among 34 factors for NHS effectiveness and screening performances.
5.Multiple regression analysis indicates outpatient factors explain 20.9% variance in outpatient returning rate, and factors of screening rate can explain 23% variance in outpatient referral rate. The results also show factors of age in confirming hearing loss, hearing aids fitting and intervention can efficiently predict ages for these three items.

第一章 緒論
第一節 研究動機……………………………………………… 1
第二節 研究目的與待答問題………………………………… 8
第三節 名詞釋義……………………………………………… 10
第四節 研究限制……………………………………………… 15
第二章 文獻探討
第一節 聽力損失對兒童的影響……………………………… 17
第二節 早期發現聽力損失和介入計劃的發展……………… 21
第三節 美國全面性新生兒聽力篩檢的實施成果…………… 28
第四節 為邁向全面性新生兒聽力篩檢的目標做準備……… 39
第三章 研究方法
第一節 研究設計理念和架構………………………………… 51
第二節 研究實施程序………………………………………… 55
第三節 研究對象與取樣方法………………………………… 57
第四節 研究工具……………………………………………… 59
第五節 資料處理和統計分析………………………………… 63
第四章 結果與討論
第一節 「新生兒聽力篩檢現況調查表」作答情形………… 64
第二節 台灣地區新生兒聽力篩檢現況……………………… 79
第三節 篩檢績效與其它變項的關係………………………… 92
第四節 新生兒聽力篩檢實施現況…………………………… 104
第五節 新生兒聽力篩檢績效相關因素與其預測力………… 109
第五章 結論與建議
第一節 結論…………………………………………………… 116
第二節 建議…………………………………………………… 120
參考文獻………………………………………………………… 128
附錄……………………………………………………………… 134

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