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研究生:蕭秀鳳
研究生(外文):HSIAO,HSIU-FENG
論文名稱:呼吸照護中心呼吸器管路更換策略之效性探討
論文名稱(外文):The effectiveness of alternative strategy for ventilator circuit in a respiratory care center in Taiwan
指導教授:許光宏許光宏引用關係
指導教授(外文):HSU,KUANG-HUNG
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:50
中文關鍵詞:呼吸器管路呼吸器相關肺炎醫療品質醫療花費
外文關鍵詞:ventilator circuitventilator associated pneumoniaquality of medical caremedical cost
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醫療服務的品質往往與執行治療或照護的過程有相當大的關係,如何控制這個過程來提升醫療品質是困難卻很重要,大多數的研究證實:呼吸器相關肺炎的發生與呼吸器管路的頻率沒有直接相關,本研究欲探討呼吸器管路不作例行性更換對醫療品質之影響及醫療費用之相關性。
本研究於北部某醫學中心呼吸照護中心(24床)使用呼吸器病患,共收樣本數60人,採隨機分配方式,選取對照組與實驗組各30人,記錄下呼吸道感染率、住院日、及住院費用。在實驗組與對照組的性別、年齡、是否洗腎、是否氣切、預後狀況之比較,皆未達統計顯著差異。而呼吸器相關肺炎發生機率實驗組與對照組分別為2.1/1,000 與1.1/1,000、RCC停留天數實驗組與對照組分別為33.7±29.18天 與33.87±21.73天及RCC花費實驗組與對照組分別為632,194.36±465,062.12元與635,702.33±356,923.82元亦未達統計顯著差異。不例行換管者,其醫療耗材及人工工時皆比原始方案節省。
不例行更換呼吸器管路並不會增加呼吸照護中心病人的呼吸器相關肺炎發生機率,在總額預算制度下,確實有降低成本的效益。
The quality of medical service is closely related to the ways of treatments and care delivered to the patients. Procedure based research is vital for improving the quality of medical service. The frequency of replacing ventilator tubing is one of the most important factors related to the occurrence of ventilated associated pneumonia (VAP), however limited evidence was appeared in the previous documents. This study aims to investigate the effect of ventilating tubing replacement on the quality and cost of medical care.
A total of 60 patients admitted to the respiratory care center of a medical center were evenly randomized to groups of experiment and control. The occurrence of lower respiratory tract infections, hospital stays, and medical consumptions were collected during the study period. The baseline information including age, sex, hemodialysis, and tracheostomy were not statistically significant between experimental groups. The comparison between experiment group and control group on ventilated associated pneumonia (2.1/1,000 vs 1.1/1,000), RCC stay (33.7±29.18days vs33.87±21.73days), and RCC medical consumptions (632,194.36±465,062.12 NTDvs635,702.33±356,923.82NTD) failed to show statistical significance. None routine replacement of ventilating tubing had shown to be lower in medical consumables and personnel works.
The study has demonstrated that non-routine replacement of ventilating tubing can reduce medical cost, increase efficiency, and contain infections under global budget. Therefore, a recommendation of non-routine replacement of ventilating tubing in ventilating care center is made from this study.
目 錄
長庚大學碩士學位論文指導教授推書…………………………
長庚大學碩士學位論文口試委員會審定書……………………
長庚大學博碩士紙本論文著作授權書……………………………iii
中文摘要……………………………………………………………iv
英文摘要……………………………………………………………v
目 錄……………………………………………………….……vii
表 目 錄……………………………………………………..………ix
第一章 緒論……..………………………………….…..…………..1
第一節 前言…………………………….………….………1
第二節 研究之重要性……………………….…………….1
第三節 研究對象…………………………………………..3
第四節 研究目的…………………………………………..4
第二章 文獻探討………………………………………………….. .5
第一節 呼吸器相關肺炎 ……………………………….5
第二節 醫療品質與成本的關係…………………………..10
第三章 研究設計與方法 ………….……………………………….11
第一節 研究假說 …..……………………………………11
第二節 研究流程與資料處理 ..…………………………..11
第三節 研究資料的變項定義 ……………………………13
第四章 結果……………………………………………………,...15
第一節 描述性統計 ………………………………,…….15
第二節 實驗組別比較 ………………………………,….18
第三節 醫療耗用分析 …………………………………20
第五章 討論………………………………………………………..22
第一節 重要研究結果討論……………….……………....22
第二節 研究限制 …………………………………….…27
第六章 結論與建議 ……………………………………………...29
第一節 結論 …………………………………………….29
第二節 建議 …. ………………………………..……….29
參考文獻 …………………………………………………………...31
附錄…………………………………………………………….……..35
附件一 受試者同意書 …………………………….……..35
附件二 呼吸照護中心呼吸器管路更換換管排程….……..38
附件三 呼吸器管路的更換標準作業規範….……………..39
附件四 收案單……………………………………….……..42

表目錄
表ㄧ:實驗組與對照組之性別分佈及收案數
表二:所有數值變項之平均值±標準差
表三:實驗組與對照組之各項研究特性比較
表四:實驗組與對照組疾病特性之比較
表五:推估實驗組與對照組間之工時成本估算
表六:推估實驗組如採7天更換呼吸器管路之工時成本估算
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