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研究生:林鴻文
研究生(外文):Hung-Wen Lin
論文名稱:醫院院內感染因素之預測與監控
論文名稱(外文):Prediction and monitor of nosocomial infection factor
指導教授:鄭博文鄭博文引用關係
指導教授(外文):Bor-Wen Cheng
學位類別:碩士
校院名稱:國立雲林科技大學
系所名稱:工業工程與管理研究所碩士班
學門:工程學門
學類:工業工程學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:50
中文關鍵詞:分類迴歸樹邏輯斯迴歸MCUSUM管制圖決策樹院內感染
外文關鍵詞:MCUSUM control chartLogistic regressionCARTDecision treeNosocomial infection
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根據衛生署疾病管制局資料指出,台灣地區從民國93~95年期間,公私立醫院住院感染病例數為78,886~79,968件,其中醫學中心感染密度增加47%;區域醫院感染密度增加27%。由於院內感染率代表住院病人之醫療品質,也是醫院評鑑的重點之一。所以目前社會大眾對於醫療品質的要求日益提高,要如何做好院內感染管制防範未然,則是醫院感染控制人員努力之方向。
本研究將針對目前醫院院內感染的現況,提出有效的改善方針,提出兩個主要目的︰(1)應用決策樹、分類迴歸樹與邏輯斯迴歸建構院內感染預測模型。(2)運用管制圖監控院內感染密度、感染率與感染人數之變化。以期能夠協助院內的感染控制人員能辨別出高感染風險因子,以降低院內的感染率。
研究發現分類迴歸樹所建構的模型ROC值80.17%為最高,顯示病患年齡、性別、就診科別、住院天數、侵入性裝置、使用營養劑、機械式換氧與發燒等變數為影響院內感染的重要因子。並藉由感控月報資料的監控因子建立MCUSUM管制圖,經由本研究測試與實際的感控狀況相符,能有效的監控院內的感染率。本研究所建構的模型尚需加入臨床的應用驗證,更能符合實務的醫院應用。
According to the statistics from the Center for Disease Control of the Health of Department, there were 78,886~79968 nosocomial infections in medical centers and regional hospitals between 2004 and 2006 in Taiwan. The mean hospital wide nosocomial infection density increase 47% and 27% for medical centers and regional hospitals, respectively. The nosocomial infection rate represents the quality of inpatient, and is emphasized by hospital accreditation. The common people are asking for high healthcare quality. The healthcare workers intend to reduce and prevent nosocomial infections.

The study put forward a plan for improving the rate of nosocomial infection. The study has two purposes.(1)Using C5.0 algorithm, classification and trees (CART) and logistic regression to construct a prediction model for nosocomial infection.(2)Using control chart to monitor three surveillance indexes that includs monthly incidence, monthly incidence density and monthly infection counts. The study hopes to help healthcare workers find risk factors and monitor nosocomial infection rate.

The results of the study show CART model has the highest Receiver Operating Characteristic Curve (ROC) 80.17%. Patient’sgender, age, specialties, length of hospital stay, invasive medical device, total parenteral nutrition, mechanical ventilation and fever were found to be important factors for nosocomial infection. The MCUSUM control chart monitors outcome of three indexes that match with reality. The model needs more clinical test to satisfy clinical need.
一、緖論 1
1.1 研究背景與動機 1
1.2 研究目的 3
1.3 研究範圍與限制 3
1.4 研究流程 4
二、文獻探討 5
2.1 醫院感染控制現況分析 5
2.1.1 院內感染風險因素 8
2.2 資料探勘 9
2.2.1 決策樹 9
2.2.2 分類迴歸樹 11
2.2.3 Logistic迴歸模型 12
2.3 多變量管制圖 14
三、研究方法 18
3.1 研究對象及範圍 19
3.2 預測變數 19
3.3 資料前處理與轉換 20
3.4 建構預測模式 22
3.5 預測模式的績效評估 23
3.5.1 正確率 23
3.5.2 作業特徵曲線 24
3.6 管制圖的建立 25
四、結果分析 28
4.1 訓練樣本與測試樣本資料量的選定 28
4.2 建構決策樹C5.0、CART與Logistic迴歸測模型 30
4.2.1建構決策樹C5.0模型 30
4.2.3 Logistic模型 32
4.3 預測模式測試與說明 33
4.4 建構監控模式 35
4.5 討論 39
五、結論與建議 42
5.1 結論 42
5.2 未來研究建議 43
參考文獻 44
附錄一 營養劑品名表 47
附錄二 抑制劑品名表 47
附錄三 第一線抗微生物製劑品名表 48
附錄四 病患基本資料表 49
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