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研究生:許寶華
研究生(外文):Pao-Hua Hsu
論文名稱:急診轉住院病人急診暫留時間長期趨勢及關聯因素分析
論文名稱(外文):Analysis of Long-term Trend and factors associated with Emergency Department Length of Stay
指導教授:周穎政周穎政引用關係蔡淑鈴蔡淑鈴引用關係
指導教授(外文):Yiing-Jenq ChouShu-Ling Tsai
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
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:2009
畢業學年度:97
語文別:中文
論文頁數:71
中文關鍵詞:急診轉住院急診暫留時間長期趨勢分析
外文關鍵詞:Patients Admitted via EDEmergency department length of stay (ED LOS)Long-term Trend Analysis
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背景:急診擁擠不僅降低醫療照護品質更威脅病人安全,文獻證實,急診需轉住院之病人滯留急診時間過長是造成急診擁擠的主要原因之一,而急診轉住院者滯留急診之長期趨勢及影響因素為何,國內研究相對有限。
目標:本研究主要目的是為瞭解急診轉住院病人急診暫留時間之長期趨勢,及探討影響病人滯留急診之相關因素。
方法:採回溯性分析研究方法,資料來源為中央健保局醫療費用申報資料,以健保台北分區1999年至2007年之急診轉住院病人為研究對象,以邏輯斯迴歸分析影響急診轉住院病人滯留急診之關聯因素。
結果:健保台北分區急診轉住院人次逐年增加,2007年達266,924人次,較1999年成長37.21%。2007年急診轉住院病人急診暫留大於6小時人次比率為21.59%,急診暫留大於48小時之人次比率為4.52%,較1999年分別成長25.67%及94.83%。與2002年(醫院總額支付制度開始實施) 相較,2004至2007之各年度,急診轉住院者急診暫留大於6小時之勝算比為1.18至1.5倍,暫留大於48小時之勝算比為1.95至3.06倍。急診轉住院病人滯留急診情形受病患特質(性別、年齡、社經地位)、疾病嚴重度、季別、假日或非假日就醫及醫院特質(層級別、權屬別、醫院所在區域別)所影響。急診暫留大於6小時之相對風險以女性、第三季就醫者及於私立醫院就醫者較高;而男性、於第一季就醫以及於公立醫院就醫者,則有較高急診暫留大於48小時之風險;年齡愈大、低收入戶、疾病嚴重度愈高、非假日就醫者、醫學中心就醫者以及於外島(金門、連江)地區就醫者,則同時易有急診暫留大於6小時及急診暫留大於48小時之情形。
結論:健保台北分區急診轉住院病人急診滯留風險自2004年起大幅增加,且明顯集中於醫學中心。建議政府相關單位及醫療提供者應正視此一現象,系統性通盤檢討,研擬改善對策且落實執行,以提升急診醫療服務效率與品質。
Background: Emergency department(ED) overcrowding not only decreases quality of care but also threatens patient’s safety. Research has shown that long ED stays prior to admission is one of the main causes of ED crowding. There are limited research on the trend and factors associated with Emergency department length of stay (ED LOS) for admitted patients in Taiwan hospitals.
Objectives: This thesis aims to examine the trend and factors associated with ED LOS for admitted patients.
Methods: This is a retrospective study. The data consist of hospital claim data from the Bureau of National Health Insurance (BNHI), with study subjects being the admitted patients from the Taipei District. The study period is 1999 to 2007. Factors associated with ED LOS are determined using logistic regression.
Results: The number of patients admitted via the ED increased over time. 266,924 ED visits were admitted in 2007 and increased by 37.21% from 1999. In 2007, 21.59% and 4.52% of the patients stayed in the ED with a waiting time greater than 6 and 48 hours respectively, representing 25.67% and 94.83% increase since 1999. In 2004-07, the odds ratio of staying in the ED for admission over 6 hours was 1.18 to 1.5 and that over 48 hours was 1.95 to 3.06, compared with 2002(the year the BNHI implemented Hospital Global Budget Payment System). The contributing factors of staying in the ED for admission were associated with patients’ characteristics (age, gender, social-economic status), severity of disease, season, admitted during holiday, and hospital characteristics (scale, ownership, location). For females, ED visits during the third season and private hospital ED visits tend to have higher relative risk, to stay in the ED over 6 hours; being male, ED visit during the first season and public hospital ED visits tend to have higher relative risk for stay in the ED over 48 hours. The relative risk of staying in the ED both over 6 hours and over 48 hours were higher for older age, low income, ED visits during non-holiday, high disease severity, the medical center ED visits and ED visits at the remote island (Kinmen County, Lienchiang County).
Conclusions: The relative risk of staying in the ED for admission in the Taipei District of BNHI increased dramatically since 2004 and this is particularly obvious for medical centers. We suggest that the government and medical service providers should face this phenomenon. Systemic review and strategies should be studied and executed in order to increase the efficiency and quality of emergency medical service.
中文摘要………………………………………………………………….i
英文摘要……………………………………………………………… ii目錄………………………………………………………………………iv
圖目錄………………………………………………………………… vi
表目錄……………………………………………………………… viii
第一章 緒論 ………………………………………………………1
第一節 背景描述……………………………………………………1
第二節 研究之重要性 ………………………………………………3
第三節 研究目的 ……………………………………………………4
第四節 預期貢獻 …………………………………………………5
第二章 文獻探討 …………………………………………………6
第一節 急診醫療服務之相關定義 …………………………………7
第二節 急診過度擁擠之定義與急診暫留時間之測量 …………11
第三節 影響急診暫留時間之原因 ………………………………15
第四節 急診過度擁擠與滯留急診時間過長可能產生之衝擊……21
第三章 材料與方法 ………………………………………………23
第一節 研究架構……………………………………………………23
第二節 研究材料及對象 …………………………………………24
第三節 操作型定義 ………………………………………………25
第四節 資料整理與分析 …………………………………………29
第四章 研究結果 …………………………………………………31
第一節 醫療需求與急性病床供給總體描述性分析 ……………31
第二節 急診轉住院病患急診暫留情形描述性分析 ……………35
第三節 影響急診轉住院病人滯留急診相關因素探討 …………48
第五章 討論 ………………………………………………………53
第一節 研究方法之討論 …………………………………………53
第二節 研究限制 …………………………………………………54
第三節 研究結果之討論 …………………………………………56
第六章 結論建議 …………………………………………………64
第一節 結論…………………………………………………………64
第二節 建議…………………………………………………………65
參考文獻 ………………………………………………………………68
附錄1以邏輯斯迴歸分析影響2004至2007年急診轉住院病人急診暫留超過6小時&急診暫留超過48小時之相關因素…………………………72
附錄2 1999至2007年急診轉住院病人各疾病嚴重度(Charlson Comorbidity Index)人次比率 ……………………………………… 73
附錄3 1999至2007年急診轉住院病人社經地位人次比率分布……74
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