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研究生:李松澤
研究生(外文):Li, Sung-Tse
論文名稱:影響兒童急診醫療品質指標之研究
論文名稱(外文):The study of affecting the indicators of medical quality in pediatric emergency
指導教授:陳瑞照陳瑞照引用關係
指導教授(外文):Chen, Juei-Chao
口試委員:尤嫣嫣鄭舜仁
口試委員(外文):Yu, Yen-YenCheng, Shuenn-Ren
口試日期:2011-06-14
學位類別:碩士
校院名稱:輔仁大學
系所名稱:應用統計學研究所
學門:數學及統計學門
學類:統計學類
論文種類:學術論文
論文出版年:2011
畢業學年度:99
語文別:中文
論文頁數:112
中文關鍵詞:非預期性返診氣候因素停留時間兒童急診品質指標
外文關鍵詞:length of stayunscheduled revisitclimate factorpediatric emergencyindicators of quality
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背景:「兒童不是縮小的成人」,兒童的生理結構和疾病特性皆和成人不一樣。因為急診資源的可進性越來越便利,這也造成急診室常常人滿為患並進而影響醫療品質。過去的兒科急診醫療品質研究皆以醫院或健保局的資料庫為主,鮮少有和氣候因素結合做分析。
目的:研究兒科急診兒童的特性分佈,並進一步分析相關的醫療品質指標。結合當地的氣候因素分析對兒童的特性分佈和醫療品質指標的影響。
方法:研究對象為2006年7月1日至2007年6月31日於新竹某區域醫院兒科急診病童為本研究之對象。由醫院的資料庫中擷取兒童相關病歷資料之彙整。氣象資料將自中央氣象局購買。根據研究目的以SPSS17.0/WIN 7進行統計分析。
結果:總共有29035人次納入分析。男童佔了55.9%,一至三歲占了45.4%。求診症狀中以發燒的比率最高為61.1%。平均停留時間是2.6小時,有胃腸道症狀時會停留較久的時間。整體非預期性返診率為7.43%。三個月至三歲的非預期性返診率較高為9.2 %。非預期性返診後有較長的停留時間(4.95小時 vs 2.3小時, p<0.05)和較低的返家率(75.03% vs 90.4%)。氣候中的當天平均溫度會影響病童求診的總人數,當平均溫度高於攝氏26.75度時,到急診室求助的病童數會減少。
結論:兒童發燒仍然是求診的主要原因,然而胃腸道的症狀的病童是會在醫院待上較長的時間。當溫度下降和假日時,院方便需要增加急診的醫療人力以維持較好的醫療品質。
Background: "Children Are Not Just Small Adults". Children's physiology and illness are all different from adults. Because emergency service is more and more convenient, this lead to the fact emergency department was crowded with patients and then influenced medical quality. Past studies of pediatric emergency service and medical quality were just according to the database from hospital or National Health Insurance, and seldom combine with the climate factor to make analysis.
Purpose: To study the characters of children who visited the pediatric emergency department, and further analyze the relevant medical quality indicator. Combine the local climate to analyze the influence of climate on children characters and medical quality indicator.
Method: All the children visited pediatric emergency department at the regional hospital in Hsinchu city from July 1, 2006 to June 31, 2007 were enrolled for the study. The data of these children was collected from the database of hospital. The meteorological materials were bought from Central Weather Bureau. Carry on statistical analysis with SPSS17.0/WIN 7 according to purpose of study.
Result: 29035 persons were enrolled for this study. The boy has accounted for 55.9%, and one to three years old has accounted for 45.4%. It is at most 61.1% to see a doctor with having fever. Average length of stay is 2.6 hours, and it would be longer if the children had gastrointestinal symptoms. Overall unscheduled revisit rate was 7.43%. Three months old to three years old had a relative high unscheduled revisit rate (9.2%). Unscheduled revisit children had the longer length of stay (4.95 hours vs 2.3 hours, p<0.05) and the lower discharged rate (75.03% vs 90.4%). When average temperature is higher than 26.75 degrees Celsius it could decrease the number of children visit pediatric emergency department.
Conclusion: Fever in children still remains the main cause of visiting pediatric emergency department, however children with gastrointestinal symptoms will has the longer length of stay. While on vacation or average temperature decrease, it is necessary for hospital to increase the medical manpower of the emergency department in order to maintain better medical quality.

表次....................................................................................................III
圖次....................................................................................................VI
第壹章 緒論..........................................................................................1
第一節 研究背景........................................................................1
第二節 研究動機與目的............................................................4
第三節 研究流程........................................................................6
第貳章 文獻探討..................................................................................8
第一節 急診醫療的定義及適用範圍........................................8
第二節 檢傷分類......................................................................13
第三節 急診患者的特性..........................................................25
第四節 急診醫療品質指標......................................................27
第五節 氣候因素和急診疾病分佈的相關性.........................39
第參章 研究方法................................................................................41
第一節 研究對象和資料來源..................................................41
第二節 研究架構......................................................................41
第三節 操作型定義..................................................................43
第四節 研究假說......................................................................45
第五節 資料分析......................................................................46
第六節 研究限制......................................................................47
第肆章 資料結果與分析...................................................................48
第一節 急診兒童各變項的分佈概況......................................48
第二節 病患特性和時間因素的分析......................................65
第三節 病患特性、時間因素與急診品質指標的分析................................................................................72
第四節 病患特性、時間因素與氣候因素之分析....................78
第五節 非計畫性返診病童的分析..........................................81
第六節 影響病童停留時間的因素..........................................87
第七節 影響病童求診人數的因素..........................................97
第伍章 研究結果之討論................................................................100
第陸章 結論.....................................................................................103
第柒章 建議.....................................................................................104
第捌章 參考文獻.........................................................................105

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