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研究生:游斯雯
研究生(外文):Yu Si-Wen
論文名稱:1997-2008年臺灣地區0-19歲兒童傷患住院醫療利用與死亡之探討
論文名稱(外文):Medical Care Utilization and Fatalities of Injured Inpatients among Children Aged 0–19 in Taiwan, 1997-2008
指導教授:簡戊鑑簡戊鑑引用關係
指導教授(外文):Chien Wu-Chien
口試委員:林金定白璐簡戊鑑
口試委員(外文):Lin Jin-DingPai LuChien Wu-Chien
口試日期:2011-05-10
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:148
中文關鍵詞:醫療利用全民健保資料庫傷害兒童死亡
外文關鍵詞:Medical care utilizationNational Health Insurance databaseInjuryChildFatalities
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本研究旨在探討臺灣地區0-19歲兒童住院傷患醫療利用(醫療費用、住院天數及手術處置)與死亡情形,分別從病患特性、就醫環境特性及傷害特性等方面來探討;研究資料來源為1997-2008年全民健保學術資料庫檔案。
住院醫療利用方面,臺灣1997-2008年,0-19歲兒童傷害住院案件共計686,171件。在病患特性部分,男童住院醫療費用較高及接受較多手術處置;年齡方面,4歲以下兒童有較高的住院醫療費用;低收入戶者住院醫療費用較低、住院天數較長及接受較多手術處置;患有重大傷病者,其住院醫療費用較高;在就醫環境特性部分,至醫學中心就醫者,其住院醫療費用較高;都市化程度方面,新興市鎮、一般鄉鎮市區及高齡化農業偏遠鄉鎮的就醫者的住院醫療費用較高;季節方面,夏季的住院醫療費用較高及手術處置較多;在傷害特性部分,燒傷的住院醫療費用較高;以傷害原因而言,溺水的住院醫療費用較高;複合性傷害數方面,住院醫療費用與手術處置隨傷害數增加而增加。
住院死亡方面,臺灣1997-2008年,0-19歲兒童傷害住院死亡者共計3,681人。傷患住院死亡的影響因子包含,一歲以下、重大傷病患者、至醫學中心就醫、居住於高都市化市鎮、顱內損傷、溺水及5種傷害。
兒童傷患所花費的醫療資源相當可觀,未來相關單位需針對高危險群進行合適的防制計畫;在病患特質方面,應隨時留意幼小兒童的行動,認識其可能會遇到的險境,並著手改善;在傷害特質方面,燒傷部分,應避免兒童有接觸到熱源的機會,溺水部分,兒童在游泳或玩水時,應有家長陪同,並對家長進行溺水事故的風險教育。除制定合適的防制計畫,並可透過教育、立法與執法等改善兒童的行為,不僅可挽救兒童生命,也可節省醫療支出。

To examine the factors associated with hospitalized medical care utilization(hospitalized medical expenditure, length of hospital stay, surgery) and fatalities of injured children aged 0-19 in Taiwan. Survey data of those who had given consent linked to National Health Insurance (NHI) database from 1997 to 2008 was used.
In terms of medical care utilization, during the 12-year period from 1997 to 2008, injuries accounted for 686,171 cases among children aged 0–19 caused by injuries. For patient characteristics, boys had more medical expenditure and required the most surgery, aged 0-4 had more medical expenditure, low income families had more length of hospital and required the most surgery, patients with catastrophic illness registry had more medical expenditure. For environmental characteristics, the regional hospitals had more medical expenditure while the town-based degree of urbanization had more medical expenditure, summer had more medical expenditure and required the most surgery. For injury characteristics, burns had more medical expenditure and required the most surgery, drowning had more medical expenditure, multiple injuries had more medical expenditure and required the most surgery.
In terms of fatalities, during the 12-year period from 1997 to 2008, injuries accounted for 23,506 deaths among children aged 0–19. The factors associated with hospital mortality caused by injuries were sex, age, low income families, catastrophic illness card, hospital level, urbanization level, season, injury type, injury causes and multiple injuries.
Inpatients among children aged 0–19 caused by injuries result significant costs in medical resources. Authorities should develop prevention strategies to reduce childhood injuries. In order to reduce injury among children aged 0–19 medical care utilization and mortality rates effectively, we should extensive education, legislation and standards for them to save children's lives and reduce medical expenditure.

表目錄 II
圖目錄 III
中文摘要 IV
英文摘要 V
第一章 緒論 1
第一節 研究背景與重要性 1
第二節 研究動機 4
第三節 研究目的 5
第二章 文獻探討 6
第一節 傷害概述 6
第二節 國內外兒童傷害之概況 10
第三節 兒童傷害住院醫療利用之影響因子 15
第三章 材料與方法 26
第一節 研究架構 26
第二節 研究假設 27
第三節 名詞解釋 28
第四節 研究對象與資料來源 29
第五節 研究流程 31
第六節 研究變項與操作型定義 32
第七節 統計分析 36
第四章 研究結果 38
第一節 兒童傷患之住院特性 38
第二節 兒童傷患住院醫療利用之影響因子 72
第三節 兒童傷患住院死亡之影響因子 90
第五章 討論 96
第一節 兒童傷患住院醫療利用之影響因子 96
第二節 兒童傷患住院死亡之影響因子 114
第三節 研究限制 123
第六章 總結 124
第一節 結論 124
第二節 建議 126

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1. 王金蓮、奉季光與林秀蓉(2007)。認識兒童骨折與照護。榮總護理 ,24(3),229 -235 。
2. 王雅玲、黃崇謙與楊啟賢(2006)。頭部外傷原因與醫療資源耗用。北市醫學雜誌, 3(11),1087-1098。
3. 李玲玲、白璐與盛培珠(2002)。社區幼童居家事故傷害預防介入研究。臺灣公共衛生雜誌 ,21(1), 61-72。
4. 邱文達、蔡宛真、蔡卓城、邱弘毅、謝屈平、蔡維謀與劉永弘(2003)。臺灣地區學齡前兒童頭部外傷之探討。中華民國急救加護醫學會雜誌, 14(1) ,7 -12 。
5. 紀煥庭、邱文達、楊大羽與蔡行瀚(2007)。臺北市輕度頭部外傷之流行病學及醫療資源使用情形。中華民國急救加護醫學會雜誌,18(2),61-70。
6. 郝宏恕(2001)。民眾對中醫藥之認知態度及消費行為特質之研究。中國醫藥大學醫務管理研究所碩士論文,臺中市。
7. 張鴻仁、黃信忠與蔣翠蘋.(2002)。全民健保醫療利用集中狀況及高、低使用者特性之探討。臺灣衛誌, 21(3),207-213。
8. 湯澡薰、郭乃文與葉壽山(1999)。臺灣醫療資源使用之公平性探討。醫護科技學刊,1(1),43-58。
9. 黃泓智、余清祥與劉明昌( 2004)。臺灣地區重大傷病醫療費用推估。人口學刊, 29,35-70。
10. 葉純志、莊義利、蔡益堅與吳秀英(2005)。我國0-12 歲兒童非致死性就醫事故傷害分析之研究-2005 年國民健康訪問暨藥物濫用調查結果。國家衛生研究院電子報,2007,190。
11. 盧瑞芬、李佳琳與莊逸洲(1999)。全民健康保險重大傷病患者住院醫療資源使用。中華公共衛生雜誌,18(4),283-292。
12. 賴文彬、嚴元隆、王建楠與蘇世斌 (2008)。臺灣南部某醫院急診溺水個案13例之臨床分析。臺灣家醫誌,18(1),29-40。
 
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