# 臺灣博碩士論文加值系統

(3.238.135.174) 您好！臺灣時間：2021/08/05 07:41

:::

### 詳目顯示

:

• 被引用:0
• 點閱:1184
• 評分:
• 下載:4
• 書目收藏:0
 背景：到院前心跳功能停止（Out-Of-Hospital Cardiac Arrest, OHCA），經常是在一個無預警的情況下發生，緊急救護上雖有明確的步驟執行OHCA，但實際執行救護上的醫療品質仍有待探討。醫療照護的品質是多面向的構念，所以無法直接測量，因此可用許多測量指標建構成為一個組合分數，以此組合分數代表品質。目的：本研究由救護隊(Emergency Medical Services)相關的2個指標做出了救護隊層級的急救品質組合分數(Composite Score)，以瞭解該組合分數的建構效度(construct validity)，亦探討該分數與病患出院死亡率的相關。方法：資料來源為台北市衛生局「網路化心跳停止病患(OHCA)登錄系統」，時間從民國95年至98年，共4年時間。本研究採用兩個組合分數的方法，分別是粗總和分數(Raw Sum Score)及全有全無分數(All or None Score)，這些組合分數是由兩個過程指標(到達醫院前恢復自主循環百分比、緊急救護團隊反應時間5分鐘內百分比)所組成。最後，分別看這兩個組合分數與結果指標(出院死亡率)的關係。結果：研究樣本總共4,000名OHCA病患，其分布在44個救護小隊，把計算出每個救護隊的兩種組合分數結果，依結果將救護隊排序。同時我們得到兩種組合分數，分別與出院死亡率和風險校正出院死亡率有顯著負相關，兩種組合分數來說，以全有全無分數的負相關為最好(分別是-0.593, p < 0.01和-0.482, p < 0.05)。結論：當應用組合分數測量救護隊品質時，發現組合分數具有建構效度（尤其是全有全無分數），因此可將全有全無分數做為分析與評估救護隊品質的候選方法。
 Background: Out-of-hospital cardiac arrest (OHCA), although emergency medical has clear of steps implementation OHCA, but implementation on the quality of care remains need to be investigated. The quality of care is a multidimensional construct that cannot be measured directly. Thus, multiple indicators are used to construct a composite score to measure ‘quality’.Objective: We investigate the association between the different composite scores developed from EMS-related process measures with post-discharge mortality.Methods: Data were collected from Taipei City OHCA Registry from the period January 1, 2006 to December 31 2009. Taipei City OHCA Registry. The composite scores in our study were derived from the following two methods: the raw sum score and the all-or-none score methods. These composite scores were calculated based on two process measures (achieving prehospital ROSC and EMS response time < 5 minutes). Finally, the association between the composite scores and the post-discharge mortality was investigated.Results: A total of 4,000 OHCA patients were analyzed, and were distributed across 44 EMS teams. The all-or-none score methods demonstrated a highest inverse relationship with post-discharge mortality and risk-adjusted post-discharge mortality respectively (-0.593, p < 0.01 and -0.482, p < 0.05) compared to the raw sum score and individual process measures.Conclusion: When applying the composite scores, especially the all-or-none score to measure the quality of EMS care, we found they show the higher validity. Thus the composite score constructed by using a number of process measures may be used as an alternative approach to analyze and access the EMS quality.
 致謝I摘要IIAbstract III目次IV表目錄VI圖目錄VII第一章 緒論1第一節 研究背景與動機1第二節 研究目的4第三節 研究流程5第二章 文獻探討6第一節 緊急醫療服務（Emergency Medical Services, EMS）6第二節 到院前心跳功能停止（Out-Of-Hospital Cardiac Arrest, OHCA）11第三節 組合分數之應用15第三章 研究方法18第一節 研究設計18第二節 研究材料與方法19第四章 研究結果25第一節 描述性統計25第二節 緊急救護隊之分析28第五章 討論36第一節 討論36第二節 研究限制40第六章 結論41參考文獻42中文部分42英文部分43表目錄表2-1 到院前心跳功能停止之因素相關研究13表2-2 組合分數之應用相關研究17表4-1 OHCA病患控制變項描述性統計（N＝4000）26表4-2 OHCA病患和緊急救護小隊的過程指標、結果指標描述性統計27表4-3 緊急救護小隊組合分數、過程指標與結果指標之Spearman相關性分析28表4-4 緊急救護小隊救護OHCA病患10人以上組合分數、過程指標與結果指標之Spearman相關性分析29表4-5 緊急救護小隊救護OHCA病患30人以上組合分數、過程指標與結果指標之Spearman相關性分析30表4-6 緊急救護小隊救護OHCA病患50人以上組合分數、過程指標與結果指標之Spearman相關性分析31表4-7 全有全無分數與粗總和分數之間的一致性、排名差距（全有全無分數為標準，N＝44）33表4-8 全有全無分數與出院死亡率之間的一致性、排名差距（全有全無分數為標準，N＝44）34圖目錄圖1-1 康復出院人數累計圖1圖1-2 研究流程圖5圖2-1 「到院前心跳功能停止」流程9圖4-1 緊急救護中隊的組合分數長條圖35
 中文部份[1]中華緊急救護技術員協會(2011)。 100學年度初級救護技術員繼續教育訓練課程。中華緊急救護技術員協會。[2]台北市政府消防局 (2011)：緊急救護統計表。取自：http://www.tfd.gov.tw/home.php?id=9。[3]行政院衛生署 (2011)：衛生法規檢索系統。取自http://dohlaw.doh.gov.tw/Chi/FLAW/FLAWDAT0202.asp。[4]吳榮平、余岐育 (2011)。消防機關執行OHCA患者到院前緊急救護之調查研究。危機管理學刊，8(1)，9-18。[5]胡勝川 (2008)。實用到院前緊急救護。金名圖書。[6]黃彥璋、林宏榮、郭浩然、嚴元隆、蔡明哲、吳政龍、…符凌斌 (2006)。專責救護隊是否能改善到院前心跳停止病患的預後。中華民國急救加護醫學會雜誌，18(1)，1-11。[7]劉信良、賴世昌、李肇瑞、劉慈安、吳宜芳、周志中、…林晏任 (2009)。針對心因性及非心因性到院前心跳停止之病人經急救後恢復自發性循環的臨床特徵及預後相關因子。臺灣急診醫學會醫誌，11(3)，77-85。[8]賴世昌、李肇瑞、蕭名豪、周志中、張進富、劉慈安、林晏任 (2009)。中臺灣地區非外傷性成人到院前心跳停止流行病學及預後分析。臺灣急診醫學會醫誌 ，11(1)，1-9。英文部份[1]Abe, T., Tokuda, Y., & Cook, E. F. (2011). Time-Based Partitioning Model for Predicting Neurologically Favorable Outcome among Adults with Witnessed Bystander Out-of-Hospital CPA. PLoS One, 6(12), e28581. doi: 10.1371/journal.pone.0028581PONE-D-11-17375 [pii][2]Abrams, H. C., Moyer, P. H., & Dyer, K. S. (2011). A model of survival from out-of-hospital cardiac arrest using the Boston EMS arrest registry. Resuscitation, 82(8), 999-1003. doi: 10.1016/j.resuscitation.2011.03.023[3]Ahn, K. O., Shin, S. D., Suh, G. J., Cha, W. C., Song, K. J., Kim, S. J., . . . Ong, M. E. H. (2010). Epidemiology and outcomes from non-traumatic out-of-hospital cardiac arrest in Korea: A nationwide observational study. Resuscitation, 81(8), 974-981. doi: 10.1016/j.resuscitation.2010.02.029[4]Berdowski, J., Berg, R. A., Tijssen, J. G. P., & Koster, R. W. (2010). Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation, 81(11), 1479-1487. doi: 10.1016/j.resuscitation.2010.08.006[5]Brunelli, A., Berrisford, R. G., Rocco, G., & Varela, G. (2009). The European Thoracic Database project: composite performance score to measure quality of care after major lung resection. Eur J Cardiothorac Surg, 35(5), 769-774. doi: S1010-7940(09)00108-0 [pii]10.1016/j.ejcts.2009.01.037[6]Callaway, C. W., Schmicker, R., Kampmeyer, M., Powell, J., Rea, T. D., Daya, M. R., . . . Nichol, G. (2010). Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest. Resuscitation, 81(5), 524-529. doi: 10.1016/j.resuscitation.2009.12.006[7]Chen, T. T., Lai, M. S., Lin, I. C., & Chung, K. P. (2011). Exploring and Comparing the Characteristics of Nonlatent and Latent Composite Scores: Implications for Pay-for-Performance Incentive Design. Medical Decision Making, 32(1), 132-144. doi: 10.1177/0272989x10395596[8]Chiang, W.-C., Ko, P. C.-I., Wang, H.-C., Yang, C.-W., Shih, F.-Y., Hsiung, K.-H., & Ma, M. H.-M. (2009). EMS in Taiwan: Past, present, and future. Resuscitation, 80(1), 9-13. doi: 10.1016/j.resuscitation.2008.10.010[9]Corcoran, J., Downing, S. M., Tekian, A., & DaRosa, D. A. (2009). Composite score validity in clerkship grading. Academic Medicine, 84(10 Suppl), S120-123. doi: 10.1097/ACM.0b013e3181b3700900001888-200910001-00031 [pii][10]Fong, J., Marsh, G. M., Stokan, L. A., Weilian, S., Vinson, C., & Ruhl, L. (2008). Hospital Quality Performance Report: An Application of Composite Scoring. American Journal of Medical Quality, 23(4), 287-295. doi: 10.1177/1062860608317064[11]Govindarajan, P., Lin, L., Landman, A., McMullan, J. T., McNally, B. F., Crouch, A. J., & Sasson, C. (2012). Practice variability among the EMS systems participating in Cardiac Arrest Registry to Enhance Survival (CARES). Resuscitation, 83(1), 76-80. doi: 10.1016/j.resuscitation.2011.06.026[12]Grmec, Š., Križmarič, M., Mally, Š., Koželj, A., Špindler, M., & Lešnik, B. (2007). Utstein style analysis of out-of-hospital cardiac arrest—Bystander CPR and end expired carbon dioxide. Resuscitation, 72(3), 404-414. doi: 10.1016/j.resuscitation.2006.07.012[13]Hayward, R. A. (2007). All-or-nothing treatment targets make bad performance measures. American Journal of Managed Care, 13(3), 126-128.[14]Hernandez, A. F., Fonarow, G. C., Liang, L., Heidenreich, P. A., Yancy, C., & Peterson, E. D. (2011). The Need for Multiple Measures of Hospital Quality: Results From the Get With The Guidelines-Heart Failure Registry of the American Heart Association. Circulation, 124(6), 712-719. doi: 10.1161/circulationaha.111.026088[15]Jacobs, R., Goddard, M., & Smith, P. C. (2005). How robust are hospital ranks based on composite performance measures? Medical Care, 43(12), 1177-1184.[16]Kajino, K., Iwami, T., Daya, M., Nishiuchi, T., Hayashi, Y., Kitamura, T., . . . Yamayoshi, S. (2010). Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest. Resuscitation, 81(5), 549-554. doi: 10.1016/j.resuscitation.2010.02.008[17]Kelley, E. (2007). All or none measurement: why we know so little about the comprehensiveness of care. International Journal for Quality in Health Care, 19(1), 1-3. doi: DOI 10.1093/intqhc/mzl066[18]Kilbourne, A. M., Farmer Teh, C., Welsh, D., Pincus, H. A., Lasky, E., Perron, B., & Bauer, M. S. (2010). Implementing composite quality metrics for bipolar disorder: towards a more comprehensive approach to quality measurement. General Hospital Psychiatry, 32(6), 636-643. doi: 10.1016/j.genhosppsych.2010.09.011[19]Li, Y., Cai, X., Glance, L. G., Spector, W. D., & Mukamel, D. B. (2009). National Release of the Nursing Home Quality Report Cards: Implications of Statistical Methodology for Risk Adjustment. Health Services Research, 44(1), 79-102. doi: 10.1111/j.1475-6773.2008.00910.x[20]Nolan, T., & Berwick, D. M. (2006). All-or-none measurement raises the bar on performance. Jama-Journal of the American Medical Association, 295(10), 1168-1170.[21]O'Keeffe, C., Nicholl, J., Turner, J., & Goodacre, S. (2010). Role of ambulance response times in the survival of patients with out-of-hospital cardiac arrest. Emergency Medicine Journal, 28(8), 703-706. doi: 10.1136/emj.2009.086363[22]Perkins, G. D., & Cooke, M. W. (2011). Variability in cardiac arrest survival: the NHS Ambulance Service Quality Indicators. Emergency Medicine Journal, 29(1), 3-5. doi: 10.1136/emermed-2011-200758[23]Peterson, E. D., DeLong, E. R., Masoudi, F. A., O'Brien, S. M., Peterson, P. N., Rumsfeld, J. S., . . . Performance, A. A. T. F. (2010). ACCF/AHA 2010 Position Statement on Composite Measures for Healthcare Performance Assessment A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures (Writing Committee to Develop a Position Statement on Composite Measures). Circulation, 121(15), 1780-1791. doi: Doi 10.1161/Cir.0b013e3181d2ab98[24]Ryan, A. M. (2009). Effects of the Premier Hospital Quality Incentive Demonstration on Medicare Patient Mortality and Cost. Health Services Research, 44(3), 821-842. doi: 10.1111/j.1475-6773.2009.00956.x[25]Scholle, S. H., Roski, J., Adams, J. L., Dunn, D. L., Kerr, E. A., Dugan, D. P., & Jensen, R. E. (2008). Benchmarking Physician Performance: Reliability of Individual and Composite Measures. American Journal of Managed Care, 14(12), 829-838.[26]Shin, S. D., Suh, G. J., Ahn, K. O., & Song, K. J. (2011). Cardiopulmonary resuscitation outcome of out-of-hospital cardiac arrest in low-volume versus high-volume emergency departments: An observational study and propensity score matching analysis. Resuscitation, 82(1), 32-39. doi: 10.1016/j.resuscitation.2010.08.031[27]Shwartz, M., Ren, J., Pekoz, E. A., Wang, X., Cohen, A. B., & Restuccia, J. D. (2008). Estimating a composite measure of hospital quality from the hospital compare database - Differences when using a Bayesian hierarchical latent variable model versus denominator-based weights. Medical Care, 46(8), 778-785.[28]Siriwardena, A. N., Shaw, D., Donohoe, R., Black, S., & Stephenson, J. (2010). Development and pilot of clinical performance indicators for English ambulance services. Emergency Medicine Journal, 27(4), 327-331. doi: 10.1136/emj.2009.072397[29]Willis, C. D., Stoelwinder, J. U., Lecky, F. E., Woodford, M., Jenks, T., Bouamra, O., & Cameron, P. A. (2010). Applying Composite Performance Measures to Trauma Care. Journal of Trauma-Injury Infection and Critical Care, 69(2), 256-262. doi: Doi 10.1097/Ta.0b013e3181e5e2a3
 電子全文
 國圖紙本論文
 推文當script無法執行時可按︰推文 網路書籤當script無法執行時可按︰網路書籤 推薦當script無法執行時可按︰推薦 評分當script無法執行時可按︰評分 引用網址當script無法執行時可按︰引用網址 轉寄當script無法執行時可按︰轉寄

 1 台灣地區小型養護機構服務品質之探討 2 網際網路品質指標構建之研究─以一般系統理論為觀點 3 顧客滿意度調查實証研究─以藥局為實例 4 到院前心肺停止病患急救成效相關因素探討 5 到院前心肺功能停止之資料分析 6 以個案研究法探討網際網路品質之評估指標 7 醫院權屬別及層級別與醫院照護品質產出相關性之研究─以院內死亡、14天及30天內再入院為例 8 軟體測試輿可靠度模式之整合研究

 1 [6]黃彥璋、林宏榮、郭浩然、嚴元隆、蔡明哲、吳政龍、…符凌斌 (2006)。專責救護隊是否能改善到院前心跳停止病患的預後。中華民國急救加護醫學會雜誌，18(1)，1-11。

 1 糖尿病論質計酬效率的影響因素探討－以兩階段資料包絡法分析 2 民眾對於醫療品質資訊公開之適用與效果評估 3 影響日照服務機構經營績效之因素 4 台灣區域級醫院品質指標對經營績效之影響 5 高雄地區外籍女性配偶在台醫療服務利用情形與就醫滿意度之探討 6 台灣地區糖尿病合併心血管疾病患者醫療資源耗用 7 不同收入重大傷病病患其醫療利用是否相同-以全民健保資料庫為例 8 緊急救護技術員工作壓力、社會支持與專業承諾關係之研究：以臺北市專責救護隊為例 9 結直腸癌病人接受手術治療前後健康相關生活品質探討 10 緊急救護服務收費問題之研究－以臺中市為例 11 臺北市緊急救護收費之研究 12 台灣緊急救護系統之評估－以台北縣淡水分隊為例 13 我國到院前緊急救護之現況與各階段法律責任之探討 14 高屏地區病人安全工作推動與執行困境之探討 15 臺北市到院前緊急救護因應行為之研究

 簡易查詢 | 進階查詢 | 熱門排行 | 我的研究室