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研究生:呂昱成
研究生(外文):Lu, Yucheng
論文名稱:應用組合分數測量救護隊的急救品質
論文名稱(外文):Applying Composite Measures To EMS Care
指導教授:陳芬如陳芬如引用關係陳宗泰陳宗泰引用關係
指導教授(外文):Chen, FenjuChen, Tsungtai
口試委員:蔡尚學羅英瑛陳芬如陳宗泰
口試委員(外文):Tsai, ShangshyueLo, YingyingChen, FenjuChen, Tsungtai
口試日期:2012-05-28
學位類別:碩士
校院名稱:義守大學
系所名稱:醫務管理學系
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:2012
畢業學年度:100
語文別:中文
論文頁數:56
中文關鍵詞:品質救護隊組合分數指標到院前心跳功能停止
外文關鍵詞:QualityEmergency Medical ServicesComposite ScoreIndicatorsOut-Of-Hospital Cardiac Arrest
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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II
Abstract 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
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英文部份
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