跳到主要內容

臺灣博碩士論文加值系統

(44.210.83.132) 您好!臺灣時間:2024/05/27 02:51
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:林韶穎
研究生(外文):Lin, Shao-Ying
論文名稱:臺灣地區急診病患三天內重返急診及其相關因素分析
論文名稱(外文):The Analysis of Factors Associated with Revisits to Emergency Department within Three Days in Taiwan.
指導教授:陳楚杰陳楚杰引用關係
指導教授(外文):Chen, Chu-Chieh
口試委員:楊銘欽柯明中
口試日期:2014-06-09
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:健康事業管理研究所
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:2015
畢業學年度:103
語文別:中文
論文頁數:85
中文關鍵詞:急診三天內重返急診全民健康保險
外文關鍵詞:Emergency Department (ED)3-day ED revisitNational Health Insurance
相關次數:
  • 被引用被引用:4
  • 點閱點閱:495
  • 評分評分:
  • 下載下載:42
  • 收藏至我的研究室書目清單書目收藏:0
中文摘要

背景:急診返診是衡量個別醫師、急診照護組織及系統績效的重要品質指標,在急診就醫人次不斷成長的今日,部分病人在短時間內重複至急診就醫,不僅增加醫療資源的耗用,其中亦隱含許多病患錯誤的就醫認知及醫療品質的問題,然而,我國急診重返相關的研究數量並不多,且以全國人口為研究對象探討急診返診的研究非常有限。

目的:本研究首先探討臺灣地區2011年急診病患三天內重返急診及因相同疾病診斷類別重返急診的概況,其次,分析影響急診病患因相同疾病診斷類別三天內重返急診的相關因素。

方法:本研究使用國家衛生研究院發行的全民健康保險研究資料庫2010年百萬人抽樣歸人檔資料,利用SAS 9.3統計套裝軟體進行資料處理及統計分析,首先使用描述性統計描述臺灣地區2011年急診病患三天內重返急診的就醫資料;其次,以廣義估計方程式(Generalized Estimating Equations, GEE)探討影響急診病患因相同疾病診斷類別三天內重返急診以及重返不同醫院急診的相關因素。

結果:臺灣地區2011年首次急診就醫共241,435人次,急診就醫後三天內重返急診有15,531人次,三天內急診重返率為6.43%;而因相同疾病診斷類別三天內重返急診有9,475人次,重返率為3.92%,其中有4,045人次(42.69%)重返不同醫院急診。影響臺灣地區急診病患因相同疾病診斷類別三天內重返急診的因素有性別、年齡層別、疾病診斷類別、投保地區區域別以及病患就醫機構層級別。(1)在性別方面,相較於女性病患,男性病患的勝算比為1.17;(2)在年齡層別方面,相較於< 6歲,6-17歲的勝算比為1.39,18-64歲的勝算比為1.33;(3)在疾病診斷類別方面,相較於神經系統,外傷的勝算比(10.47)最高;(4)在投保地區區域別方面,相較於東部地區,北區的勝算比為1.33;(5)在病患就醫機構層級別方面,相較於醫學中心,區域醫院的勝算比為1.12。而影響臺灣地區急診病患因相同疾病診斷類別三天內重返不同醫院急診的因素有性別、年齡層別、檢傷分類級數、投保地區都市化程度、是否為低收入戶、病患就醫機構層級別及就醫機構權屬別。(1)在性別方面,相較於女性病患,男性病患的勝算比為1.21;(2)在年齡層別方面,相較於< 6歲,18-64歲的勝算比為1.41;(3)在檢傷分類級數方面,相較於檢傷分類第5級,檢傷分類第1級的勝算比為1.80,檢傷分類第2級的勝算比為1.85,檢傷分類第4級的勝算比為1.58;(4)在投保地區都市化程度方面,相較於鄉村,都市的勝算比為0.76;(5)在是否為低收入戶方面,相較於低收入戶,非低收入戶的勝算比為1.49;(6)在病患就醫機構層級別方面,相較於醫學中心,區域醫院的勝算比為0.60;(7)在病患就醫機構權屬別方面,相較於非公立醫院,公立醫院的勝算比為1.29。

結論:急診病患因相同疾病診斷類別三天內重返急診率為3.92%,有42.69%的急診病患重返不同醫院急診。影響急診病患因相同疾病診斷類別三天內重返急診的相關因素為性別、年齡層別、疾病診斷類別、檢傷分類級數、投保地區區域別、投保地區都市化程度、是否為低收入戶、病患就醫機構層級別及就醫機構權屬別。
Abstract

BACKGROUND:Return visit to emergency department (ED) is an important index to evaluate the performance of individual doctors and the whole care system of ED. The visits to ED increases in the recent decades, and some patients visit ED repeatedly in short term. It not only increases the waste of medical resources but also decreases the quality of medical services. It also indicates that most patients have wrong cognition of medical services. However, there are only a few of researches regarding return visits to ED, and the researches based on national population are much fewer in Taiwan.

OBJECTIVES:First of all, we discussed the situation that patients revisit ED within 3 days and with the same diagnosis in Taiwan in 2011. Besides, we analyzed the factors resulting in repeated visiting ED.

METHODS:Data will be obtained from theNational Health Insurance Research Database (NHIRD). The annual files of one million subjects randomly selected from all beneficiaries in year 2010 will be analyzed in this study.All statistic analysis was done with statistic software SAS 9.3. Firstly, we stated the data of return visits to ED within 3 days in Taiwan in 2011 by descriptive statistics. Furthermore, we discussed factors affecting return visits due to the same diagnosis categoryand revisiting different hospitals by Generalized Estimating Equations (GEE).

RESULT: In 2011,there were 241,435 person-times of first visit to ED and 15,531 person-times of return visit within 3 days in Taiwan. The 3-day ED revisit rate was 6.43%. Besides, there were 9,457 person-times of return visit due to the same diagnosiscategory, and the return visit rate is 3.92%. Of the 9,457 revisits, 4,045 (42.69%) werereturned to the ED of a different hospital.In adjusted analyses, revisit to ED with the same diagnostic categorywithin 3 days was associated with gender, age, diagnostic category, insuring region, and level of hospital.The important findings of this research as following: (1) Comparedtofemale,malewas associated with a higher rate of revisited to ED, adjusted OR 1.17.(2) Comparedto the age of <6 year-old, 6 to 17year-old and 18 to 64 year-old were associated with a higher rate of revisited to ED, adjusted OR 1.39 and 1.33.(3) Comparedtothe diagnostic category of neurological system, injurieswasassociated with thehighest rate of revisited to ED, adjusted OR 10.47. (4)Comparedtothe patients who live in the eastern region of Taiwan, patients who live in thenorthern region ofTaiwanwasassociated with a higher rate of revisited to ED, adjusted OR 1.33. (5) Comparedto the patients who visited to the ED of medical center, patients who visited to the ED of regional hospital was associated with a higher rate of revisited to ED, adjusted OR 1.12. Further analysis of data, revisit to ED of a different hospital with the same diagnostic categorywithin 3 days was associated with gender, age, level of emergency triage, level of urbanization of insuring region, low-income earner, level and type of hospital.The important findings of this research as following: (1) Comparedtofemale, male was associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.21. (2) Comparedto the age of <6 year-old, 18 to 64 year-old wasassociated with a higher rate of revisited to EDof a different hospital, adjusted OR 1.41. (3) Comparedto the patients with lever 5 of Taiwan triage and acuity scale (TTAS), the patients with lever 1 of TTAS, lever 2 of TTAS and lever 4 of TTAS were associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.80, 1.85 and 1.33. (4) Comparedto the patients who live in rural areas, patients who live in urban areas was associated with a lower rate of revisited to ED of a different hospital, adjusted OR 0.76. (5)Comparedto low-income earner, patients who were not low-income earner was associated with a higher rate of revisited to EDof a different hospital, adjusted OR 1.49. (6) Comparedto the patients who visited to the ED of medical center, patients who visited to the ED of regional hospital was associated with a lower rate of revisited to ED of a different hospital, adjusted OR0.60. (7) Comparedto the patients who visited to the ED of private hospital, patients who visited to the ED of public hospital was associated with a higher rate of revisited to ED of a different hospital, adjusted OR 1.29.

CONCLUSION:The 3-day ED revisit rate with the same diagnosiscategory was 3.92% , and there were 42.69% of them who returning tothe ED of a different hospitals.The factors associated with revisited to the ED with the same diagnostic categorywithin 3 days were as following: gender, age, diagnosis, level of emergency triage, insuring region, level of urbanization of insuring region, low-income earner, level and type of hospital.
目錄
致謝 I
中文摘要 II
英文摘要 IV
目錄 VII
表目錄 VIII
圖目錄 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的與研究問題 7
第三節 研究的重要性 8
第二章 文獻探討 9
第一節 急診醫療的定義 9
第二節 急診部門的功能 10
第三節 急診檢傷分類系統 11
第四節 急診醫療利用者的特質 12
第五節 病患重返急診的相關因素 15
第三章 研究方法 24
第一節 研究架構 24
第二節 研究對象 25
第三節 資料來源及處理 27
第四節 研究變項及其操作型定義 29
第五節 資料分析方法 33
第四章 研究結果 37
第一節 研究對象之急診就醫狀況 37
第二節 急診病患因相同疾病診斷類別三天內重返急診之情形及相關因素分析 41
第三節 急診病患因相同疾病診斷類別三天內重返不同醫院急診之情形及相關因素分析 47
第五章 討論與建議 54
第一節 研究結論 54
第二節 研究結果之討論 56
第三節 研究優點與限制 63
第四節 建議 66
參考文獻 68 

表目錄
表1 重返急診的相關實證研究之文獻整理 18
表2 2011年急診醫療利用概況表 26
表3 研究變項之操作型定義與屬性 30
表4 比較迴歸模式之膨脹係數 35
表5 2011年首次急診之就醫資料 39
表6 影響急診病患因相同疾病診斷類別三天內重返急診之相關因素分析 43
表7 影響急診病患因相同疾病診斷類別三天內重返不同醫院急診之相關因素分析 50

圖目錄
圖1 研究架構 25
圖2 研究對象篩選流程圖 26
圖3 重返急診之檔案間變項串檔 28


中文文獻
中華民國醫師公會全國聯合會(2014).2013年度統計資料.取自http://www.tma.tw/tma_stats_2013/2013_stats.pdf
李佳穎(2013).氣候因素對慢性呼吸道疾病醫療利用之影響(未發表之碩士論文).國立臺北護理健康大學,台北市,臺灣。
李松澤(2011).影響兒童急診醫療品質指標之研究(未發表之碩士論文).天主教輔仁大學,新北市,臺灣。
李孟智、張永福、呂碧鴻(1987).臺灣省立台北醫院急診病人的特性.中華民國公共衛生學會雜誌,6(3),74-82。
李麗惠、薛亞聖、楊長興(2006).周末假日就醫與治療結果之相關探討.臺灣公共衛生雜誌,25(2),107-114。
余陳瑋、張哲輔、柯朝元(2011).從延遲性外傷後腦出血探討輕度頭部外傷病人之處置.家庭醫學與基層醫療,26(10),423-428。
吳秋芬、吳肖琪、石富元、許銘能(2008).影響急診病患暫留時間之相關因素探討.臺灣公共衛生雜誌,27(6),507-518。
沈希哲、胡鎮如、李中一、柯明中、陳楚杰(2014).臺灣地區兒童急診醫療利用及其相關因素之研究.臺灣公共衛生雜誌,34(1),50-60。doi: 10.6288/TJPH201534103108
邱曉彥、陳麗琴、林琇珠、桑穎穎、康巧娟、邱艷芬(2008).臺灣急診檢傷新趨勢-五級檢傷分類系統.護理雜誌,55(3),87-91。
吳姿璇、謝碧晴、李中一、蘇慧芳(2013).健保居家照護使用者急診醫療利用.臺灣公共衛生雜誌,32(1),18-30。
林桂枝(2009).影響兒科急診病患72小時再返之相關因素-以2005-2007年北部某醫院為例(未發表之碩士論文).臺北醫學大學,台北市,臺灣。
林民浩、楊安琪、溫在弘(2011).利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則.臺灣公共衛生雜誌,30(4),347-361。
周歆凱、張怡秋、黃興進、蔡明足、翁林仲、蘇喜(2007).運用購物籃分析技術採討滯留急診超過24小時病患特性.醫務管理期刊,8(3),216-231。
周歆凱、黃興進、蔡明足、翁林仲、蘇喜、陳真吟(2009).運用資料探勘之叢雙分析技術探討急診72小時再返診病患特性.澄清醫護管理雜誌,5(3),13-20。
胡鎮如(2012).臺灣地區兒童急診醫療利用及其相關因素之研究(未發表之碩士論文).國立臺北護理健康大學,台北市,臺灣。
姜錦燁、王榮德(1987).台北巿十一家急救責任醫院急診室之使用適當性評估.中華民國公共衛生學會雜誌,6(3),56-73。
哈多吉、張菊惠、林文德(2008).急診病患流向分析研究-中央健康保險局委託研究報告.臺北:中華民國急救加護醫學會
胡勝川、顏鴻章、高偉峰(2001).東部某醫學中心急診之人口學及品質檢討.慈濟醫學雜誌,13(4),223-229。
范渚鑫、高偉峰、顏鴻章、王立敏、黃俊一、李建賢(2005).急診三日內再回診病患收住加護病房之探討.Journal of Taiwan Emergency Medicine, 7(1),8-19。
洪慈慧(2012).低收入戶急診醫療利用及其相關因素之研究(未發表之碩士論文).國立臺北護理健康大學,台北市,臺灣。
洪世昌、賴世偉、李亞欣、謝豐年、陳玉如、劉翎玲(2010).急診近期返診之探討:以南投市某地區醫院為例.中華民國急救加護醫學會雜誌,21(S),21-27。
財團法人醫院評鑑暨醫療品質策進會(2014).臺灣臨床成效指標:綜合照護指標執行手冊.臺北:財團法人醫院評鑑暨醫療品質策進會。
陳靜誼(2005).醫院規模與急診病患照護結果(未發表之碩士論文).國立陽明大學,台北市,臺灣。
陳世雄、胡百敏、廖浩欽、廖訓禎(2009).以全民健康保險研究資料庫之抽樣歸人檔資料分析急診病人就醫後流向.臺灣急診專科醫師期刊, 1(1),11-21。
張齡芝(2006).臺灣醫院急診於白天、傍晚及夜間醫療利用之分析(未發表之碩士論文).元智大學,中壢市,臺灣。
莊逸洲、黃崇哲(2005).醫院功能與管理—門診、急診、住院.台北:華杏。
梁亞文、蔡哲宏、陳文意(2011).非緊急急診病人特性及其相關因素探討.臺灣公共衛生雜誌,30(5),505-516。
黃妙鈴(1999).全民健康保險急診醫療利用之分析研究:兼論其對緊急醫療政策與管理之意涵(未發表之碩士論文).國立陽明大學,台北市,臺灣。
黃郁清、支伯生、鄭守夏(2010).照護連續性與醫療利用之相關性探討.臺灣公共衛生雜誌,29(1),46-53。
黃耀緯、游斯雯、簡戊鑑(2010).老年群體急診醫療利用與非計劃性返診之探討.臺灣老人保健學刊,6(2),158-167。
黃金安、賴其勛、胡哲生(2006).急診醫療服務與其它醫療服務之類別間關係.臺灣公共衛生雜誌,25(5),384-393。
黃金安、賴其勛、翁瑞宏、胡為雄、楊大羽(2004).病患非計畫性重返急診之因素分析-以病人觀點探討.Journal of Taiwan Emergency Medicine, 6(2),306-314。
曾柏昌、胡百敏、廖浩欽、黃紀倫、廖訓禎(2009).非特異性徵候症狀之急診病人初探:全民健康保險研究資料庫之抽樣歸人檔資料分析.臺灣急診專科醫師期刊,1(1),22-28。
楊正偉(2008).兒童急診醫療利用及品質之探討(未發表之碩士論文).國立陽明大學,台北市,臺灣。
詹雪娥(2008).總額預算制度對急診醫療資源利用及品質之影響(未發表之碩士論文).高雄醫學大學,高雄市,臺灣。
詹靜媛(2003).急診檢傷護理人員檢傷分類正確性與決策能力之相關性探討(未發表之碩士論文).國立台北護理學院,台北市,臺灣。
葉時烊、胡百敏、廖浩欽、林作彥、王少谷、廖訓禎(2010).急診病人三日內重返急診之分析:全民健康保險研究資料庫之抽樣歸人檔資料分析.臺灣急診專科醫師期刊,2(1),6-13。
鄭生芳(2008).臺灣地區急診(高)使用者就醫頻率及趨勢分析(未發表之碩士論文).高雄醫學大學,高雄市,臺灣。
廖晏辰、胡百敏、廖浩欽、林作彥、葉美枝(2010).以全民健康保險研究資料庫之承保抽樣歸人檔分析急診就醫後死亡之病人.臺灣急診專科醫師期刊,2(2),39-47。
衛生福利部(2008).新急診五級檢傷分類標準實施讓緊急醫療資源妥善運用.取自http://www.mohw.gov.tw/cht/Ministry/DM2_P.aspx?f_list_no=7&fod_list_no=4473&doc_no=38090
衛生福利部中央健康保險署(2013a).2013-2014年全民健康保險年報.臺北:衛生福利部中央健康保險署。
衛生福利部中央健康保險署(2013b).101年7月至12月急診壅塞率及急診處置效率相關指標執行情形.取自http://www.nhi.gov.tw/Resource/webdata/24281_1_101年7月至12月急診壅塞率及急診處置效率相關指標執行情形.pdf
衛生福利部中央健康保險署(2015a).103年12月份全民健康保險業務執行報告.取自http://www.nhi.gov.tw/Resource/webdata/27819_1_1040126全民健康保險會2屆104年第1次委員會議-103年12月份全民健康保險業務執行報告.pdf
衛生福利部中央健康保險署(2015b).全民健康保險醫療服務給付項目及支付標準.取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=20&menu_id=710&webdata_id=3633
衛生福利部中央健康保險署(2015c).全民健康保險醫療品質之醫院總額指標.取自http://www.nhi.gov.tw/AmountInfoWeb/iDesc.aspx?rtype=2&Q5C2_ID=1078
衛生福利部中央健康保險署(2015d).全台各鄉鎮(區)醫療院所數統計圖.取自http://www.nhi.gov.tw/webdata/webdata.aspx?menu=18&menu_id=683&webdata_id=3552
衛生福利部統計處(2014a).87年度全民健康保險醫療統計年報.取自 http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=2536
衛生福利部統計處(2014b).101年度全民健康保險醫療統計年報.取自 http://www.mohw.gov.tw/cht/DOS/Statistic.aspx?f_list_no=312&fod_list_no=4724
劉彦芳(2011).探討急診病人非計畫性返診之重要影響因素(未發表之碩士論文).中國醫藥大學,台中市,臺灣。
劉詩婷(2010).臺灣醫院數分佈對於急診可近性之影響:長期資料分析(未發表之碩士論文).國立臺灣大學,台北,臺灣。
賴春輯(2005).臺灣地區急診利用與重返急診病患資源耗用分析(未發表之碩士論文).國立臺灣大學,台北市,臺灣。

英文部份
Alpern, E. R., Clark, A. E., Alessandrini, E. A., Gorelick, Kittick, M., Stanley, R. M., et al. (2014). Recurrent and high-frequency use of the emergency department by pediatric patients.Academic Emergency Medicine, 21(4), 365-373. doi: 10.1111/acem.12347
American College of Emergency Physicians (2008).Definition of emergency medicine, Retrieved from http://www.acep.org/content.aspx?id=29164&terms=definition%20of%20Emergency%20medicine
Anderson, M., Dobkin, C., & Gross, T. (2012).The effect of health insurance coverage on the use of Medical services.American Economic Journal: Economic Policy, 4(1), 1-27. doi: http://dx.doi.org/10.1257/pol.4.1.1
Baumgartner, E. A., Belson, M., Rubin, C., & Patel, M. (2008). Hypothermia and other cold-related morbidity emergency department visits: United States, 1995-2004. Wilderness and Environmental Medicine, 19(4), 233-237.
Ben-Isaac, E., Schrager, S. M., Keefer, M., & Chen, A. Y. (2010). National profile of nonemergent pediatric emergency department visits. Pediartics, 125(3), 454-459. doi: 10.1542/peds.2009-0544
Bernstein, S. L., Aronsky, D., Duseja, R., Epstein, S., Handel, D., Hwang, U., ...& Asplin, B. R. (2009). The effect of emergency department crowding on clinically oriented outcomes. Academic Emergency Medicine, 16(1), 1-10. doi: 10.1111/j.1553-2712.2008.00295.x
Berry, A., Brousseau, D., Brotanek, J. M., Tomany-Korman, S., & Flores, G. (2008). Why do parents bring children to the emergency department for nonurgent conditions? A qualitative study.Ambulatory Pediatrics, 8(6), 360-367.
Blom, M. C., Jonsson, F., Landin-Olsson, M., & Ivarsson, K. (2014). Associations between in-hospital bed occupancy and unplanned 72-h revisits to the emergency department: A register study. International Journal of Emergency Medicine, 7(1), 25.doi: 10.1186/s12245-014-0025-4
Brousseau, D. C., Gorelick, M. H., Hoffmann, R. G., Flores, G., & Nattinger, A. B. (2009). Primary care quality and subsequent emergency department utilization for children in Wisconsin Medicaid.Academic Pediatrics, 9(1), 33-39. doi: 10.1016/j.acap.2008.11.004
Brown, E. M., & Goel, V. (1994). Factors related to emergency department use: Results from the Ontario health survey, 1990. Annals of Emergency Medicine, 24(6), 1083-1091. doi: 10.1016/S0196-0644(94)70237-3
Buesching, D. P., Jablonowski, A., Vesta, E., Dilts, W., Runge, C., Lund, J., & Porter, R. (1985). Inappropriate emergency department visits. Annals of Emergency Medicine, 14(7), 672-676. doi: 10.1016/S0196-0644(85)80886-6
Burt, C. W., & McCaig, L. F. (2006).Staffing, capacity, and ambulance diversion in emergency departments: United States, 2003-2004. Advance data from vital and health statistics: no 376. Hyattsville, MD: National Center for Health Statistics.
Callahan, S. T., & Cooper, W. O. (2010).Changes in ambulatory health care use during the transition to young adulthood.Journal of Adolescent Health, 46(5), 407-413. doi:10.1016/j.jadohealth.2009.09.010
Castillo, E. M., Brennan, J. J., Killeen, J. P., & Chan, T. C. (2014).Identifying frequent users of emergency department resources.The Journal of Emergency Medicine, 47(3), 343-347. doi: 10.1016/j.jemermed.2014.03.014
Chua, K. P., Schuster, M. A., & McWilliams, J. M. (2013). Differences in health care access and utilization between adolescents and young adults with asthma. Pediatrics, 131(5), 892-901. doi:10.1542/peds.2012-2881
Cowan, R. M., & Trzeciak, S. (2004). Clinical review: Emergency department overcrowding and the potential impact on the critically ill. Critical Care, 9(3), 291.doi: 10.1186/cc2981
Derlet, R. W., &Richards, J. R. (2000).Overcrowding in the Nation’s Emergency Departments: Complex Causes and Disturbing Effects.Annals of Emrgency Medicine, 35(1), 63-68.
Ding, R., McCarthy, M. L., Li, G., Kirsch, T. D., Jung, J. J. & Kelen, G. D. (2006). Patients who leave without being seen: Their characteristics and history of emergency department use. Annals of Emergency Medicine, 48(6), 686-693. doi:10.1016/j.annemergmed.2006.05.022
Drummond, A. J. (2002). No room at the inn: Overcrowding in Ontario’s emergency departments. Canadian Journal of Emergency Medicine, 4(2), 91-97.
Fagenholz, P. J., Sheridan, R. L., Harris, N. S., Pelletier, A. J., & Camargo, C. A. (2007). National study of emergency department visits for burn Injuries, 1993 to 2004. Journal of Burn Care and Research, 28(5), 681-690.
Foran, A., Wuerth-Sarvis, B., & Milne, W. K. (2010).Bounce-back visits in a rural emergency department. Canadian Journal of Rural Medicine, 15(3), 108-112.
Fox, R. A. (1998). Atypical presentation of geriatric infections.Geriatrics, 43(5), 58-68.
Gambert, S.R., &Escher, J. E.(1988). Atypical presentation of endocrine disorders in the elderly.Geriatrics, 43(7), 69-78.
Garcia, T. C., Bernstein, A. B., & Bush, M. A. (2010). Emergency department visitors and visits: Who used the emergency room in 2007? National Center for Health Statistics Data Brief, 38(38), 1-8.
Gardner, R. L., Sarkar, U., Maselli, J. H. & Gonzales, R. (2007). Factors associated with longer ED lengths of stay. American Journal of Emergency Medicine, 25(6), 643-650. doi: 10.1016/j.ajem.2006.11.037
Gordon, J. A., An, L. C., Hayward, R. A., & Williams, B.C. (1998). Initial emergency department diagnosis and return visits: risk versus perception. Annals of Emergency Medicine, 32(5), 569-73.doi: 10.1016/S0196-0644(98)70034-4
Gruneir, A., Bell, C. M., Bronskill, S. E., Scbull, M., Anderson, G. M., & Rocbon, P. (2010). Frequency and pattern of emergency department visits by long-term care residents: A population-based study. Journal of American Geriatrics Society, 58(3), 510-517. doi: 10.1111/j.1532-5415.2010.02736.x
Gupta, K. L., Dworkin, B., & Gambert, S.R.(1988). Common nutritional disorders in the elderly: atypical manifestations. Geriatrics, 43(2), 87-97.
Hirshon, J. M., Weiss, S. R., Locasale, R., Levine, E., & Blaisdell, C. J. (2006).Looking beyond urban/rural differences: Emergency department utilization by asthmatic children.Journal of Asthma, 43(4), 301-306. doi: 10.1080/02770900600623255
Holliman, J. (2004). What is emergency care? Prague Medical Report, 105(1), 5-12.
Hsia, R. Y., Macisaac, D., Palm, E., & Baker, L. C. (2008).Trends in charges and payments for nonhospitalized emergency department pediatric visits, 1996-2003.Academic Emergency Medicine, 15(4), 347-354. doi: 10.1111/j.1553-2712.2008.00075.x
Hu, K. W., Lu, Y. H., Lin, H. J., Guo, H. R., & Foo, N. P. (2012). Unscheduled return visits with and without admission post emergency department discharge. The Journal of Emergency Medicine, 43(6), 1110-1118. doi:10.1016/j.jemermed.2012.01.062
Hu, S. C. (1992). Analysis of patients revisits to the emergency department. American Journal of Emergency Medicine, 10(4), 366-70.doi: 10.1016/0735-6757(92)90022-P
Huang, J. A., Hu, W. H., Yang, D. Y., Weng, R. H., & Tsai, W. C. (2003). Analysis of emergency department utilization by elderly patients under National Health Insurance.The Kaohsiung Journal of Medical Sciences, 19(3), 113-120. doi: 10.1016/S1607-551X(09)70458-9
Huang, Y. C., & Chen, M. H. (2007).Characteristics of the very frequent user of the emergency department.Journal of Emergency Medicine, Taiwan, 9(4), 93-100.
Hunt, K. A., Weber, E. J., Showstack, J. A., Colby, D. C. & Callaham, M. L. (2006). Characteristics of frequent users of emergency departments.Annals of Emergency Medicine, 48(1), 1-8. doi: 10.1016/j.annemergmed.2005.12.030
Institute of Medicine. (2006). Hospital-based emergency care: At the breaking point. Washington, DC: National Academies Press.
International Federation of Emergency Medicine.(n.d.).IFEM definition of emergency medicine. Retrieved from http://www.ifem.cc/About_IFEM.aspx
Jee, S. H., Antonucci, T. C., Aida, M., Szilagyi, M. A., & Szilagyi, P. G. (2005). Emergency department utilization by children in foster care.Ambulatory Pediatrics, 5(2), 102-106.
Kelly, A. M., Chirnside, A. M., & Curry, C. H. (1993). An analysis of unscheduled return visits to an urban emergency department. New Zealand Medical Journal. 106(961), 334-336.
Keith, K. D., Bocka, J. J., Kobernick, M. S., Krome, R. L., & Ross, M. A. (1989). Emergency department revisits. Annals of Emergency Medicine, 18(9), 964-968.
Kroner, E. L., Hoffmann, R. g., & Brousseau, D. C. (2010). Emergency department reliance: A discriminatory measure of frequent emergency department users. Pediartics, 125(1), 133-138. doi: 10.1542/peds.2009-0960
Kuan, W. S., & Mahadevan, M. (2009). Emergency unscheduled returns: Can we do better? Singapore Medical Journal, 50(11), 1068-71.
LaCalle, E., & Rabin, E. (2010). Frequent users of emergency departments: The myths, the data, and the policy implications. Annals of emergency medicine,56(1), 42-48. doi: 10.1016/j.jemermed.2010.01.032
Larkin, G. L., & Claassen, C. (2007).Trends in emergency department use of gastric lavage for poisoning events in the United States, 1993-2003.Clinical Toxicology, 45(2), 164-168. doi: 10.1080/15563650601155038
Larkin, G. L., Smith, R. P., & Beautrais, A. L. (2008). Trends in US emergency department visits for suicide attempts, 1992-2001. The Journal of Crisis Intervention and Suicide Prevention, 29(2), 73-80. doi: org/10.1027/0227-5910.29.2.73
Lambe, S., Washington, D. L., Fink, A., Herbst, K., Liu, H., Fosse, J. S., & Asch, S. M. (2002). Trends in the use and capacity of California's emergency departments, 1990-1999. Annals of Emergency Medicine, 39(4), 389-396. doi: 10.1067/mem.2002.122433
Lerman, B., & Kobernick, M. S. (1987). Return visits to the emergency department. The Journal of Emergency Medicine, 5(5), 359-62.doi: 10.1016/0736-4679(87)90138-7
Li, G., Lau, J. T., McCarthy, M. L., Schull, M. J., Vermeulen, M., & Kelen, G. D. (2007).Emergency department utilization in the United States and Ontario, Canada.Academic Emergency Medicine, 14(6), 582-584. doi: 10.1197/j.aem.2007.02.030
Liaw, S. J., Bullard, M. J., Hu, P. M., Chen, J. C., & Liao, H. C. (1999).Rates and causes of emergency department revisits within 72 hours.Journal of the Formosan Medical Association, 98(6), 422-425.
Loke, S. S., Liaw, S. J., Tiong, L. K., Ling, T. S., & Chiang, W. T. (2002).Evaluation of nurse-physician inter-observer agreement on triage categorization in the emergency department of a Taiwan medical center.Chang Gung Medical Journal, 25(7), 446-452.
Lowthian, J. A.,& Cameron, P. A. (2009). Emergency demand access block and patient safety: A call for national leadership. Emergency Medicine Australasia, 21(6), 435-9.doi: 10.1111/j.1742-6723.2009.01226.x
Lowthian, J. A., Curtis, A. J., Cameron, P. A., Stoelwinder, J. U., Cooke, M. W., & McNeil, J. J. (2011). Systematic review of trends in emergency department attendances: An Australian perspective. Emergency Medicine Journal, 28(5), 373-377. doi: 10.1136/emj.2010.099226. Epub 2010 Oct 20
Lucas, R., Farley, H., Twanmoh, J., Urumov, A., Olsen, N., Evans, B., & Kabiri, H. (2009). Emergency department patient flow: The influence of hospital census variables on emergency department length of stay. Academic Emergency Medicine, 16(7), 597-602. doi: 10.1111/j.1553-2712.2009.00397.x
Ludwick, A., Fu, R., Warden, C., & Lowe, R. A. (2009). Distances to emergency department and to primary care provider’s office affect emergency department use in children. Academic Emergency Medicine, 16(5), 411-417. doi: 10.1111/j.1553-2712.2009.00395.x
McCaig, L. F., &Nawar, E. W. (2006).National hospital ambulatory medical care survey: 2004 emergency department summary. National health statistics reports: no 372. Hyattsville, MD: National Center for Health Statistics.
McCusker, J., Cardin, S., Bellavance, F., & Belzile, E. (2000). Return to the emergency department among elders: Patterns and predictors. Academic Emergency Medicine, 7(3), 249-259.
Moore, G., Gerdtz, M., Manias, E., Hepworth, G., & Dent, A. (2007). Socio-demographic and clinical characteristics of re-presentation to an Australian inner-city emergency department: Implications for service delivery. BioMed Central Public Health, 7, 320.doi: 10.1186/1471-2458-7-320
Mustard, C. A., Kozyrskyj, A. L., Barer, M. L., & Sheps, S. (1998). Emergency department use as a component of total ambulatory care: A population perspective. Canadian Medical Association Journal, 158(1), 49-55.
Nawar, E. W., Niska, R. W., & Xu, J. (2007).National hospital ambulatory medical care survey: 2005 emergency department summary. National health statistics reports: no 386. Hyattsville, MD: National Center for Health Statistics.
Niska, R., Bhuiya, F., & Xu, J. (2010).National hospital ambulatory medical care survey: 2007 emergency department summary. National Health Statistics Reports: No 26. Hyattsville, MD: National Center for Health Statistics.
O’Dell, C. (1988). Atypical presentations of neurological illness in the elderly.Geriatrics, 43(1), 35-37.
O’Dwyer, F., & Bodiwala, G. G. (1991). Unscheduled return visits by patients to the accident and emergency department. Archives of emergency medicine, 8(3), 196-200.doi: 10.1136/emj.8.3.196
Owens, P. L., Zodet, M. W., Berdahl, T., Dougherty, D., McCormick, M. C., & Simpson, L. A. (2008). Annual report on health care for children and youth in the United States: Focus on injury-related emergency department utilization and expenditures. Ambulatory Pediatrics, 8(4), 219-240.
Pierce, J. M., Kellerman, A. L., & Oster, C. (1990). “Bounces”: an analysis of short-term return visits to a public hospital emergency department. Annals of Emergency Medicine, 19(7), 752-757. doi:10.1016/S0196-0644(05)81698-1
Pitts, S. R., Niska, R. W., Xu, J., & Burt, C. W. (2008).National hospital ambulatory medical care survey: 2006 emergency department summary. National health statistics reports: no 7. Hyattsville, MD: National Center for Health Statistics.
Richards, J. R., Navarro, M. L., & Derlet, R. W. (2000).Sruvey of directors of emergency departments in California on overcrowding.The Western Journal of Medicine, 172(6), 385-388.
Richardson, D. B., &Mountain, D. (2009). Myths versus facts in emergency department overcrowding and hospital access block. Medical Journal of Australia, 190(7), 369-74.
Rosychuk, R. J., Voaklander, D. C., Klassen, T. P., Senthilselvan, A., Marrie, T. J., & Rowe, B. H. (2010). A population-based study of emergency department presentations for asthma in regions of Alberta.Canadian Journal of Emergency Medicine, 12(4), 339-346.
Russi, C. S., & Hamilton, G. C. (2005).A case for emergency medicine in the undergraduate medical school curriculum.Academic Emergency Medicine, 12(10), 994-998. doi: 10.1197/j.aem.2005.05.028
Schneider, S. M., Hamilton, G. C., Moyer, P., & Stapczynski, J. S. (1998).Definition of emergency medicine.Academic Emergency Medicine, 5(4), 348-351. doi: 10.1111/j.1553-2712.1998.tb02720.x
Schull, M. J., Morrison, L. J., Vermeulen, M., & Redelmeier, D. A. (2003). Emergency department overcrowding and ambulance transport delays for patients with chest pain. Canadian Medical Association Journal, 168(3), 277-283.
Schull, M. J., Slaughter, P. M., & Redelmeier, D. A. (2002). Urban emergency department overcrowding: Defining the problem and eliminating misconceptions. Canadian Journal of Emergency Medicine, 4(2), 76-83.
Schull, M. J., Szalai, J. P., Schwartz, B., & Redelmeier, D. A. (2001). Emergency department overcrowding following systematic hospital restructuring: Trends at twenty hospitals over ten years. Academic Emergency Medicine, 8(11), 1037-1043.
Schull, M. J., Vermeulen, M., Slaughter, G., Morrison, L., & Daly, P. (2004).Emergency department crowding and thrombolysis delays in acute myocardial infarction. Annals of Emergency Medicine, 44(6), 577-585. doi: 10.1016/j.annemergmed.2004.05.004
Schull, M. J., Vermeulen, M. J., & Stukel, T. A. (2006). The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume. Annals of Emergency Medicine, 48(6), 647-655. doi: 10.1016/j.annemergmed.2006.03.025
Shah, M. N., Cushman, J. T., Davis, C. O., Bazarian, J. J., Auinger, P., & Friedman, B. (2008). The epidemiology of emergency medical services use by children: An analysis of the national hospital ambulatory medical care survey. Prehospital Emergency Care, 12(3), 269-276. doi: 10.1080/10903120802100167
Sharma, V., Simon, S. D., Bakewell, J. M., Ellerbeck, E. F., Fox, M. H., & Wallace, D. D. (2000).Factors influencing infant visits to emergency departments.Pediatrics, 106(5), 1031-1039.
Shen, Y. C., & Hsia, R. Y. (2010).Changes in emergency department access between 2001 and 2005 among general and vulnerable populations.American Journal of Public Health, 100(8), 1462-1469. doi: 10.2105/AJPH.2009.175828
Skarbek-Borowska, S., Amanullah, S., Mello, M. J., & Linakis, J. G. (2006). Emergency department visits for sledding injuries in children in the United States in 2001/2002. Academic Emergency Medicine, 13(2), 181-185. doi: 10.1197/j.aem.2005.09.009
Suruda, A., Burns, T. J., Knight, S., & Dean, J. M. (2005). Health insurance, neighborhood income, anHd emergency department usage by Utah children 1996-1998.BioMed Central Health Services Research, 5, 29-34. doi:10.1186/1472-6963-5-29
Tang, N., Stein, J., Hsia, R. Y., Maselli, J. H., & Gonzales, R. (2010). Trends and characteristics of US emergency department visits, 1997-2007. Journal of American Medical Association, 304(6), 664-670. doi: 10.1001/jama.2010.1112
Timm, N. L., Ho, M. L., & Luria, J. W. (2008). Pediatric emergency department overcrowding and impact on patient flow outcomes. Academic Emergency Medicine, 15(9), 832-837. doi: 10.1111/j.1553-2712.2008.00224.x
Tresch, D. D. (1987). Atypical presentations of cardiovascular disorders in the elderly.Geriatrics, 42(10), 31-46.
Trivedy, C. R., & Cooke, M. W. (2013). Unscheduled return visits (URV) in adults to the emergency department (ED): A rapid evidence assessment policy review. Emergency Medicine Journal, Emermed-2013.doi: 10.1136/emermed-2013-202719
Trzeciak, S., & Rivers, E. P. (2003). Emergency department overcrowding in the United States: An emerging threat to patient safety and public health. Emergency Medicine Journal, 20(5), 402-405. doi: 10.1136/emj.20.5.402
van der Linden, M. C., Lindeboom, R., de Haan, R., van der Linden, N., de Deckere, E. R., Lucas, C., … Goslings, J. C. (2014). Unscheduled return visits to a Dutch inner-city emergency department. International Journal of Emergency Medicin.doi: 10.1186/s12245-014-0023-6.
Verelst, S., Pierloot, S., Desruelles, D., Gillet, J. B., & Bergs, J. (2014). Short-term unscheduled return visits of adult patients to the emergency department. The Journal of Emergency Medicine, 47(2), 131-139. doi: 10.1016/j.jemermed.2014.01.016.
Wajnberg, A., Hwang, U., Torres, L., & Yang, S. (2012). Characteristics of frequent geriatric users of an urban.The Journal of Emergency Medicine, 43(2), 376-381. doi: 10.1016/j.jemermed.2011.06.056
Wang, H. Y., Chew, G., Kung, C. T., Chung, K. J., & Lee, W. H. (2007).The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours.Chang Gung Medical Journal, 30(5), 437-444.
Williams, R. M. (1996). The costs of visits to emergency departments.The New England Jouranl of Medicine, 334(10), 642-646. doi: 10.1056/NEJM199603073341007
Wong, H. J., Morra, D., Caesar, M., Carter, M. W., & Abrams, H. (2010). Understanding hospital and emergency department congestion: An examination of impatient admission trends and bed resources. Canadian Journal of Emergency Medicine, 12(1), 18-26.
Wong, T. W., & Lam, K. W. (1994).Reattendance audit in an inner-city emergency department.Journal of Accident & Emergency Medicine, 11(4), 213-217. doi: 10.1136/emj.11.4.213
Wood, T. C. A., & Cliff, K. S. (1986).Accident and emergency department-why people attend with minor injuries and aliments.Public Health, 100(1), 15–20. doi: 10.1016/S0033-3506(86)80081-6
Wu, C. L., Wang F. T., Chiang Y. C., Chiu, Y. F., Lin, T. G., Fu, L. F., & Tsai, T. L. (2010). Unplanned emergency department revisits within 72 hours to a secondary teaching referral hospital in Taiwan.The Journal of Emergency Medicine, 38(4), 512-517. doi: 10.1016/j.jemermed.2008.03.039
Xu, K. T., Nelson, B. K., & Berk, S. (2009). The changing profile of patients who used emergency department services in the United States: 1996 to 2005. Annals of Emergency Medicine, 54(6), 805-810.
Yen, Z. S., Shih, F. Y., Tsai, K. C., Chen, S. C., & Chen, W. J. (2003). Revisits to the emergency department: analysis of risk factors and reasons. Journal of Emergency and Critical Care Medicine, 14(3), 93-98.
Zuckerman, S., & Shen, Y. C. (2004). Characteristics of occasional and frequent emergency department users: Do insurance coverage and access to care matter? Medical care,42(2), 176-182. doi: 10.1097/01.mlr.0000108747.51198.41
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
1. 李孟智、張永福、呂碧鴻(1987).臺灣省立台北醫院急診病人的特性.中華民國公共衛生學會雜誌,6(3),74-82。
2. 李麗惠、薛亞聖、楊長興(2006).周末假日就醫與治療結果之相關探討.臺灣公共衛生雜誌,25(2),107-114。
3. 余陳瑋、張哲輔、柯朝元(2011).從延遲性外傷後腦出血探討輕度頭部外傷病人之處置.家庭醫學與基層醫療,26(10),423-428。
4. 吳秋芬、吳肖琪、石富元、許銘能(2008).影響急診病患暫留時間之相關因素探討.臺灣公共衛生雜誌,27(6),507-518。
5. 沈希哲、胡鎮如、李中一、柯明中、陳楚杰(2014).臺灣地區兒童急診醫療利用及其相關因素之研究.臺灣公共衛生雜誌,34(1),50-60。doi: 10.6288/TJPH201534103108
6. 吳姿璇、謝碧晴、李中一、蘇慧芳(2013).健保居家照護使用者急診醫療利用.臺灣公共衛生雜誌,32(1),18-30。
7. 林民浩、楊安琪、溫在弘(2011).利用地區差異與人口學特徵評估全民健保資料庫人口居住地變項之推估原則.臺灣公共衛生雜誌,30(4),347-361。
8. 周歆凱、張怡秋、黃興進、蔡明足、翁林仲、蘇喜(2007).運用購物籃分析技術採討滯留急診超過24小時病患特性.醫務管理期刊,8(3),216-231。
9. 周歆凱、黃興進、蔡明足、翁林仲、蘇喜、陳真吟(2009).運用資料探勘之叢雙分析技術探討急診72小時再返診病患特性.澄清醫護管理雜誌,5(3),13-20。
10. 姜錦燁、王榮德(1987).台北巿十一家急救責任醫院急診室之使用適當性評估.中華民國公共衛生學會雜誌,6(3),56-73。
11. 胡勝川、顏鴻章、高偉峰(2001).東部某醫學中心急診之人口學及品質檢討.慈濟醫學雜誌,13(4),223-229。
12. 洪世昌、賴世偉、李亞欣、謝豐年、陳玉如、劉翎玲(2010).急診近期返診之探討:以南投市某地區醫院為例.中華民國急救加護醫學會雜誌,21(S),21-27。
13. 陳世雄、胡百敏、廖浩欽、廖訓禎(2009).以全民健康保險研究資料庫之抽樣歸人檔資料分析急診病人就醫後流向.臺灣急診專科醫師期刊, 1(1),11-21。
14. 梁亞文、蔡哲宏、陳文意(2011).非緊急急診病人特性及其相關因素探討.臺灣公共衛生雜誌,30(5),505-516。
15. 黃郁清、支伯生、鄭守夏(2010).照護連續性與醫療利用之相關性探討.臺灣公共衛生雜誌,29(1),46-53。