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研究生:趙憶婷
研究生(外文):CHAO, YI-TING
論文名稱:預測非計畫性再入院之模型建構與比較:以骨科為例
論文名稱(外文):The Comparisons among Different Models for the Prediction of the Unplanned Readmission: An Example of Orthopedic
指導教授:許碩芬許碩芬引用關係林兆欣林兆欣引用關係
指導教授(外文):HSU, SHUO-FENLIN, CHAO-HSIN
口試委員:許碩芬林兆欣陳建宏周百隆潘麗馡
口試委員(外文):HSU, SHUO-FENLIN, CHAO-HSINCHEN, CHIEN-HUNGCHOU, PAI-LUNGPAN, LI-FEI
口試日期:2020-07-15
學位類別:碩士
校院名稱:國立高雄科技大學
系所名稱:風險管理與保險系
學門:商業及管理學門
學類:風險管理學類
論文種類:學術論文
論文出版年:2020
畢業學年度:108
語文別:中文
論文頁數:106
中文關鍵詞:骨科病患非計畫性再入院LACE指數邏輯斯迴歸醫療品質
外文關鍵詞:Orthopaedic patientsUnplanned readmissionLACE indexLogistic RegressionQuality of health care
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目錄
摘 要 i
ABSTRACT ii
誌 謝 iii
目 錄 iv
表 目 錄 vi
圖 目 錄 vii
壹、緒論 1
一、研究背景與動機 1
二、研究目的 7
貳、文獻回顧 8
一、非計畫性再入院之相關因素探討 8
二、骨科之相關研究 16
三、LACE指數 26
四、查爾森共病指標 29
參、研究設計與方法 33
一、研究架構 33
二、研究對象 34
三、研究操作型定義 38
四、研究方法 42
五、實證模型 49
肆、實證分析 52
一、敘述性統計 52
二、疾病列表 55
三、t檢定與卡方檢定 58
四、LACE指數與臨界點之衡量 61
五、邏輯斯迴歸分析(Logistic Regression) 66
六、多元邏輯斯迴歸(Multinomial Logistic Regression) 78
伍、結論與建議 81
一、研究結論 81
二、研究建議 85
三、研究限制 85
參考文獻 86
一、中文文獻 86
二、英文文獻 90

表目錄
表2- 1 LACE對照表 28
表2- 2 查爾森共病對照表 31
表3- 1 第一型誤差、第二型誤差與ROC分類之關係 44
表3- 2 混淆矩陣(confusion matrix) 45
表3- 3 列聯表 47
表4- 1 敘述性統計表 54
表4- 2 骨科前5%疾病排名 57
表4- 3 t檢定與卡方檢定 60
表4- 4每個LACE分數的比率 61
表4- 5 LACE指數每個臨界點的敏感性、特異性和正確率 65
表4- 6 邏輯斯迴歸(模型一、模型二) 71
表4- 7 邏輯斯迴歸(模型三、模型四、模型五) 72
表4- 8 多元邏輯斯迴歸(模型四) 79

圖目錄
圖1-1 六十五歲老年人口占總人口數之百分比 2
圖1-2 NHE金額及占GDP比重 3
圖3-1 研究架構 33
圖3-2 資料歸戶流程圖 36
圖3-3 骨科篩選樣本圖 37
圖4- 1 骨科病患之查爾森共病17群分群 56
圖4- 2 ROC曲線 62
圖4- 3 模型一ROC曲線 75
圖4- 4 模型二ROC曲線 75
圖4- 5 模型三ROC曲線 76
圖4- 6 模型四ROC曲線 76
圖4- 7 模型五ROC曲線 77
一、中文文獻
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4.張政國,江季蓉,林玲玉,孫茂勝,吳盈瑩,2017, “驗證LACE 指數運用於各專科病人出院30 日內再住院或死亡風險評估適配度:以臺灣某醫學中心為例” 醫務管理期刊,第18卷,第4期,頁269-291。
5.謝生蘭,李金德,江秀珠,劉芹芳,2013, “經出院準備服務病人於14天非計畫性再住院之相關因素” 醫院,第46卷,第2期,頁34-44。
6.吳盈瑩,張政國,林玲玉,陳美如,江季蓉,孫茂勝,2018, “結合LACE、8P 工具及醫院整合醫學專科醫師介入創新制度降低出院後30 日內再住院率及照護費用:以某醫學中心為例” 醫務管理期刊,第19卷,第2期,頁79-98.
7.余桂霖,2012,多元迴歸分析,五南圖書出版股份有限公司,臺北市。
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9.張紹勳,2016,Stata與高等統計分析,五南圖書出版股份有限公司,臺北市。
10.張紹勳,2018,邏輯斯迴歸及離散選擇模型—應用STaTa統計,五南圖書出版股份有限公司,臺北市。
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20.衛生福利部中央健康保險署,2017,什麼是分級醫療?, https://www.nhi.gov.tw/Content_List.aspx?n=9E7392780F830646&topn=0B69A546F5DF84DC,查詢日期2020/4/6。
21.衛生福利部中央健康保險署,2017b,肌肉拉傷、關節扭傷、脫臼及骨折, https://www.nhi.gov.tw/Content_List.aspx?n=895A87E39BFE961F&topn=5FE8C9FEAE863B46,查詢日期2020/5/12。
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26.衛生福利部統計處,2018,107年度全民健康保險醫療統計年報, https://dep.mohw.gov.tw/DOS/np-4647-113.html,查詢日期2020/4/27。
27.衛生福利部統計處,2019,107年醫療機構現況及醫院醫療服務量-電子書, https://dep.mohw.gov.tw/DOS/cp-4487-49166-113.html,查詢日期2020/4/21。

二、英文文獻
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