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博碩士論文 etd-0718114-145351 詳細資訊
Title page for etd-0718114-145351
論文名稱
Title
小兒科急診之效益評估:全民健保資料庫研究
The Evaluation of Pediatric Emergency Treatment : a Nationwide Population-Based Cohort Study
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
68
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2014-06-09
繳交日期
Date of Submission
2014-08-18
關鍵字
Keywords
醫療資源、兒科醫師、急診、兒科、全民健康保險研究資料庫
Medical resources, Pediatricians, Emergency, Pediatrics, National Health Insurance Research Database
統計
Statistics
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中文摘要
「急診」為給予患者之緊急診治,以拯救生命、縮短病程,保留肢體或維持功能為目的。但小兒科急診在臨床症狀上有其獨特之處,如: 兒童藥物特殊用法與劑量,少數處方可能帶有風險,不能以成人疾病觀點視之,需由小兒科醫師進行專業診斷。目前國內小兒科醫師數目不足,多數由非小兒科醫師進行兒童急診病情之診斷。難免產生無法正確拿捏兒童病情之嚴重性或兼顧兒童身心發育與全身性評估,導致採取醫療資源使用不當。
由於兒童往往因年紀小無法明確陳述病情,加上幼兒病狀與成人不同,醫師對於幼兒病情之診斷與掌握較為困難,需受過專業兒科訓練之兒科醫師做更詳細診斷,加上幼兒體重及抵抗力低,各項診療、藥物使用量標準更加嚴格。在能獲得完全治癒之情況下,減少醫療資源濫用、降低醫療成本支出,甚至降低因醫療不當、病情判斷錯誤導致病情未獲控制而轉重入院之情形發生,是極為重要之醫療課題。
本研究評估兒科急診由小兒科醫師與非小兒科醫師看診造成之差異。研究樣本為臺灣全國人口為基礎之隊列研究,原始數據來自臺灣之全民健康保險研究資料庫(NHIRD)。追查1996-2004年資料庫內小兒科急診117,285件案例,分成由兒科醫師看診及非兒科醫師看診兩組,其中兒科醫師看診34,869例,非兒科醫師看診82,416例,比較兩群組於門診給藥天數(p< .001)、診療明細金額(p< .001)、合計金額(p< .001)、用藥明細金額(p< .05)與看診後三天內可能因病情轉重而入院治療等相關醫療資源花費:如住院天數(p< .005)、住院花費(p< .05)等資料,比較雙方於醫療資源花費上差異,兩者皆有統計上之差異。均顯示出由兒科醫師看診效益高於非兒科醫師,其做為小兒科急診需由小兒科醫師看診以減少醫療資源濫用、降低醫療成本支出及作為相關醫療人員訓練等依據,期能改善小兒科急診於醫療資源使用效益。
Abstract
"Emergency" provides the emergency diagnosis and treatment for patients, in order to save lives、shorten the courses、retain or maintain physical function. However, There was something unique about the clinical symptoms of pediatric emergency.Ex : special usage and dosage of medicines,some prescriptions may carry risks.It can not be depending on the viewpoint of adult disease, they need some professional diagnosis by a pediatrician.The number of pediatricians is not enough, most of situation is performed by the non-pediatrician,it prone to get misdiagnosis and lead to waste of medical resources.
Because children can not describe the condition clearly, there are different between children and adults,especially in diagnosis and control of the disease.Childern require doing more detailed diagnosis by pediatricians who has pediatric training,the amount of drug use has more stringent.
The thesis results are from a nationwide population-based cohort study assessing the evaluation of pediatric emergency treatment. The original data were derived from Taiwan’s National Health Insurance Research Database (NHIRD). To track 1996-2004 data .The cohort study comprised patients treated by pediatrician(group 1)or non-pediatrician(group 2) .117,285 pieces of pediatric emergency cases, including 34,869 cases of group 1, 82,416 cases of group 2. Outpatient fee(365.05±852.668 vs. 322.46±750.553, p< .001), drugs fee(129.4±1270.65 vs. 115.84±338.11, p< .05), outpatient total fee(906.31±1547.52 vs. 859.79±856.06, p< .001), hospital days(4.52±4.26 vs. 4.27±3.64, p< .01) and hospitalization charge(19616.23±90516.62 vs. 15575.6±49279.53, p< .01) significantly increased with visits by non-pediatrician. Pediatrician’s diagnosis is considerably more efficient than the other one.
目次 Table of Contents
論文審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
目錄 v
圖目錄 vii
表目錄 viii

第一章 簡介 1
1.1背景與目的 1
1.2全民健康保險研究資料庫 3
1.3國際疾病分類 6

第二章 相關研究 8
2.1兒科急診概述 8
2.2相關研究 8

第三章 研究方法 10
3.1資料來源 10
3.2研究設定 11
3.3研究變項 11
3.4研究架構 12
3.5資料處理及統計方法 14
3.5.1 描述性統計 14
3.5.2 獨立樣本T檢定 14
3.5.3 卡方檢定 14
3.5.4 95%信賴區間 15

第四章 實驗結果 17

第五章 討論 23

參考文獻 25

附錄 27
附錄1-1 門診處方及治療明細檔(適用85~92年) 27
附錄1-2 門診處方及治療明細檔(適用93後) 31
附錄1-3 門診處方醫令明細檔(適用86~9年) 35
附錄1-4 門診處方醫令明細檔(適用86~9年) 36
附錄1-5住院醫療費用清單明細檔(適用85~年) 38
附錄1-6 住院醫療費用清單明細檔(適用83~95年) 43
附錄1-7 住院醫療費用清單明細檔(適用96後) 48
附錄1-8 承保資料檔(適用98年前) 53
附錄1-9 承保資料檔(適用99年以後) 54
附錄1-10 醫事機構基本資料檔 55
附錄1-11 專科醫師證書主檔 57
附錄1-12醫事人員基本資料檔 58
參考文獻 References
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[2]胡鎮如,『台灣地區兒童急診醫療利用及其相關因素之研究』,2011。
[3]郭夢菲,『台大兒童醫院經營策略之探討』,國立臺灣大學商學組碩士論文,2007。
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[13]Hampers LC, Faries SG, "Practice variation in the emergency management of croup, " Pediatrics, pp.505-pp.508, 2002.
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[17]Powell EC, Hampers LC, "Physicians variation in test ordering in the management of gastroenteritis in children, " Arch Pediatr Adolesc Med, Vol.157, pp.978-pp.983, 2003.
[18]Harris N, Hostetler MA, "Parental expectations of care and charges in a tertiary care pediatric ED, " Am J Emerg Med, Vol.20, pp.601-pp.603, 2005.
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[21]王慧婷,“臨床實用統計學”,合記圖書出版社,2008。
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