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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 董鈺琪(Yu-Chi Tung) | |
| dc.contributor.author | Chen-I Wu | en |
| dc.contributor.author | 吳貞儀 | zh_TW |
| dc.date.accessioned | 2021-06-08T01:05:40Z | - |
| dc.date.copyright | 2014-10-20 | |
| dc.date.issued | 2014 | |
| dc.date.submitted | 2014-08-19 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18447 | - |
| dc.description.abstract | 研究背景：腦血管疾病為我國第三大主要死因。為提升腦中風患者之照護過程與結果，各國成立腦中風中心，並結合腦中風責任醫院計畫，朝區域化腦中風照護體系發展。台灣於2009年7月實施醫院緊急醫療能力分級制度，結合腦中風中心及責任醫院之概念，期望能達到改善腦中風患者之照護過程及結果之目標。目前，探討腦中風責任醫院計畫是否能有效提升腦中風患者照護過程及照護結果之研究並不多。
研究目的：探討醫院緊急醫療能力分級評定之實施，對於急性缺血性腦中風病患之照護過程與照護結果之影響。 研究方法：本研究使用全民健康保險研究資料庫2005年百萬承保抽樣歸人檔進行次級資料分析，以2006年至2011年急性缺血性腦中風病患為研究對象，利用廣義估計方程式(Generalized Estimating Equations, GEE)控制病患特性及醫院特性，探討醫院緊急醫療照護能力分級標準之實施對於急性缺血性腦中風病患照護過程與照護結果之影響。 研究結果：醫院緊急醫療能力分級標準實施後，全國血栓溶解劑之使用率增加之情形，達統計邊際顯著水準；CT/MRI檢查呈現上升趨勢，達統計上顯著差異。 研究結論：台灣醫院緊急醫療能力分級標準之實施，對於急性缺血性腦中風患者部份照護過程有改善的情形，但對於患者照護結果則未見顯著差異。 | zh_TW |
| dc.description.abstract | Backgrounds: Cerebrovascular disease is the third leading cause of death in Taiwan. To improve processes and outcomes of care in acute ischemic stroke patients, many countries have developed the acute stroke system toward the regionalization by establishing the stroke centers and implementing the stroke center designation project. The hierarchical system of emergent rescuer responsive hospitals which combines the concept of stroke center with responsive hospitals was implemented in Taiwan in July 2009. Recently, there is little research to analyze the effectiveness of the stroke center designation project in the processes and outcomes of care.
Objectives: The main purpose of this study is to evaluate the association of the implementation of the hierarchical system of emergent rescuer responsive hospitals with processes and outcomes of care for patients with acute ischemic stroke. Methods: A retrospective population-based study used claims data of 1 million sampled registry from Taiwan National Health Insurance Research Database. The study population were all patients admitted with acute ischemic stroke to each hospital from 2006 to 2011. Generalized Estimating Equations (GEE) were used to test the hypotheses, adjusting for the characteristics of patients and hospitals. Results: After implementing the hierarchical system of emergent rescuer responsive hospitals, the utilization of the recombinant tissue plasminogen activator (rt-PA) has increased and reached marginally significant. The utilization of CT/MRI has significantly increased after the implementation. Conclusions: Due to the implementation of the hierarchical system of emergent rescuer responsive hospitals, there are improvements in certain processes of care, but there is no improvement in outcomes of care for patients with acute ischemic stroke. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-08T01:05:40Z (GMT). No. of bitstreams: 1 ntu-103-R01848012-1.pdf: 5766131 bytes, checksum: f92f7602fef881780bb164fec7bc0124 (MD5) Previous issue date: 2014 | en |
| dc.description.tableofcontents | 目錄
口試委員審定書 i 中文摘要 ii Abstract iii 目錄 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 研究重要性 5 第二章 文獻探討 6 第一節 腦中風之介紹 6 第二節 國際腦中風照護體系之介紹 12 第三節 醫院緊急醫療能力分級制度之介紹 21 第四節 相關實證研究 26 第五節 小結 39 第三章 研究方法與設計 40 第一節 研究設計 40 第二節 研究假說 41 第三節 研究架構 42 第四節 資料來源 43 第五節 研究變項與操作型定義 44 第六節 資料處理流程 47 第七節 統計分析方法 48 第四章 研究結果 50 第一節 描述性統計 50 第二節 雙變項分析 57 第三節 多變項分析 70 第五章 討論 74 第一節 研究方法討論 74 第二節 研究結果討論 76 第三節 研究限制 82 第六章 結論與建議 83 第一節 結論 83 第二節 建議 84 參考文獻 86 附錄一 92 附錄二 97 | |
| dc.language.iso | zh-TW | |
| dc.title | 探討醫院緊急醫療能力分級標準之實施對於急性缺血性腦中風患者照護過程與照護結果之影響 | zh_TW |
| dc.title | Impact of implementing the hierarchical system of emergent rescuer responsive hospitals on processes and outcomes of care for patients with acute ischemic stroke | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 102-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 鄭守夏(Shou-Hsia Cheng),鄭建興(Jiann-Shing Jeng) | |
| dc.subject.keyword | 腦中風,醫院緊急醫療能力分級, | zh_TW |
| dc.subject.keyword | stroke,the hierarchical system of emergent rescuer responsive hospitals, | en |
| dc.relation.page | 98 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2014-08-20 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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