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標題: | 臺灣重度級與中度級急救責任醫院之空間可近性分析 Spatial Analysis on Accessibility to Advanced Emergency Responsibility Hospitals and Intermediate Emergency Responsibility Hospitals in Taiwan |
作者: | Yu-Syun Hung 洪鈺珣 |
指導教授: | 董鈺琪(Yu-Chi Tung) |
關鍵字: | 緊急醫療資源,可近性,空間分析,羅倫茲曲線,吉尼係數, emergency medical resources,accessibility,spatial analysis,Lorenz curve,Gini coefficient, |
出版年 : | 2020 |
學位: | 碩士 |
摘要: | 研究背景:建立起系統性提供急重症治療的區域化照護服務,被廣泛認為是能夠提升照護品質的有效策略,台灣於2009年實施醫院緊急醫療能力分級制度,依據醫院之緊急醫療處理能力進行分級,期望透過區域化提供照護服務的方式,使急重症之病人獲得適當、即時之服務,而透過地理資訊系統進行空間分析,將能夠了解急重症醫院在黃金搶救時間內之可近性,但目前此類型的研究並不多。
研究目的:本研究從空間分佈觀點,探討台灣重度級和中度級急救責任醫院在15公里、30公里的服務範圍,並針對重度級和中度級急救責任醫院提供之四項服務項目:緊急外傷醫療、高危險妊娠、急性腦中風、急性冠心症,計算台灣各次醫療區中不同急重症之潛在需求者,未能獲得重度級與中度級急救責任醫院醫療服務之人口比例,最後,運用吉尼係數與羅倫茲曲線,探討各次醫療區之不同急重症的醫療資源分佈狀況。 研究方法:本研究以ArcGIS的ArcMap第10.4版進行路網分析(Network Analyst)中之服務範圍分析(Service Area Analysis)和起點-終點矩陣(Origin-Destination Matrix)進行製圖和計算,並且以計算吉尼係數和繪製羅倫茲曲線的方式,對各次醫療區之醫療資源分佈進行評估。 研究結果:整體而言,玉里、成功、恆春、鳳林這四個次醫療區的急重症醫療資源可近性較差,在各次醫療區中,全體人口對外科醫師、育齡婦女對婦產科醫師、老年人口對神經外科醫師、老年人口對內科醫師的吉尼係數分別為:0.268、 0.25、0.369、0.233,且從羅倫茲曲線中可以觀察到,有3.4%的老年人口沒有神經外科醫師之醫療資源。 研究結論:台灣當前的緊急醫療資源仍存在空間上分佈不均勻的狀態,建議未來研究可持續以地理資訊系統之方式分析不同醫療資源之分佈,並期望政策制定者持續重視、提升緊急醫療資源不足地區之空間可近性。 關鍵字:緊急醫療資源、可近性、空間分析、羅倫茲曲線、吉尼係數 Backgrounds: Regionalization of medical critical care has been known as an effective strategy to offer systematic health care services for patients. Taiwan had established an evaluation system to categorize hospitals by recognizing their abilities on medical critical care. All hospitals were classified into three groups, among them, “Intermediate Emergency Responsibility Hospitals,” and “ Advanced Emergency Responsibility Hospitals” had sufficient medical devices and well-training medical personnel to deal with complex emergency illness. GIS is a likely technology to analyze the access to healthcare service, but there was no study using GIS as an analysis tool to evaluate the spatial accessibility to emergency medical services in Taiwan so far. Objective: The main purpose of the study is to evaluate spatial accessibility to special emergency medical service, including trauma, high risk pregnancy, cerebrovascular accident, and acute coronary syndrome in Taiwan. Methods: First, using network analysis in a geographic information system, I calculated areas within 15- and 30-kilometer travel distance to Advanced and Intermediate Emergency Responsibility Hospitals. Second, evaluating the accessibility for the proportion of the population, women of childbearing, and elderly that resided outside of service areas of Intermediate or Advanced Emergency Responsibility Hospitals that offered trauma, high risk pregnancy, cerebrovascular accident, and acute coronary syndrome medical services. Last, uniformity in the geographical distribution of trauma, high risk pregnancy, cerebrovascular accident, and acute coronary syndrome specialists were then evaluated by using Gini coefficient and Lorenz curve. Results: Overall, secondary medical areas that located in the southeast part of Taiwan had lower accessibility to Advanced Emergency Responsibility Hospitals than other secondary medical areas. Lorenz curve presented that there were 3.4% of elderly resided in the secondary medical area that had no neurosurgeons. Conclusion: Regional disparity in the spatial accessibility to emergency medical service is still an important issue that should be concerned. The results of this study might provide useful information for evidence-based policy making. Keywords: emergency medical resources, accessibility, spatial analysis, Lorenz curve, Gini coefficient |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/19476 |
DOI: | 10.6342/NTU202003641 |
全文授權: | 未授權 |
顯示於系所單位: | 健康政策與管理研究所 |
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