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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鍾國彪 | |
dc.contributor.author | Wei-Hsin Chang | en |
dc.contributor.author | 張維辛 | zh_TW |
dc.date.accessioned | 2021-06-13T08:22:03Z | - |
dc.date.available | 2017-03-02 | |
dc.date.copyright | 2012-03-02 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-07-19 | |
dc.identifier.citation | 英文參考文獻
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/36906 | - |
dc.description.abstract | 研究背景與目的
「可避免住院」是一衡量基層照護可近性、品質及效率照護結果的重要指標,國外研究發現「照護連續性」為重要影響因素之一。為了解臺灣可避免住院之疾病及其影響因素,本研究目的為尋找適用於國內兒童可避免住院疾病,並探討照護連續性指標與可避免住院疾病之相關性。 研究方法 首先以問卷調查國內15位兒科相關專家,選出適合於國內兒童的可避免住院疾病。再根據全民健康保險學術研究資料庫2005年百萬承保抽樣歸人檔,研究樣本共有139,867位12歲以下兒童,以羅吉斯迴歸及負二項式迴歸分析照護連續性與照護結果的情形。 研究結果 本研究依照專家共識選入氣喘、脫水/耗竭、下呼吸道疾病、腸胃炎等共12項兒童可避免住院疾病。以Usual Provider of Care(UPC)、Continuity of Care Index(COCI)、Sequential Continuity(SECON)做為照護連續性指標,以不同面向的指標來測量病人實際的照護連續情形,結果顯示三種照護連續性指標與住院、可避免住院都呈負相關且存在劑量效應關係,意指照護連續性指標分數越高,其住院的風險越低。 結論 國內外兒童可避免住院疾病略有不同,國際疾病分類碼(ICD-9-CM)也有所差異,但照護連續性越好確實有效降低兒童住院及可避免住院,本研究未來可做為醫院提升照護品質及國家政策制定之參考。 | zh_TW |
dc.description.abstract | Background: Avoid Hospitalization is a vital indicator of measuring basic healthcare performances for accessibility, quality and efficiency.Several research studies showed that it is affected by the continuity of care.The objectives of this study were to find the suitable pediatric ambulatory care sensitive conditions(ACSCs)in Taiwan, and to discuss the association between child continuity of care indicator and pediatric avoid hospitalization.
Methods: We conducted a survey among 15 pediatric-related professionals,in order to choose the appropriate ACSCs for children in Taiwan.139,867 patients under age 12 were analyzed from Taiwan National Health Insurance Research Database in 2005 according to criteria decided by the survey results.Then we analyzed the data by using logistic regression and negative binominal regression models. Results: There were 12 pediatric ACSCs selected in agreement with pediatric professionals, including asthma, dehydration, lower respiratory condition and gastroenteritis. By using usual provider of care(UPC), continuity of care index(COCI), and sequential continuity(SECON) as the indicators for continuity of care, we inspected the actual situations for child continuity of care in different aspects. The results performed a negative correlation and a dose-response effect relationship between continuity of care and avoid hospitalization, which indicated the higher scores for continuity of care, the lower hospital admission risk. Conclusions: Although the pediatric ACSCs and the ICD-9-CM Medical Codes in Taiwan differ from those in other countries, a good child continuity of care can effectively reduce hospitalization and avoid hospitalization among children. This study can be the future direction for healthcare quality improvement in both organizational and governmental policy levels. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T08:22:03Z (GMT). No. of bitstreams: 1 ntu-100-R98843010-1.pdf: 619972 bytes, checksum: 78a8032511eb7e38af2d91982cea248e (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 致謝 i
中文摘要 ii Abstract iii 目錄 v 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 3 第三節、研究重要性及貢獻 3 第二章 文獻探討 4 第一節、照護連續性定義及分類 4 第二節、照護連續性理論與實證研究 6 第三節、照護連續性指標之分類 7 第四節、可避免住院起源及定義 13 第五節、可避免住院理論及實證研究 15 第六節、可避免住院疾病列表發展 20 第七節、照護連續性與住院、可避免住院相關之實證研究 26 第三章 研究方法 29 第一節、研究架構 29 第二節、研究假說 30 第三節、研究材料與研究方法 31 第四節、研究變項與操作型定義 35 第五節、統計分析方法 39 第四章 研究結果 41 第一節、兒童門診照護敏感病況問卷之描述性分析 41 第二節、學者專家對兒童門診照護敏感病況之修改意見 43 第三節、專家學者的個人資料分析 45 第四節、樣本特徵與各個變項分布情形 46 第五節、研究自變項與控制變項雙變項分析 49 第六節、研究變項與依變項之雙變項分析 55 第七節、研究變項與住院、可避免住院及非可避免住院之多變項分析 65 第五章 討論 74 第一節、兒童可避免住院疾病 74 第二節、兒童照護連續性指標 78 第三節、照護連續性與住院、可避免住院之假說驗證 80 第四節、研究限制 84 第六章 結論與建議 85 第一節、結論 85 第二節、建議 86 參考文獻 88 附錄 96 附錄一、Solberg(1990)可避免住院疾病 96 附錄二、Weissman(1992)可避免住院疾病 97 附錄三、Billings(1993)可避免住院疾病 98 附錄四、AHRQ(2004)預防性品質指標 99 附錄五、Caminal(2004)可避免住院疾病 101 附錄六、Alfradique(2009)可避免住院疾病 102 附錄七、Pudy(2009)可避免住院疾病 103 附錄八、Chen(2011)可避免住院疾病及其疾病分類代碼 105 附錄九、Dafny(2005)可避免住院疾病及其疾病分類代碼 106 附錄十、Baker(2005)可避免住院疾病及其疾病分類代碼 106 附錄十一、Garg(2003)可避免住院疾病及其疾病分類代碼 107 附錄十二、Hakim(2001)可避免住院疾病及其疾病分類代碼 108 附錄十三、Shi(2000)可避免住院疾病及其疾病分類代碼 109 附錄十四、Parker(2000)可避免住院疾病及其疾病分類代碼 110 附錄十五、兒童可避免住院疾病專家意見問卷 111 附錄十六、兒童專家名單 117 附錄十七、兒童可避免住院問卷之描述性統計 118 附錄十八、兒童可避免住院問卷之修改意見 120 附錄十九、過去與本研究所選取之兒童可避免住院疾病 124 附錄二十、德菲法「二分法」選出之可避免住院疾病 126 | |
dc.language.iso | zh-TW | |
dc.title | 兒童照護連續性與可避免住院之相關性研究 | zh_TW |
dc.title | Association between child continuity of care and pediatric avoid hospitalizations | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳麗光,鄭守夏,董鈺琪 | |
dc.subject.keyword | 可避免住院,照護連續性,初級照護,兒童門診敏感照護狀況, | zh_TW |
dc.subject.keyword | Avoid Hospitalizations,Continuity of care,Primary care,Pediatric Ambulatory Care Sensitive Conditions, | en |
dc.relation.page | 126 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-07-20 | |
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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