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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鍾國彪(Kuo-Piao Chung) | |
dc.contributor.author | Zih-Fang Chen | en |
dc.contributor.author | 陳姿方 | zh_TW |
dc.date.accessioned | 2021-06-15T07:04:04Z | - |
dc.date.available | 2011-03-03 | |
dc.date.copyright | 2011-03-03 | |
dc.date.issued | 2010 | |
dc.date.submitted | 2010-12-31 | |
dc.identifier.citation | 呂庭輝(2004)醫師醫院服務量及醫師經驗與肝癌病人治療成效之關係。 國立台北護理學院醫護管理研究所未出版的碩士論文。
林家正(2007)醫院手術量、醫師手術量與醫師專科別對口腔癌3年存活情形率的影響。私立臺北醫學大學醫務管理學研究所未出版的碩士論文。 謝宜真, & 盧勝男. (2007). 肝癌病患接受射頻消融術後立即合併症之相關因素之探討. 實證護理(3卷2期), 10. 蔡欣芸(2008)乳癌核心測量在病人層次的指標遵從度分析及其與病患存活之相關性研究。國立臺灣大學醫療機構管理研究所未出版的碩士論文。 朱育增(2008)探討共病測量方法於健保次級資料之應用。國立陽明大學衛生福利研究所未出版的碩士論文。 盧勝男, 顏毅豪, 林芷芸, 紀廣明, 王景弘, & 張簡吉幸. (2008). 肝細胞癌之臨床分期. 中華民國癌症醫學會雜誌(24卷5期), 9. 行政院衛生署 民國96年死因統計 國民健康局的癌症防治中心品質提升評估整合之三年研究計畫 衛生署國民健康局(2007/10/08),97年度癌症診療品質認證基準及評分說明。http://www.bhp.doh.gov.tw/BHPnet/Portal/AnnounceShow.aspx?No=200712250974 衛生署國民健康局(2007/10/08),97年癌症診療品質認證作業程序。http://www.bhp.doh.gov.tw/BHPnet/Portal/AnnounceShow.aspx?No=200712250974 衛生署國民健康局(2007/11/19),落實推動全方位癌症診療 提高個案治療完成率與存活率。http://www.bhp.doh.gov.tw/BHPnet/Portal/PressShow.aspx?No=200712250348 國家衛生研究院(2008/01/31),97年度癌症診療品質認證醫院說明會簡報。http://www.nhri.org.tw/nhri_org/ca/accredit/index.htm TOT癌症關懷照護網(2007/11/20),全方位癌症診療 提升癌症醫療品質。http://www.totcare.com.tw/homenews.asp?newsid=1012 Bruix, J. (2005). Hepatocellular carcinoma. [Editorial Material]. 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G., Stassen, L. P., Steup, W. H., et al. (2008). High-volume versus low-volume for esophageal resections for cancer: The essential role of case-mix adjustments based on clinical data. Annals of Surgical Oncology, 15(1), 80-87. Yeung, Y. P., Hui, J., & Yip, W. C. A. (2008). Hepatectomy for hepatocellular carcinoma in a community hospital: The importance of surgeon procedural volume in operative outcomes. [Article]. Hepato-Gastroenterology, 55(82-83), 647-652. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/48601 | - |
dc.description.abstract | 背景與目的
肝癌是世界癌症別死亡率的第三名,在國內癌症別死因排於第二位,顯見對於國人健康影響甚鉅。雖然在國內外癌症照護的研究中,有非常多是針對病人、醫院或醫師特質對於癌症治療結果關係的探討,但其中探討肝癌治療與上述特質的相關文獻卻相對很少;而目前關於肝癌的研究又多半是針對其臨床照護的療效,更少文獻會從照護病患的過程去分析該照護結果是否會受到醫院、醫師或病人特質的影響,其實照護過程對於病患結果也是會造成影響的。因此,本研究期望針對接受積極治療的肝癌病患和主要照護該病患之醫院與醫師的特質,而該照護過程更以國內學者建立的癌症照護品質測量工具去分析照護病患間所存在的變異情形,探討病患實際所接受到的照護過程與上述所有特質對於照護結果的相關影響。 研究方法 採回溯性世代研究,透過次級資料庫(TCDB、NHI)的分析,選取2004年新診斷肝癌之接受積極治療(肝切除、肝移植、經皮穿肝注射、無線電射頻燒灼)的病人,共有2114名病患,受到29家醫院照護,其中1548位病患受275位醫師照護(進行首次積極治療手術者)。藉由病人特質(人口學特性與臨床特性)在結構面(醫院與醫師特質)、過程面(醫療照護過程)的資料探討之間的差異情形與相互關係。以卡方檢定、ANOVA、Log-rank test進行雙變項分析,以及使用Multiple regression、Logistic regression、Cox proportion hazard model做迴歸分析。 研究結果 本研究中顯著影響醫療照護過程與照護結果的因素有:醫院特質之權屬別(私立醫院照護之病人接受的醫療照護項目比較多,但受私立醫院照護病人之1年存活情形或3年存活情形的預後卻都較差)、醫院評鑑等級(受醫學中心照護病人之1年存活情形較差)、醫院所在地區(受中區醫院照護的病人接受之醫療照護項目最少,但受北區、南區醫院照護的病人,1年存活情形或3年存活情形最差、中區次之、東區最後)、3年服務量(受中服務量醫院照護的病人所接受的照護項目最少,但受高服務量醫院照護的病人之1年存活情形最好)、醫師特質之專科別(排除專科別不詳者,外科醫師所照護的病人接受醫療照護項目最多、內科醫師照護的病人接受醫療照護項目最少,而1年存活情形的表現,則以受其他科別醫師照護的病人最差)。 研究結論 在本研究中會顯著影響病患所接受的醫療照護情形與照護結果的因素包括了病人特質之性別、年齡分組、腫瘤轉移、腫瘤期別、腫瘤大小、手術方式、診斷面醫療照護情形;醫院特質之權屬別、醫院評鑑等級、醫院所在地區、3年服務量;醫師特質之專科別等。 | zh_TW |
dc.description.abstract | Background
Hepatocellular carcinoma (HCC) is the second death cause of cancer in Taiwan, and its incidence is increasing worldwide. The volume-outcome relationship has been established for several complex disease treatments including cancer care. However, few studies have examined the relationships between the pattern of care measured by HCC core measure indicators and hospital/physician volume-outcome relationship for patients received HCC curative therapies. Purpose The study has examined the associations among hospital/physician characteristics, the pattern of care, and outcomes for patients with HCC via national databases. Method A retrospective cohort study was conducted of 2,114 HCC patients received curative therapies that had registry in Taiwan Cancer Database (TCDB) in 2004. The 2,114 patients were received care from 29 hospitals, and 1,548 patients were treated by 275 physicians. Also their three-year National Health Insurance claims data and three-year survivals were collected from respectively National Health Research Institute and death cause database of Department of Health. Relationships between hospital/physician volume characteristics, pattern of care, and 1-year/3-year survivals were assessed by X2, ANOVA, Log-rank test, and the associations among variables were assessed by multiple regression, logistic regression, and Cox proportional hazard regressions with accounting for potentially confounding patient characteristics. Results Hospital characteristics (including ownership, accreditation level, geography, and 3-year service volume), physician characteristics (including specialty) were identified to be significantly related to the pattern of care and outcomes of patients with HCC. Conclusion Both hospital and physician characteristics are significantly related to survival outcome for patients with HCC. Besides, the diagnosis of pattern are also significantly related to 3-year survival outcome for patients with HCC. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T07:04:04Z (GMT). No. of bitstreams: 1 ntu-99-R96843012-1.pdf: 1782875 bytes, checksum: f3b826d37267d2c47f716f5fb86c46cb (MD5) Previous issue date: 2010 | en |
dc.description.tableofcontents | 口試委員審查書 i
致謝 ii 中文摘要 iii Abstract v 第一章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的與重要性 4 第二章 文獻探討 6 第一節 肝癌概況與主要積極治療相關介紹 6 第二節 癌症照護模型的發展與測量 9 第三節 病人特質對於照護過程與結果的影響 13 第四節 醫院與醫師特質對於照護過程與結果的影響 15 第三章 研究方法 20 第一節 研究設計與研究架構 20 第二節 資料來源、研究對象與處理流程 30 第三節 統計方法 34 第四章 研究結果 36 第一節 描述統計 36 第二節 推論統計 45 第五章 結果與討論 76 第一節 研究資料品質 76 第二節 研究結果討論 77 第三節 研究限制 84 第六章 結論與建議 86 第一節 結論 86 第二節 建議 87 參考文獻 90 附件一:肝癌核心測量指標 97 附件二:控制變項的統計結果 109 | |
dc.language.iso | zh-TW | |
dc.title | 醫院特質與醫師特質對於接受積極治療的肝癌病患之照護與結果相關探討 | zh_TW |
dc.title | Relationship among the Hospital/Physician’s Characteristics, Process of Care and Outcome in Curative Therapies for Patients with Hepatocellular Carcinoma | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-1 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 賴美淑(Mai-Sui Lai) | |
dc.contributor.oralexamcommittee | 胡文郁,謝碧晴,許駿 | |
dc.subject.keyword | 肝癌,積極治療,肝切除,肝移植,經皮穿肝注射,無線電射頻燒灼,醫院特質,服務量,醫師特質,醫師經驗,病人特質,醫療照護過程,照護結果, | zh_TW |
dc.subject.keyword | Hepatocellular carcinoma,HCC,curable therapy,resection,transplantation,percutaneous treatments,radio frequency ablation,hospital characteristics,volume,physician characteristics,specialty,patient characteristics,pattern of care,outcome, | en |
dc.relation.page | 120 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2011-01-03 | |
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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