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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 董鈺琪 | |
dc.contributor.author | Cheng-Chieh Wang | en |
dc.contributor.author | 王政傑 | zh_TW |
dc.date.accessioned | 2021-06-16T02:47:38Z | - |
dc.date.available | 2020-09-14 | |
dc.date.copyright | 2015-09-14 | |
dc.date.issued | 2015 | |
dc.date.submitted | 2015-07-16 | |
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/54268 | - |
dc.description.abstract | 研究背景:品質報告卡已成為加速品質改善的最廣泛提倡的策略之一。為提升急性心肌梗塞照護品質,中央健康保險署自102年10月實施急性心肌梗塞品質報告卡。 研究目的:探討醫療品質資訊公開對急性心肌梗塞照護過程與結果之影響。 研究方法:本研究使用中央健康保險署急性心肌梗塞醫療品質資訊公開之2011年上半年至2014年上半年資料,總計115家醫院納入分析,利用廣義估計方程式(Generalized Estimating Equations, GEE)控制病人特性、醫院特性及時間趨勢,探討醫療品質資訊公開對急性心肌梗塞照護過程與結果之影響。為深入瞭解醫療提供者對於品質資訊公開之看法與因應,本研究也針對3位醫院管理階層與3位心臟內科醫師進行深度訪談。 研究結果:醫療品質資訊公開與血脂低密度脂蛋白檢測比率、阿斯匹靈給藥比率、乙型阻斷劑給藥比率及血管收縮素轉換酶抑制劑或血管張力素受體阻滯劑給藥比率、3日內急診返診比率及14天內再住院比率變化無關。資訊公開指標項目及醫師對此政策瞭解程度可能影響急性心肌梗塞資訊公開之成效。 結論:醫療品質資訊公開對急性心肌梗塞照護過程與結果之改善,初期未有影響,尚待評估長期影響。 | zh_TW |
dc.description.abstract | Backgrounds: Report Cards have emerged as one of the most widely advocated strategies for accelerating quality improvement. In order to promote quality of care in acute myocardial infarction, the acute myocardial infarction report card has been implemented by the National Health Insurance Administration since October 2013. Objectives: The main purpose of this study was to evaluate the impact of a quality reporting program on processes and outcomes of care for acute myocardial infarction. Methods: This study used the public data of acute myocardial infarction report cards from the first half of 2011 to the first half of 2014 from the National Health Insurance Administration. A total of 115 hospitals were selected for analysis. Generalized Estimating Equations (GEE) models were used after adjustment for patients and hospitals characteristics, and time trend to examine the effect of a quality reporting program on processes and outcomes of care for acute myocardial infarction. We also conducted an in-depth interview with three hospital managers and three cardiologists to better understand their opinions and responses on acute myocardial infarction report cards. Results: The implementation of a quality reporting program was not associated with changes in the rates of low-density lipoprotein cholesterol (LDL-C) test, aspirin use, beta-blocker use, angiotensin-converting enzyme inhibitors (ACEIs)/ angiotensin II receptor blockers (ARBs) use, 3-day return to the emergency department, and 14-day readmission. The measured indicators of report cards and the level of cardiologists’ awareness about the program may affect the effectiveness of acute myocardial infarction report cards. Conclusions: The implementation of the quality reporting program does not initially affect improvements in processes and outcomes of care for acute myocardial infarction. The long-term effects of the program need to be evaluated. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T02:47:38Z (GMT). No. of bitstreams: 1 ntu-104-R02848029-1.pdf: 11244673 bytes, checksum: 49ea4a3ae79935db5e8553ab04e05b33 (MD5) Previous issue date: 2015 | en |
dc.description.tableofcontents | 國立臺灣大學(碩)博士學位論文口試委員會審定書 I 致謝 II 中文摘要 III Abstract IV 目錄 VI 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 第二章 文獻探討 4 第一節 簡介醫療品質資訊公開 4 第二節 急性心肌梗塞之簡介 12 第三節 醫療照護過程對照護結果之影響 25 第四節 醫療品質資訊公開對照護過程與照護結果之影響 35 第三章 研究方法與設計 48 第一節 研究設計 48 第二節 研究架構 49 第三節 研究假說 50 第四節 資料來源與研究對象 51 第五節 研究變項與操作型定義 52 第六節 資料處理流程 54 第七節 統計分析方法 55 第八節 深度訪談 57 第四章 研究結果 58 第一節 描述性分析結果 58 第二節 雙變項分析結果 66 第三節 多變項分析結果 76 第四節 深度訪談結果 80 第五章 討論 88 第一節 研究方法討論 88 第二節 假說驗證 92 第三節 研究限制 99 第六章 結論與建議 100 第一節 結論 100 第二節 建議 101 參考文獻 103 附件一 訪談大綱(醫院管理階層) 114 附件二 訪談大綱(心臟內科醫師) 116 | |
dc.language.iso | zh-TW | |
dc.title | 品質資訊公開對於急性心肌梗塞照護過程與結果之影響 | zh_TW |
dc.title | Impact of a quality reporting program on processes and outcomes of care for acute myocardial infarction | en |
dc.type | Thesis | |
dc.date.schoolyear | 103-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 鍾國彪 | |
dc.contributor.oralexamcommittee | 李丞華,黃瑞仁,楊哲銘 | |
dc.subject.keyword | 急性心肌梗塞,品質報告卡,醫療品質資訊公開,照護過程,照護結果, | zh_TW |
dc.subject.keyword | acute myocardial infarction,report card,quality reporting program,process of care,outcome of care, | en |
dc.relation.page | 116 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2015-07-16 | |
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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