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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 張睿詒 | |
dc.contributor.author | Feng-Jung Yang | en |
dc.contributor.author | 楊豐榮 | zh_TW |
dc.date.accessioned | 2021-06-17T08:27:11Z | - |
dc.date.available | 2024-08-28 | |
dc.date.copyright | 2019-08-28 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-08-13 | |
dc.identifier.citation | 1. United States Renal Data System. 2018 USRDS annual data report: Epidemiology of kidney disease in the United States. . 2018: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2018.
2. Tsai, M.H., et al., Incidence, Prevalence, and Duration of Chronic Kidney Disease in Taiwan: Results from a Community-Based Screening Program of 106,094 Individuals. Nephron, 2018. 140(3): p. 175-184. 3. Hsieh, H.-M., et al., Economic evaluation of a pre-ESRD pay-for-performance programme in advanced chronic kidney disease patients. Nephrology Dialysis Transplantation, 2016. 32(7): p. 1184-1194. 4. Slinin, Y., et al., Timing of dialysis initiation, duration and frequency of hemodialysis sessions, and membrane flux: a systematic review for a KDOQI clinical practice guideline. Am J Kidney Dis, 2015. 66(5): p. 823-36. 5. Abra, G. and M. Kurella Tamura, Timing of initiation of dialysis: time for a new direction? Current opinion in nephrology and hypertension, 2012. 21(3): p. 329-333. 6. Wagner, E.H., M. Austin Bt Fau - Von Korff, and M. Von Korff, Organizing care for patients with chronic illness. 1996(0887-378X (Print)). 7. Wagner, E.H., M. Austin Bt Fau - Von Korff, and M. Von Korff, Improving outcomes in chronic illness. 1996(1064-5454 (Print)). 8. Barnett, K., et al., Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 2012. 380(9836): p. 37-43. 9. Francesca, R.M., et al., Is the Digital Divide an Obstacle to e-Health? An Analysis of the Situation in Europe and in Italy. 2015. 21(1): p. 24-35. 10. Bonner, A., et al., Evaluating the prevalence and opportunity for technology use in chronic kidney disease patients: a cross-sectional study. 2018. 19(1): p. 28. 11. Goldstein, K., et al., Using Digital Media to Promote Kidney Disease Education. Advances in Chronic Kidney Disease, 2013. 20(4): p. 364-369. 12. Chen, S.H., et al., The impact of self-management support on the progression of chronic kidney disease--a prospective randomized controlled trial. Nephrol Dial Transplant, 2011. 26(11): p. 3560-6. 13. Eden, E.L., et al., Condition Help: A Patient- and Family-Initiated Rapid Response System. J Hosp Med, 2017. 12(3): p. 157-161. 14. Cedillo-Couvert, E.A., et al., Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD. Clinical Journal of the American Society of Nephrology, 2018. 13: p. 1659-1667. 15. Zolnierek, K.B. and M.R. Dimatteo, Physician communication and patient adherence to treatment: a meta-analysis. Med Care, 2009. 47(8): p. 826-34. 16. Ho, P.M., et al., Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med, 2006. 166(17): p. 1836-41. 17. Lo, C., et al., Gaps and barriers in health-care provision for co-morbid diabetes and chronic kidney disease: a cross-sectional study. BMC Nephrology, 2017. 18(1): p. 80. 18. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis, 2002. 39(2 Suppl 1): p. S1-266. 19. Cooper, B.A., et al., A Randomized, Controlled Trial of Early versus Late Initiation of Dialysis. New England Journal of Medicine, 2010. 363(7): p. 609-619. 20. Razzaghi, M.R. and L. Afshar, A conceptual model of physician-patient relationships: a qualitative study. J Med Ethics Hist Med, 2016. 9: p. 14. 21. WHO | Global Action Plan for the Prevention and Control of NCDs 2013-2020. WHO 2015 2015-10-05 03:00:00; Available from: https://www.who.int/nmh/events/ncd_action_plan/en/. 22. Wen, C.P., et al., All-cause mortality attributable to chronic kidney disease: a prospective cohort study based on 462 293 adults in Taiwan. The Lancet, 2008. 371(9631): p. 2173-2182. 23. Levey, A.S., et al., The definition, classification, and prognosis of chronic kidney disease: a KDIGO Controversies Conference report. Kidney International, 2011. 80(1): p. 17-28. 24. Imai, E. and S. Matsuo, Chronic kidney disease in Asia. The Lancet, 2008. 371(9631): p. 2147-2148. 25. Jha, V., et al., Chronic kidney disease: global dimension and perspectives. The Lancet, 2013. 382(9888): p. 260-272. 26. Webster, A.C., et al., Chronic Kidney Disease. The Lancet, 2017. 389(10075): p. 1238-1252. 27. Coleman, K., et al., Evidence on the Chronic Care Model in the new millennium. Health Affairs, 2009. 28(1)(1544-5208 (Electronic)). 28. Nuño, R., et al., Integrated care for chronic conditions: The contribution of the ICCC Framework. Health Policy, 2012. 105(1): p. 55-64. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74269 | - |
dc.description.abstract | 慢性病照護模式將慢性病照護管理將獲得醫療保健服務的社區以及涉及醫療系統中。強調了“自我管理支持”的重要性-讓患者了解自身管理狀況的知識,信心和技能。“健康服務輸送系統”對於促進以患者為中心的跨學科團隊照護方法也很重要。需要“決策支持”以確保提供者和患者能夠獲得最新和相關的基於證據的指南。最後,該模型強調“臨床資訊系統”的作用,以提供對所需數據,信息和知識的採用。改善健康。有效且富有成效的患者和提供者互動是慢性病照護模式的核心,也是改善結果的關鍵。
目標:第五期慢性腎病的患者,有較高的風險,進入透析及尿毒併發。由於提早開始透析無法延長壽命且開始常規血液透析時腎功能較高者,透析後存活率反而較低在透析開始前周全準備透析通路,能改善透析預後並節省支出。這些證據皆指出,故現階段開始透析的主要考量,仍建議以臨床出現無法以藥物控制的尿毒症狀或末期腎臟病併發症,亦即以臨床症狀為主,生化檢驗為輔。 方法:本研究是經由網際網路通訊科技的方式,來協助慢性腎病第五期的患者,和主責醫師有更佳醫病的溝通,安全延緩進入透析的時間,以慢性照護模式加上新的通訊科技,提供是最佳照護模式 結果:在我們的研究中有社交網路服務的病患有較晚進入透析的時間(761.7 ±616.2 days)。在基礎腎功能(eGFR)調整後,有社交網路服務的患者有統計上意義的延緩了每eGFR下降一個單位天數(84.8±65.1天)比其他組更長,且較晚進入透析的時間,延緩了約417天。 結論:第五期慢性腎病的患者經由以社交網路服務增強智能照護模式可以解決溝通的差距,為慢性腎病創造更多的益處,可以安全的延遲透析的開始。本研究是經由網際網路通訊科技的方式,來協助慢性腎病第五期的患者,和主責醫師有更佳醫病的溝通,安全延緩進入透析的時間,以慢性照護模式加上新的通訊科技,提供是最佳照護模式。 | zh_TW |
dc.description.abstract | Background: CKD stage V is a high risk for dialysis initiation and complication such as uremic encephalopathy, uremic symptoms, gastrointestinal bleeding and infection. IDEAL trial provides guidance on the safety of waiting for symptoms or lower levels of estimated glomerular filtration rate prior to beginning dialysis. There was a serious communication gap during CKD stage V care.
Objective: Our aim was to establish a powerful care model with Social Networking Services (SMS) to improved care quality in health care and dialysis initiation. Methods: Our study is retrospective cohort from 2007 to 2017. The patient age is between 20-85 years. In 2014, Dr H started to use with SMS app to connect with CKD stage V patients and their family. In case of emergency, the patients and their family can report any condition to Dr H. Dr H help promote the “productive interactions” between CKD stage V patients and Healthcare system. End point is to delay initiation of dialysis therapy with safety. Patient divided to four group, Team during 2007 to 2014(Team), Dr H during 2007 to 2014( Dr H), Team without SMS(Team-mob) during 2014 to 2017 and Dr H with SMS(Dr H +mob). Results: In our study, 4 group patients have different time to dialysis. Before adjusting, Group “Dr H +mob” had longer time to dialysis (761.7 ±616.2 days) than another group (vs Team p=0.011*, vs Dr H p=0.039*, vs Team-mob p=0.049*) . After adjusting with baseline eGFR , “Dr H +mob” had prolonged more duration of each eGFR drop (84.8 ±65.1 days) than other group (vs Team p=0.005*, vs Dr H p=0.032*, vs Team-mob p=0.002**) . Conclusions: SMS in Chronic stage V patients and physician can resolve the gap of communication and create more benefits for Chronic kidney disease to delay initiation of dialysis. Therefore, the role of SMS and the associated care model should be further investigated in more large population. Trial Registration: The study has been approved by the ethical review board of National Taiwan University Hospital (NTUH 201901030RINB and 201903005RINA). | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T08:27:11Z (GMT). No. of bitstreams: 1 ntu-108-P06848013-1.pdf: 5736605 bytes, checksum: 144e3381a9a420d181746b7a81d28da5 (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 口試委員會審定書 1
誌謝 2 中文摘要 3 英文摘要 5 目錄 7 圖目錄 10 表目錄 11 第一章 Introduction 12 第二章 Methods 17 第一節 Ethics statement 17 第二節 Study population 17 第三節 Measurement of kidney function 19 第四節 Other variables 20 第五節 Statistical analyses 20 第三章 Results 22 第一節 Baseline demographic, clinical and laboratory measurements 22 第二節 Age : not increased with Daily eGFR decline rate in late enrolled CKD stage V 22 第三節 Time to dialysis and Duration of each eGFR drop 23 第四節 Difference in Difference (DID) in care model 23 第四章 Discussion 30 第一節 Principal Results 30 第二節 Limitations 30 第三節 Comparison with Prior Work 30 第五章 Conclusions 33 第一節 Consent for Publication 33 第二節 Availability of Data and Material 33 第三節 Competing Interests 33 第四節 Funding 33 第五節 Authors’ Contributions 34 第六節 Acknowledgements 34 第七節 Abbreviations 34 第六章 文獻探討 35 第一節 世界慢性疾病 35 第二節 慢性照護模式 38 第三節 慢性腎病的照護模式 42 第四節 慢性腎臟病進入透析的時機 43 一、 提早透析無法延長壽命 43 二、 觀察型研究發現開始血液透析時GFR較高者,其存活率較低 44 三、 台灣開始透析的eGFR相對其他各國較低且存活率較佳 45 四、 在透析開始前周全準備透析通道,能改善預後並節省支出 45 五、 接受透析治療的時機與準備 46 第七章 參考文獻 47 第八章 投稿論文 50 第一節 期刊投稿 50 第二節 投稿文件 50 | |
dc.language.iso | zh-TW | |
dc.title | 以社交網路服務增強智能照護模式:第五期慢性腎病之慢性照護模式新理論 | zh_TW |
dc.title | Social Networking Services Enhanced Smart Care Model:New theory from Chronic Care Model for Chronic kidney disease stage V | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 張宜秋,黃政文 | |
dc.subject.keyword | 慢性腎病第五期,透析,慢性照護模式,社交網路服務, | zh_TW |
dc.subject.keyword | Chronic kidney disease stage V,Chronic care model,Dialysis,Initiation,Social Networking Services, | en |
dc.relation.page | 50 | |
dc.identifier.doi | 10.6342/NTU201902533 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-08-13 | |
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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