請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74737
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 孫秀卿(Shiow-Ching Shun) | |
dc.contributor.author | Nai-Wen Ku | en |
dc.contributor.author | 古乃文 | zh_TW |
dc.date.accessioned | 2021-06-17T09:06:44Z | - |
dc.date.available | 2029-12-31 | |
dc.date.copyright | 2020-03-12 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-12-24 | |
dc.identifier.citation | 中文部分
王少谷、廖訓禎、胡百敏、馬雲鵬、張玉龍、葉時烊、彭錦池(2002)‧急診 轉診制度執行現況之探討-以某區域醫院及某地區醫院之經驗為例‧中華民 國急診醫學會醫誌,4(2),82-90。 尹賢琪、郭昭吟、陳啟元(2017)‧導入緊急傷病患電子轉診系統對醫護人員 臨床實務的衝擊-以嘉義網絡為例‧醫療資訊雜誌,26(1),1-18。 中華民國統計資訊網(無日期)‧都會區分類定義‧取自 https://www.stat.gov.tw/ct.asp?xItem=955&ctNode=1313 朱永華 (1995)‧醫院服務知覺品質與病患滿意度之關係研究‧台南市:成功 大學企業管理研究所。 黃集仁(2005)‧建立醫療衛生功能群緊急醫療救護救護教育訓練課 程及訓練中心合適發展模式-已建構急診新檢傷制度及教育訓練制度為例. (行政院衛生署委託研究計畫DOH94-TD-H-113-006)‧台北市:台灣急 診醫學會。 江旺財、李衛華、廖芝倩(2015)‧台灣急診擁塞初探‧輔仁醫學期刊, 13(4),224-231。 吳秋芬、吳肖琪、石富元、許銘能(2008)‧影響急診病患暫留時間之相關因 素探討‧台灣公共衛生雜誌,27(6),507-518。 施兆明、許恩得(2016)‧急診轉院原因與地區醫療品質提升的相關性-以中 部某地區醫院為例‧臺灣醫界,59(4),50-54。 胡勝川(2015,5月)‧如何因應急診壅塞‧ 取自 http://issue.thrf.org.tw/Page_Show.asp?Page_ID=2077. 張宏泰(2010)‧醫學中心急診壅塞問題的分析及改善措施之研究-以某醫學中 心改善方案為例‧高雄市:國立中山大學管理學院。 張祺君、陳威明、陳正豐、吳肖琪(2016)‧慢性腎臟病對全髖關節置換術病 患預後情形之影響‧台灣公共衛生雜誌,35(1),53-65。 doi:10.6288/TJPH201635104066 許銘能(2013)‧急診壅塞分析及對策‧取自 file:///C:/Users/User/Downloads/%E7%AC%AC1%E5%B1%86102%E5%B9%B 4%E7%AC%AC2%E6%AC%A1%E6%9C%83%E8%AD%B0— %E6%80%A5%E8%A8%BA%E5%A3%85%E5%A1%9E%E5%88%86%E6%9 E%90%E5%8F%8A%E5%B0%8D%E7%AD%96_0029930000%20(2).pdf 游淑敏、詹尚易、璩大成、陳永泰(2017)‧「臺北市醫學中心急診待床轉院 計畫」實施成效與滿意度報告‧北市醫學雜誌,14(2),171-177。 黎伊文(2014)‧急診檢傷分類之分級、等候時間與預後相關性之探討(未發表的博/碩士論文)‧台北市:臺灣大學護理學研究所。doi:10.6342/NTU.2014.02054 蔡哲宏(2013)‧急診病患住院後非計劃性轉入加護病房之風險預測模式建構 與實證分析‧台中市:東海大學工業工程與經營資訊學系。 衛生福利部保護司(2010)‧選擇通過評鑑的優質醫院就醫,養成分級就醫好 習慣‧取自 https://www.mohw.gov.tw/cp-3161-26460-1.html 衛生福利部中央健康保險署(2019,4月)‧重大傷病項目‧取自 https://www.nhi.gov.tw/Content_List.aspx?n=3AE7F036072F88AF&topn=D39E2B72B0BDFA15 英文部分 Alemkere, G., Tenna, A., & Engidawork, E. (2019). Antibiotic use practice and predictors of hospital outcome among patients with systemic bacterial infection: Identifying targets for antibiotic and health care resource stewardship. PLoS One, 14(2), e0212661. doi:10.1371/journal.pone.0212661 American College of Emergency, P. (2006). Crowding. Annals of Emergency Medicine, 47(6), 585. doi:10.1016/j.annemergmed.2006.02.025 Austin, P. C. (2011a). Comparing paired vs non-paired statistical methods of analyses when making inferences about absolute risk reductions in propensity-score matched samples. Statistics in Medicine, 30(11), 1292-1301. doi:10.1002/sim.4200 Austin, P. C. (2011b). An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Multivariate Behavioral Research, 46(3), 399-424. doi:10.1080/00273171.2011.568786 Austin, P. C. (2011c). Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharmaceutical Statistics, 10(2), 150-161. doi:10.1002/pst.433 Biber, R., Bail, H. J., Sieber, C., Weis, P., Christ, M., & Singler, K. (2013). Correlation between age, emergency department length of stay and hospital admission rate in emergency department patients aged >/=70 years. Gerontology, 59(1), 17-22. doi:10.1159/000342202 Bullard, M. J., Liaw, S. J., Chen, J. C., & Hu, P. M. (1998). Compliance with the law and appropriate medical standards during interhospital transfers. Journal of the Formosan Medical Association, 97(11), 770-776. Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40(5), 373-383. Chen, R.-C. (2013). Physicians Should Actively involve in Providing Good Death to Terminal Patients. Taiwan Journal of Hospice Palliative Care, 18(1), 51-61. doi: 10.6537/TJHPC.2013.18(1).5 Chen, Y. Y., Chen, Y. S., Chu, T. S., Lin, K. H., & Wu, C. C. (2016). Further deliberating the relationship between do-not-resuscitate and the increased risk of death. Scientific Reports, 6, 23182. doi:10.1038/srep23182 Diesburg-Stanwood, A., Scott, J., Oman, K., & Whitehill, C. (2004). Nonemergent ED patients referred to community resources after medical screening examination: characteristics, medical condition after 72 hours, and use of follow-up services. Journal of Emergency Nursing, 30(4), 312-317. doi:10.1016/j.jen.2004.04.001 Frost, S. A., Alexandrou, E., Bogdanovski, T., Salamonson, Y., Parr, M. J., & Hillman, K. M. (2009). Unplanned admission to intensive care after emergency hospitalisation: risk factors and development of a nomogram for individualising risk. Resuscitation, 80(2), 224-230. doi:10.1016/j.resuscitation.2008.10.030 Hamilton, R., Driver, S., Noorani, S., Callender, L., Bennett, M., & Monden, K. (2017). Utilization and access to healthcare services among community-dwelling people living with spinal cord injury. Journal of Spinal Cord Medicine, 40(3), 321-328. doi:10.1080/10790268.2016.1184828 Harikrishnan, S., Sanjay, G., Anees, T., Viswanathan, S., Vijayaraghavan, G., Bahuleyan, C. G., . . . Trivandrum Heart Failure, R. (2015). Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry. European Journal of Heart Failure, 17(8), 794-800. doi:10.1002/ejhf.283 Hill, A. D., Fowler, R. A., & Nathens, A. B. (2011). Impact of interhospital transfer on outcomes for trauma patients: a systematic review. The Journal of Trauma, 71(6), 1885-1900; discussion 1901. doi:10.1097/TA.0b013e31823ac642 Holland, C. M., Lovasik, B. P., Howard, B. M., McClure, E. W., Samuels, O. B., & Barrow, D. L. (2017). Interhospital Transfer of Neurosurgical Patients: Implications of Timing on Hospital Course and Clinical Outcomes. Neurosurgery, 81(3), 450-457. doi:10.1093/neuros/nyw124 Hoot, N. R., & Aronsky, D. (2008). Systematic review of emergency department crowding: causes, effects, and solutions. Annals of Emergency Medicine, 52(2), 126-136. doi:10.1016/j.annemergmed.2008.03.014 Hwang, U., Richardson, L. D., Sonuyi, T. O., & Morrison, R. S. (2006). The effect of emergency department crowding on the management of pain in older adults with hip fracture. Journal of the American Geriatrics Society, 54(2), 270-275. doi:10.1111/j.1532-5415.2005.00587.x Jhao-Yin Li, Lin, J.-W., Wu, Z.-H., Wu, H.-W., Yeh, C.-C., & Yang, Y.-W. (2008). A Study on the Characteristics and Medical Resource Utilization of Patients with Chronic Obstructive Pulmonary Disease. Journal of Healthcare Management, 9(3), 5. Kachalia, A., Gandhi, T. K., Puopolo, A. L., Yoon, C., Thomas, E. J., Griffey, R., . . . Studdert, D. M. (2007). Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Annals of Emergency Medicine, 49(2), 196-205. doi:10.1016/j.annemergmed.2006.06.035 Kellett, J., & Deane, B. (2006). The Simple Clinical Score predicts mortality for 30 days after admission to an acute medical unit. An international Journal of Medicine, 99(11), 771-781. doi:10.1093/qjmed/hcl112 Kennedy, M., Joyce, N., Howell, M. D., Lawrence Mottley, J., & Shapiro, N. I. (2010). Identifying infected emergency department patients admitted to the hospital ward at risk of clinical deterioration and intensive care unit transfer. Academic Emergency Medicine, 17(10), 1080-1085. doi:10.1111/j.1553-2712.2010.00872.x Khaing, W., Vallibhakara, S. A., Attia, J., McEvoy, M., & Thakkinstian, A. (2017a). Effects of education and income on cardiovascular outcomes: A systematic review and meta-analysis. European Journal Preventive Cardiology, 24(10), 1032-1042. doi:10.1177/2047487317705916 Khaing, W., Vallibhakara, S. A., Attia, J., McEvoy, M., & Thakkinstian, A. (2017b). Effects of education and income on cardiovascular outcomes: A systematic review and meta-analysis. European Journal of Preventive Cardiology, 24(10), 1032-1042. doi:10.1177/2047487317705916 Lakomkin, N., Kothari, P., Dodd, A. C., VanHouten, J. P., Yarlagadda, M., Collinge, C. A., . . . Sethi, M. K. (2017). Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma. Journal of Orthopaedic Trauma, 31(1), 21-26. doi:10.1097/BOT.0000000000000701 Liu, S., Hobgood, C., & Brice, J. H. (2003). Impact of critical bed status on emergency department patient flow and overcrowding. Academic Emergency Medicine, 10(4), 382-385. Lucas, R., Farley, H., Twanmoh, J., Urumov, A., Olsen, N., Evans, B., & Kabiri, H. (2009). Emergency department patient flow: the influence of hospital census variables on emergency department length of stay. Academic Emergency Medicine, 16(7), 597-602. doi:10.1111/j.1553-2712.2009.00397.x Miro, O., Antonio, M. T., Jimenez, S., De Dios, A., Sanchez, M., Borras, A., & Milla, J. (1999). Decreased health care quality associated with emergency department overcrowding. European Journal of Emergency Medicine, 6(2), 105-107. Nadig, N. R., Goodwin, A. J., Simpson, A. N., Simpson, K. N., Richards, J., & Ford, D. W. (2017). Patient and Hospital Characteristics Associated with Interhospital Transfer for Adults with Ventilator-Dependent Respiratory Failure. Annals of the American Thoracic Society, 14(5), 730-736. doi:10.1513/AnnalsATS.201611-918OC Ofori-Asenso, R., Zomer, E., Chin, K. L., Si, S., Markey, P., Tacey, M., . . . Liew, D. (2018). Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke. International Jouranl Environmental Research and Public Health, 15(11). doi:10.3390/ijerph15112532 Renaud, B., Santin, A., Coma, E., Camus, N., Van Pelt, D., Hayon, J., . . . Labarere, J. (2009). Association between timing of intensive care unit admission and outcomes for emergency department patients with community-acquired pneumonia. Critical Care Medicine, 37(11), 2867-2874. doi:10.1097/CCM.0b013e3181b02dbb Rondeau, K. V., & Francescutti, L. H. (2005). Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction. Journal of Healthcare Management 50(5), 327-340; discussion 341-322. Rowe, B. H., Channan, P., Bullard, M., Blitz, S., Saunders, L. D., Rosychuk, R. J., . . . Holroyd, B. R. (2006). Characteristics of patients who leave emergency departments without being seen. Academic Emergency Medicine, 13(8), 848-852. doi:10.1197/j.aem.2006.01.028 Rush, B., Tyler, P. D., Stone, D. J., Geisler, B. P., Walley, K. R., & Celi, L. A. (2018). Outcomes of Ventilated Patients With Sepsis Who Undergo Interhospital Transfer: A Nationwide Linked Analysis. Critical Care Medicine,, 46(1), e81-e86. doi:10.1097/CCM.0000000000002777 Sauter, T. C., Capaldo, G., Hoffmann, M., Birrenbach, T., Hautz, S. C., Kammer, J. E., . . . Hautz, W. E. (2018). Non-specific complaints at emergency department presentation result in unclear diagnoses and lengthened hospitalization: a prospective observational study. Scandinavian Journal Trauma, Resuscitation and Emergency Medicine, 26(1), 60. doi:10.1186/s13049-018-0526-x Salehi, L., Phalpher, P., Valani, R., Meaney, C., Amin, Q., Ferrari, K., & Mercuri, M. (2018). Emergency department boarding: a descriptive analysis and measurement of impact on outcomes. Canadian Journal of Emergency Medicine, 20(6), 929-937. doi:10.1017/cem.2018.18 Schull, M. J., Morrison, L. J., Vermeulen, M., & Redelmeier, D. A. (2003). Emergency department gridlock and out-of-hospital delays for cardiac patients. Academic Emergency Medicine, 10(7), 709-716. Schwartz, N., Sakhnini, A., & Bisharat, N. (2018). Predictive modeling of inpatient mortality in departments of internal medicine. Internal and Emergency Medicine, 13(2), 205-211. doi:10.1007/s11739-017-1784-8 Singer, A. J., Thode, H. C., Jr., Viccellio, P., & Pines, J. M. (2011). The association between length of emergency department boarding and mortality. Academic Emergency Medicine, 18(12), 1324-1329. doi:10.1111/j.1553-2712.2011.01236.x Sonig, A., Lin, N., Krishna, C., Natarajan, S. K., Mokin, M., Hopkins, L. N., . . . Siddiqui, A. H. (2016). Impact of transfer status on hospitalization cost and discharge disposition for acute ischemic stroke across the US. Journal of Neurosurgy, 124(5), 1228-1237. doi:10.3171/2015.4.JNS141631 Sprivulis, P. C., Da Silva, J. A., Jacobs, I. G., Frazer, A. R., & Jelinek, G. A. (2006). The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. The Medical Journal of Australia, 184(5), 208-212. Stenhouse, C., Coates, S., Tivey, M., Allsop, P., & Parker, T. (2000). Prospective evaluation of a modified Early Warning Score to aid earlier detection of alpatients developing critical illness on a general surgical ward. British Journal of Anaesthesia, 84(5), 663P. doi:https://doi.org/10.1093/bja/84.5.663 Stuart, E. A. (2010). Matching methods for causal inference: A review and a look forward. Statistical Science, 25(1), 1-21. doi:10.1214/09-STS313 Tan, C., Ng, Y. S., Koh, G. C., De Silva, D. A., Earnest, A., & Barbier, S. (2014). Disability impacts length of stay in general internal medicine patients. Journal of General Internal Medicine, 29(6), 885-890. doi:10.1007/s11606-014-2815-z Tam, V., Frost, S. A., Hillman, K. M., & Salamonson, Y. (2008). Using administrative data to develop a nomogram for individualising risk of unplanned admission to intensive care. Resuscitation, 79(2), 241-248. doi:10.1016/j.resuscitation.2008.06.023 Washington, D. L., Stevens, C. D., Shekelle, P. G., Henneman, P. L., & Brook, R. H. (2002). Next-day care for emergency department users with nonacute conditions. A randomized, controlled trial. Annals of Internal Medicine, 137(9), 707-714. Weiss, S. J., Ernst, A. A., Derlet, R., King, R., Bair, A., & Nick, T. G. (2005). Relationship between the National ED Overcrowding Scale and the number of patients who leave without being seen in an academic ED. American Journal of Emergency Medicine, 23(3), 288-294. Yang, Y. T., Iqbal, U., Ko, H. L., Wu, C. R., Chiu, H. T., Lin, Y. C., . . . Elsa Hsu, Y. H. (2015). The relationship between accessibility of healthcare facilities and medical care utilization among the middle-aged and elderly population in Taiwan. International Journalfor Quality Health Care, 27(3), 222-231. doi: 10.1093/intqhc/mzv024. Yeo, H., Indes, J., & Rosenthal, R. ( 2017). Surgery in the Geriatric Patient Sabiston Textbook of Surgery, Chapter 13, 33. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74737 | - |
dc.description.abstract | 前言:自全民健保實施以來,伴隨而來重要的影響是國人的就醫習慣,導致輕症病患至全國各大醫學中心急診就診;持續失衡的結果,逐漸使得真正「急」和「重」的病患無法適當的得到醫療資源和照護。為改善醫學中心急診壅塞、病患待床時間過長問題,衛生福利部協同台北市政府衛生局於104年2月開始實行「台北市醫學中心急診待床轉院計畫」,其初步的滿意度雖已達正面的效果,但國內在接受轉院和拒絕轉院的病患特色分佈、病患接受適當的下轉至區域醫院層級之醫院接受後續的治療成效及其與續留醫學中心接受治療的病患之住院天數及死亡率是否有差異皆未有研究探討。
研究目的:探討北部某家醫學中心:(1)醫學中心符合急診待床轉院計畫病患之基本屬性與疾病特性;(2)醫學中心急診病患同意轉至區域醫院住院過程中,轉入的時間、轉入醫院及等待轉入時間對預後的影響;(3)比較轉往區域醫院接受治療的病患和拒絕轉院續留醫學中心接受治療的病患,兩者間候床天數、動向死亡率及住院天數的差異。 研究方法:此研究為回溯式世代(retrospective cohort)設計,以緊急傷病患電子轉診系統(Mars)、北區某醫學中心醫院電子病歷檔案和區域醫院紙本病歷回覆為資料之來源,收案期間為2016/01/01~2016/12/31,經北區某醫學中心醫療團隊評估後可由急診轉台北市立聯合醫院住院之所有的成人病患為研究對象,排除直接轉入加護病房、安寧病房及手術病患等,以描述性統計分析各變項,以相關性統計、傾向分數配對及多變項邏輯斯迴歸分析兩群體間預後(死亡率、住院天數)的差異。 研究結果:總轉出率26.9%,其中有效個案數為858人,拒絕轉院續留醫學中心治療個案共438人,轉往聯合醫院為420人,聯合醫院病歷回覆數為283人。相較拒絕轉至區域醫院續留醫學中心接受治療的病患,影響轉院重要因素為年齡(OR=0.984, p<0.001)、檢傷平均動脈壓(OR=1.008, p = 0.047)及檢傷到詢問時間(OR=0.998, p <0.001),意指當病患年紀越年輕、生命徵象越趨於穩定和及早介入詢問轉院意願其接受轉院的程度越高。與預後相關的死亡分析結果指出:當共病指數越高(OR=1.789, p <0.001)、有不實施心肺復甦/安寧緩和註記者(OR=45.408, p <0.001)和疾病診斷有改變者(OR=10.212, p= 0.005)其較容易有死亡發生,有無轉院則未發現統計上顯著影響。整體總住院平均天數為10.7天,研究結果中發現當共病指數越高(β=0.148 , p <0.001)、出院診斷是肺炎(β= 0.106 , p=0.003)和蜂窩性組織炎者(β=0.075 ,p=0.03)、後續醫療處置越多(β=0.32, p <0.001)、等待轉入時間較長(β=0.243, p <0.001),總住院天數將隨之增加;反之,急診出院(β= -0.57, p <0.001)與轉院(β= -0.123, p=0.005)則總住院天數會減少。 結論:本研究為臨床醫療照護模式提供重要資訊,在醫學中心符合急診待床轉院計畫中年齡、生命徵象與檢傷到詢問時間為影響病患轉院意願的相關因子,更從而探討出轉院至區域醫院住院過程中,轉入的時間、轉院和等待轉入時間與總住院天數的減少有顯著的相關,但與死亡預後無關。 | zh_TW |
dc.description.abstract | Background: Patients’ preferences concerning medical utilities in Taiwan have shifted greatly owing to implementation of National Health Insurance. People now tend to visit emergency departments in medical centers even for trivial problems, invariably causing overcrowding and prolonged waiting times in emergency departments. Thus, the “Taipei Medical Center Emergency Department Referral Program” was implemented in February 2014. Patients waiting for admission were suggested to transfer from the emergency department in a medical center to an admission ward in a regional hospital following their evaluation. This program has received positive feedback. However, the characteristics of patients accepting or refusing referrals, the duration of hospitalization and outcomes remain unclear.
Purpose: The aims of the study are to (1) characterize patients accepting or refusing referral in the “Taipei Medical Center Emergency Department Referral Program” ; (2) examine the influence of admission timing, emergency boarding time and the receiving regional hospital on clinical outcomes; and (3) determine the differences in mortality and duration of hospitalization between patients who accept or refuse referral from a medical center to a regional hospital. Methods: This was a retrospective cohort study, utilizing data from the urgent patient electronic referral system “Mars”, electronic medical records from one medical center in Taipei and hard copies of referral sheets from receiving regional hospitals. The study included adult patients who were evaluated and considered appropriate for transferring during 1 January to 31 December 2016. We analyzed the prognosis (mortality rate and duration of hospitalization) between patients accepting and refusing referral from the medical center to a regional hospital using multiple logistic regression analysis after propensity score 1:1 matching. The factors related to patient transfers and their influences on outcomes were studied. Results: The rate of transfer to regional hospitals was 26.9%. There were 858 patients evaluated and suggested to transfer to a regional hospital. Of these, 420 patients accepted the referral. Medical records were completed and sent back from regional hospitals for 283 patients. The factors associated with refusing referral included age more than 65 years [odds ratio OR: 0.984, p < 0.001], lower triage mean arterial blood pressure (OR: 1.008, 95%, p = 0.047) and longer duration from triage to request for transferring time (OR: 0.998, p < 0.001). After propensity score matching, inter-hospital transfer was not associated with a difference in in-hospital mortality (p = 0.541). The factors related to in-hospital mortality were higher Charlson comorbidity index (OR: 1.789, p < 0.001), having a “do not resuscitate” order (OR: 45.408, p < 0.001) and having a diagnosis change (OR: 10.212, p = 0.005). The factors related to longer hospital length of stay included higher Charlson comorbidity index (β = 0.148, p < 0.001), discharge diagnosis of pneumonia (β = 0.106, p = 0.003) and cellulitis (β = 0.075, p = 0.03), and more subsequent management after suggesting the transfer (β = 0.32, p < 0.001). However, inter-hospital transfer was associated with shorter total hospital length of stay (β = −0.123, p = 0.005) as well as with direct discharge from emergency department (β = −0.57, p < 0.001). Conclusions: This retrospective propensity score-matching cohort study delineates the age, vital signs, duration from triage to request for transferring time are the major factors which affecting the patient’s willing of transfer. Transferring from an overcrowded emergency department in a medical center to a regional hospital is associated with better outcomes of shorter duration of hospitalization without effects on in-hospital mortality. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T09:06:44Z (GMT). No. of bitstreams: 1 ntu-108-R05426012-1.pdf: 2266395 bytes, checksum: 2261cd31de86b4b1dbbc647e7cefc100 (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | 中文摘要 1
英文摘要 3 第一章 緒論 10 第一節 研究背景與動機 10 第二節 研究目的 13 第二章 文獻查證 14 第一節 急診壅塞之影響 14 第二節 台灣現行急診轉院制度執行現況及成效 17 第三節 轉院病患特性分佈 20 第四節 影響轉院病患預後的因素 23 第三章 研究方法 32 第一節 研究架構 32 第二節 研究設計 34 第三節 研究場所與對象 35 第四節 研究假設 36 第五節 名詞定義 37 第六節 研究工具 43 第七節 研究流程 44 第八節 資料處理與分析 45 第九節 研究倫理考量 49 第四章 研究結果 50 第一節 病患之基本屬性、疾病因素、醫學中心檢傷與轉院特性 52 第二節 影響病患轉院相關因子分析 65 第三節 病歷完整性探討與相關預後分析 67 第四節 續留醫學中心與轉往聯合醫院病患之傾向分數配對 79 第五節 轉院與否與死亡相關性之獨立因子分析 90 第六節 轉院與否與小於48小時不預期住入加護病房之獨立因子分析 92 第七節 轉院與否與住院天數相關之獨立因子分析 92 第五章 討論 94 第一節 影響轉院因素及其相關因素分析 94 第二節 影響死亡之相關因素分析 98 第三節 影響住院天數之相關因素分析 101 第六章 結論與建議 106 第一節 結論 106 第二節 研究限制 107 第三節 建議 108 參考文獻 111 附錄 附錄一 臺大醫院倫理委員會審核研究通過公文 118 圖目錄 圖3-1 研究架構 32 圖3-2 評估轉院流程圖 33 圖4-1 樣本篩選流程圖 51 圖4-2 前十名急診診斷分佈圖 62 圖4-3 前十名出院診斷分佈圖 63 圖4-4 傾向分數機率點狀分佈圖 89 表目錄 表2-1 共變項對預後的影響 30 表3-1 研究問題及統計方法 47 表4-1 基本屬性資料表(配對前) 53 表4-2 過去病史及共病指數資料表(配對前) 54 表4-3 疾病因素分佈(配對前) 55 表4-4 醫學中心檢傷特性資料表(配對前) 57 表4-5 轉院特性資料表(配對前) 58 表4-6 重大手術 60 表4-7 前十疾病診斷分佈 61 表4-8 急診疾病診斷分佈 64 表4-9 出院疾病診斷分佈 64 表4-10 以多變項邏輯回歸分析探討影響轉院之獨立因子 66 表4-11 轉往聯合醫院病患基本屬性資料表 68 表4-12 轉往聯合醫院病患過去病史及共病指數資料表 69 表4-13 基本屬性資料表(配對前) 71 表4-14 過去病史及共病指數資料表(配對前) 72 表4-15 疾病因素分佈(配對前) 74 表4-16 醫學中心檢傷特性資料表(配對前) 76 表4-17 轉院特性資料表(配對前) 77 表4-18 預後資料表(配對前) 78 表4-19 基本屬性資料表(配對後) 80 表4-20 過去病史及共病指數資料表(配對後) 81 表4-21 疾病因素分佈(配對後) 83 表4-22 醫學中心檢傷特性資料表(配對後) 85 表4-23 轉院特性資料表(配對後) 86 表4-24 預後資料表(配對後) 87 表4-25 以多變項邏輯回歸分析探討影響死亡因子 91 表4-26 以多變項線性逐步回歸模式探討影響住院總天數之獨立因子 93 | |
dc.language.iso | zh-TW | |
dc.title | 比較同意或拒絕由醫學中心急診轉入區域醫院住院之病患特性與相關預後 | zh_TW |
dc.title | A Comparison of Patient Characteristics and
Prognosis for Those Who Accept or Refuse Transferring to Regional Hospitals Admission from Emergency Department in Medical Center | en |
dc.type | Thesis | |
dc.date.schoolyear | 108-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 陳石池(Shyr-Chyr Chen),蔡居霖(Chu-Lin Tsai) | |
dc.subject.keyword | 急診壅塞,急診暫留時間,轉院,預後, | zh_TW |
dc.subject.keyword | Emergency department overcrowding,Emergency boarding time,Inter-hospital transfer,Outcomes, | en |
dc.relation.page | 120 | |
dc.identifier.doi | 10.6342/NTU201904426 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-12-25 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 護理學研究所 | zh_TW |
顯示於系所單位: | 護理學系所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-108-1.pdf 目前未授權公開取用 | 2.21 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。