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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/24798完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 楊銘欽 | |
| dc.contributor.author | Yu-Chia Chang | en |
| dc.contributor.author | 張育嘉 | zh_TW |
| dc.date.accessioned | 2021-06-08T05:56:34Z | - |
| dc.date.copyright | 2008-02-20 | |
| dc.date.issued | 2008 | |
| dc.date.submitted | 2008-01-29 | |
| dc.identifier.citation | 一、中文部分
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/24798 | - |
| dc.description.abstract | 背景：近三十年來，「服務量-照護結果」的研究大都贊同服務量愈高，照護結果愈好的關係，不過，由於大部分的研究均屬於橫斷性研究設計，研究結果僅能驗證服務量與照護結果間的相關性，並無法驗證服務量對照護結果的影響，因此值得深入探討。
目的：探討新進開始執行冠狀動脈繞道手術(Coronary Artery Bypass Graft Surgery; CABG)的心臟外科醫師(以下簡稱「新進醫師」)，隨著CABG手術經驗的累積，對病患照護結果的影響。希望藉此一長期資料之研究設計，驗證「服務量-照護結果」之熟能生巧效果。 方法：利用1997-2005年全民健康保險學術研究資料庫，擷取2000年至2005年6月間，接受新進醫師執行CABG手術之病患的相關資料。在控制病患特質、醫師特質、醫院特質及年份等變項後，以廣義估計方程式分析隨著新進醫師手術經驗的累積，病患之住院期間死亡機率、住院期間及出院當天死亡機率、住院期間及出院後30天內死亡機率、出院後30天內因相關疾病再住院機率、住院天數及醫療費用的變化情形。 結果：2000年至2005年6月間，共有3,063位病患接受68名CABG新進醫師執行手術。研究結果顯示，隨著新進醫師累積的手術經驗愈多，病患之「住院期間死亡機率」、「住院期間及出院當天死亡機率」及「住院期間及出院後30天內死亡機率」均愈低。此外，新進醫師之累積手術經驗亦與「住院天數」及「醫療費用」呈現顯著的負相關趨勢。不過，新進醫師累積手術經驗與病患之「出院後30天內因相關疾病再住院機率」則無顯著相關。敏感度分析亦呈現相同的研究結果。 結論：隨著CABG新進醫師累積的手術經驗愈多，病患的照護結果愈好，驗證了CABG新進醫師「熟能生巧」之效果。 | zh_TW |
| dc.description.abstract | Background: In the past three decades, many “volume-outcome” studies have supported the hypothesis that higher volume was associated with better outcomes. However, most studies were based on cross-sectional design, and their results only demonstrated the association between volume and outcome, but not the effect of volume on outcome.
Purpose: This study aimed to examine the practice-makes-perfect effect on care outcomes by using longitudinal data to examine how the accumulated experience of Coronary Artery Bypass Graft Surgery (CABG) operation done by junior surgeon may affect patients’ health outcomes. Methods: Data came from 1997-2005 National Health Insurance Database. Patients received CABGs by junior surgeon between 2000 to 2005/06 were identified. Major health outcomes included in-hospital mortality rate, mortality rate during the period from admission to discharge, mortality rate during the period from admission to 30 days after discharge, and readmission rate within 30 days after discharge. Other outcomes, including length of length of hospital stay and medical fees, were also examined. Generalized Estimating Equations(GEE) were used to estimate the effect of volume on outcome after adjusting selected characteristics of patients, surgeons, and hospitals. Results: Sixty-eight junior surgeons performed CABGs for 3,063 patients during 2000 to 2005/06. All major health outcomes, except for readmission rate within 30 days after discharge, were significantly better among patients receiving CABGs as surgeons’ experience accumulated. In addition, surgeons’ volume was inversely associated with length of hospital stay and medical fees. Sensitivity analyses revealed the same results. Conclusions: As junior surgeons’ CABGs experience accumulated, patients’ outcomes tend to become better. The finding supports the effect of 'practice-makes-perfect' by junior surgeons performing CABGs. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-08T05:56:34Z (GMT). No. of bitstreams: 1 ntu-97-D91843003-1.pdf: 896673 bytes, checksum: b5070184e311d55b1cf50264dd0733b9 (MD5) Previous issue date: 2008 | en |
| dc.description.tableofcontents | 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 3 第二章 文獻探討 5 第一節 「服務量-照護結果」的研究歷程及應用情形 5 第二節 CABG手術的簡介及影響照護結果的相關因素 19 第三節 CABG手術之「服務量-照護結果」相關研究成果 23 第四節 探討「服務量-照護結果」因果關係之相關研究 32 第五節 綜合評論 38 第三章 材料與方法 39 第一節 研究架構 39 第二節 研究假說 41 第三節 資料來源與研究對象 42 第四節 研究變項定義 44 第五節 資料分析 48 第四章 結果 51 第一節 描述性統計結果 51 第二節 雙變項分析結果 62 第三節 多變項分析結果 79 第四節 敏感度分析結果 96 第五節 累積手術經驗與照護結果關係圖 110 第五章 討論 113 第一節 研究設計與方法之討論 113 第二節 研究對象基本特質之討論 118 第三節 醫師累積手術經驗與照護結果相關性之討論 121 第四節 其它控制變項與照護結果之關係的討論 127 第五節 研究限制 128 第六章 結論與建議 129 第一節 結論 129 第二節 建議 131 參考文獻 133 附錄A 144 附錄B 145 附錄C 147 | |
| dc.language.iso | zh-TW | |
| dc.subject | 冠狀動脈繞道手術 | zh_TW |
| dc.subject | 長期資料 | zh_TW |
| dc.subject | 新進醫師 | zh_TW |
| dc.subject | 服務量-照護結果 | zh_TW |
| dc.subject | 熟能生巧效果 | zh_TW |
| dc.subject | junior surgeon | en |
| dc.subject | longitudinal data | en |
| dc.subject | Coronary Artery Bypass Graft Surgery | en |
| dc.subject | practice-makes-perfect effect | en |
| dc.subject | volume-outcome | en |
| dc.title | 利用長期資料探討新進醫師之服務量-照護結果的熟能生巧效果
－以冠狀動脈繞道手術為例 | zh_TW |
| dc.title | A Longitudinal Study Exploring Junior Surgeons' Practice-makes-perfect Effect between Volume and Outcome
--Using Coronary Artery Bypass Graft Surgery as an Example | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 96-1 | |
| dc.description.degree | 博士 | |
| dc.contributor.oralexamcommittee | 楊志良,江東亮,李丞華,吳肖琪,鄭守夏,虞希禹 | |
| dc.subject.keyword | 服務量-照護結果,熟能生巧效果,冠狀動脈繞道手術,新進醫師,長期資料, | zh_TW |
| dc.subject.keyword | volume-outcome,practice-makes-perfect effect,Coronary Artery Bypass Graft Surgery,junior surgeon,longitudinal data, | en |
| dc.relation.page | 147 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2008-01-29 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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