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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 楊銘欽 | |
dc.contributor.author | Hsiao-Hsuan Chiu | en |
dc.contributor.author | 邱曉萱 | zh_TW |
dc.date.accessioned | 2021-06-13T05:56:58Z | - |
dc.date.available | 2007-07-31 | |
dc.date.copyright | 2006-07-31 | |
dc.date.issued | 2006 | |
dc.date.submitted | 2006-06-28 | |
dc.identifier.citation | 【中文部分】
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/34175 | - |
dc.description.abstract | 本研究目的在於分別由病人和醫院觀點,分析內科ICU轉出的病人,住在中繼照護病房(以下簡稱中繼組)或普通病房(以下簡稱普通組)等兩種照護方式的成本與效果。資料分析所需之參數,主要來源是台北市某醫學中心,不足之處則由專家意見、文獻補足。
本研究的重要結果如下: (1)從2004年10月起到2005年底期間,轉出內科ICU的病人中,有279位符合轉到中繼病房或普通病房。轉入中繼病房的101位病人中,有9位在轉出ICU七天內發生重返、另有5位死亡,重返比率為8.91%(含死亡為13.86%);轉入普通病房的178位病人中,有18位在轉出ICU七天內發生重返、另有13位死亡,重返比率為10.11% (含死亡為17.42%)。根據此一效果,中繼組較普通組佳。 (2)以醫院觀點而言,中繼組每人每天成本為7886.08元,普通組每人每天成本為7572.01元,中繼組比普通組多了314.07元。 (3)以病人觀點而言,中繼組每人每天成本為3513.29元,普通組每人每天成本為3032.97元,中繼組比普通組多了480.32元。 (4) 以醫院觀點而言,相較於普通組,使一位病人因轉入中繼而使七天內的重返降低1%,則醫院需要多支出的成本為2197.99元,平均一天要花費314元;若包括降低死亡的機會,則七天需多支出617.55元,平均每天多支出88.22元。以普通組為基準校正後,則七天內降低1%重返機會,需多支出的成本降為473.63元,包含死亡則降為98.68元。 (5)以病人觀點而言,相較於普通組,使一位病人因轉入中繼而使七天內重返降低1%的機會,則每人需多付出的成本為2861.87元,平均一天要花費408.84元;若包括降低死亡的機會,則七天需多花134.92元,平均每人每天多花134.92元。以普通組為基準校正後,則七天內降低1%重返機會需多花的成本降為1059.4元,包含死亡則降為221.17元。 本研究結論為中繼照護病床雖然會花費較高的成本,但也有較好的效果,考量到以病人為中心的重要性以及總額支付制度,建議醫院可以考慮發展中繼照護病床。 | zh_TW |
dc.description.abstract | Readmission to ICU will use a lot of medical resources, and patients’ prognosis would be bad. For these reasons, the readmission rate is long regarded as an important medical quality indicator. The study hospital recently set up an intermediate care ward use assessment tools to identify those with high readmission risk from ICU discharge patients. a lower nurse to bed ratio, the medical team will focus on the cooperation and communication about the discharge plan with patients and their relatives. In this unit, patients would receive the connective therapy and be transferred to the general ward when they are stable. It is believed that this unit could reduce the incidence of readmission to ICU.
The purpose of this study is to estimate in the cost and effectiveness of patients transferred to the intermediate care ward and to the general ward after they were discharged from the ICU. The analysis was conducted from the viewpoints of hospital and patients, respectively. Main source of parameters for analysis came from the study medical center in Taipei City, only limited data came from expert opinions and existing literature. The major results of this study are as follow: (1) From October, 2004 to the end of 2005, there were 279 patients discharged from the medical ICU who were qualify to be transferred to either the intermediate care ward or general wards. Among 101 patients transferred to the intermediate care ward, 9 patients readmitted to ICU and, in addition, 5 patients died in 7 days since they had discharged from ICU. The readmission rate of intermediate care ward is 8.91% (13.86% including death). On the other sidehand, among 178 patients transferred to general wards were collected in group2, 18 patients readmitted to ICU and additional 13 patients died in 7 days since discharged from ICU. The readmission rate of general ward is 10.11% (17.42% including death). Judging from the readmission rates, the intermediate care ward is more effective than general wards. (2) In the view of the hospital, the cost per patient per day of intermediate care ward is $ 7886.08 and the cost of general ward is $ 7572.01. (3) In the view of patients, the cost per patient per day of intermediate care ward is $ 353.29 and the cost of general ward is $ 480.32. (4)In the view of the hospital, compared to general ward, the cost of reducing 1% readmission rate is $2197.99 ($617.55 if including death) in 7 days after a patients was admitted to the intermediate care ward. If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $473.63($98.68 if including death) (5)In the view of patients, compared to general ward, the cost of reducing 1% readmission rate is $1497.01 ($504.61 if including reducing death). If both cost and outcome are adjusted on the basis of general ward group, then the ICER in 7 days would be reduced to $1059.4($224.17 if including death) We conclude that the intermediate care ward will cost more then general wards but reduce more admission rate and death rate within7 days after patients were discharged from ICU. It is worthwhile for hospitals to consider establishing an intermediate care ward. | en |
dc.description.provenance | Made available in DSpace on 2021-06-13T05:56:58Z (GMT). No. of bitstreams: 1 ntu-95-R93843002-1.pdf: 682908 bytes, checksum: 269c744e31a8245b5f752dedeb52d80f (MD5) Previous issue date: 2006 | en |
dc.description.tableofcontents | 誌 謝 II
中文摘要 IV Abstract VI 表目錄 IX 圖目錄 XI 附錄目錄 XI 第一章 緒論 1 第一節 研究背景 1 第二節 研究動機 3 第三節 研究目的 6 第四節 研究預期貢獻 7 第二章 文獻探討 8 第一節 重返ICU之相關研究 8 第二節 中繼照護的發展與中繼照護病床的設置 13 第三節 醫療經濟評估方法 21 第四節 中繼照護臨床的實證研究及經濟評估 26 第五節 綜合討論 32 第三章 研究設計與方法 34 第一節 研究設計 34 第二節 研究假說 37 第三節 研究變項與定義 38 第四節 研究材料與分析方法 43 第四章 研究結果 45 第一節 由醫院觀點估計照護成本 45 第二節 醫院其他成本與親友自費成本 56 第三節 病人觀點成本 69 第四節 效果評估 77 第五節 成本效果分析 87 第五章 討論 93 第一節 研究結果討論 93 第二節 研究限制 104 第六章 結論與建議 106 第一節 結論 106 第二節 建議 108 參考文獻 110 表目錄 表2-1中繼照護的三種理論模式 15 表2-2不同層級單位的人力和設備 18 表2-3 中繼照護病床跟conventional Model的比較 20 表2-4 經濟評估分類 21 表2-5中繼照護單位的臨床實證研究 26 表3-1 本研究的人口學變項 38 表3-2 醫院成本變項(每床每日) 39 表3-3病人成本變項 40 表4-1 中繼照護病床及內科部病房佔床率 46 表4-2中繼照護病床及內科部病房病床週轉率 47 表4-3中繼照護病床與普通病房每人每天人事成本 51 表4-4 各病房平均每月成本 53 表4-5 中繼照護病床與普通病房平均每床每月成本 54 表4-6 中繼照護病床與普通病房平均每床每日成本 54 表4-7 各組使用各醫療項目情形 58 表4-8 ICU轉出後中繼組病人在中繼照護病床、普通組病人在普通病房住 院前七天期間每人每天各醫療項目金額檢定結果(未去極值) 60 表4-9 ICU轉出後中繼組病人在中繼照護病床、普通組病人在普通病房住院前七天期間每人每天全部醫療項目金額檢定結果(未去極值) 60 表4-10 ICU轉出後中繼組病人在中繼照護病床、普通組病人在普通病房住院前七天期間每人每天各醫療項目金額檢定結果(去極值) 63 表 4-11 ICU轉出後中繼組病人在中繼照護病床、普通組病人在普通病房住院前七天期間每人每天全部醫療項目金額檢定結果(去極值) 63 表4-12病人特質與所有醫療項目每人每天自費金額對數值之複迴歸分...65 表4-13病人特質與所有醫療項目每人每天健保申報金額對數值複迴歸…66 表4-14 醫院觀點計價藥品醫材與其他醫療服務每人每天成本 68 表4-15受訪親友照顧之病人特質描述性統計 71 表4-16 受訪親友照顧病人所使用的成本項目與數量 72 表4-17 受訪親友照顧病人所使用的成本項目與金額(每人每天) 73 表4-18 受訪親友所照顧的病人特質雙變項統計分析結果 75 表4-19-A 不同組別間親友所照顧病人花費的成本項目分析 76 表4-19-B不同組別間親友所照顧病人花費的成本項目金額分析 76 表4-20-A 轉出ICU中繼和普通組病人特質分佈檢定結果 79 表4-20-B 轉出ICU中繼和普通組病人特質分佈檢定結果 79 表4-21 轉出ICU中繼和普通組病人七天內是否重返ICU與第七天情況分佈檢定結果 80 表4-22-A 七天內是否重返ICU與病人特質、住院結果間分佈檢定結果 82 表4-22-B 七天內是否重返ICU與病人特質、住院結果間分佈檢定結果 82 表4-23-A 轉出7天內情況與病人特質、住院結果間分佈檢定結果 83 表4-23-B 轉出7天內情況與病人特質、住院結果間分佈檢定結果 83 表4-24 病人特質與七天內是否重返之羅吉斯迴歸分析重返 85 表4-25 病人特質與七天內是否重返或死亡之羅吉斯迴歸分析 86 表4-26 中繼和普通組每人每天成本一覽 87 表4-27 中繼和普通兩組間效果 87 表4-28 醫院觀點敏感度分析結果 90 表4-29 病人觀點敏感度分析 90 表4-30 以普通組為基準校正之成本與結果 92 表4-31 校正後之ICER值 92 圖目錄 圖1-1 2002年TQIP非計畫性重返ICU比率 2 圖1-2 個案醫院非計畫性重返ICU比率統計 3 圖2-1 台大醫院90至92年非計畫性ICU重返率 9 圖3-1研究對象篩選流程 35 圖3-2研究架構 36 圖4-1 中繼照護病床及內科部病房佔床率(%) 46 圖4-2中繼照護病床及內科部病房病床週轉率 47 圖5-1個案醫院內科ICU轉出人次 94 圖6-1 醫院觀點成本效果圖-校正前..................100 圖6-2 病人觀點成本效果圖-校正前...................100 圖6-3 醫院觀點成本效果圖-校正後....................102 圖6-4 病人觀點成本效果圖-校正後...................103 附錄目錄 附錄一 本研究問卷 115 | |
dc.language.iso | zh-TW | |
dc.title | 中繼照護病床之成本效果分析-以台北市某醫學中心為例 | zh_TW |
dc.title | A Cost-Effectiveness Analysis of the Intermediate Care Ward-The Case of A Medical Center in Taipei City | en |
dc.type | Thesis | |
dc.date.schoolyear | 94-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 湯澡薰,古世基 | |
dc.subject.keyword | 中繼照護病床,經濟評估,成本效果分析, | zh_TW |
dc.subject.keyword | Intermediate Care Ward,Economic Evaluation,Cost-effectiveness Analysis, | en |
dc.relation.page | 119 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2006-06-29 | |
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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