請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/41835
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏 | |
dc.contributor.author | Yu-Yin Fang | en |
dc.contributor.author | 方俞尹 | zh_TW |
dc.date.accessioned | 2021-06-15T00:33:41Z | - |
dc.date.available | 2012-02-10 | |
dc.date.copyright | 2009-02-10 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-01-12 | |
dc.identifier.citation | 中文:
丁淑敏(2001)。過敏氣喘兒。臺北市:健康文化。 中央健康保險局(2001)。全民健康保險氣喘醫療給付改善方案試辦計畫(90年第一版)。臺北市:中央健康保險局。 中央健康保險局(2002)。從為全民購買健康談全民健保五項疾病醫療給付改善方案,為民眾買到健康的健保新理念。全民健康保險雙月刊,35,20-22。 中央健康保險局(2006)。醫療給付改善方案營造三贏局面。全民健康保險雙月刊,62,6-8。 中央健康保險局(2007)。全民健康保險氣喘醫療給付改善方案試辦計畫(96年第四版)。臺北市:中央健康保險局。 中央健康保險局(2007)。實施醫療給付改善方案,全民健保照護成效顯著。全民健康保險雙月刊,67,8-11。 中央健康保險局(2008)。全民健康保險氣喘醫療給付改善方案試辦計畫(97年第五版)。臺北市:中央健康保險局。 王淇俐(2007)。乳癌論質計酬試辦計劃初期成效分析-以南區醫療利用。長榮大學醫務管理學研究所碩士論文,未出版,臺南縣。 石雅慧(2006)。全民健保論質計酬財務誘因之增加是否增加醫療院所參與率—以氣喘為例。國立陽明大學衛生福利研究所碩士論文,未出版,臺北市。 行政院衛生署(2000)。氣喘診療指引。臺北市:行政院衛生署。 行政院衛生署(2007)。民國95年死因統計上冊統計表之歷年死亡統計。2008年8月14日,取自:http://www.doh.gov.tw/statistic/data/衛生統計叢書2/95/上冊/表10.xls/ 李待弟(2007)。全民健康保險糖尿病醫療給付改善方案初步影響評估。臺灣大學衛生政策與管理研究所碩士論文,未出版,臺北市。 杜美蓮(2004)。某醫學中心氣喘疾病管理模式之成效探討。高雄醫學大學公共衛生學研究所碩士在職專班論文,未出版,高雄市。 吳時捷(2003)。實施門診合理量對區域級以上醫院門診利用與費用的影響。臺灣大學醫療機構管理研究所碩士論文,未出版,臺北市。 吳家興、林瑞雄、謝貴雄、邱文達、陳麗美、邱淑媞等人(1998)。臺灣北部國中學生氣喘盛行率調查。中華公共衛生雜誌 ,17,214-225。 周昭宏(2003)。全民健保疾病管理模式運用於氣喘病患連續性照護之成效評估---以南部某區域教學醫院為例。高雄醫學大學公共衛生學研究所碩士在職專班論文,未出版,高雄市。 林慧修(2001)。部分負擔對不同種類醫療服務之影響分析。陽明大學醫務管理研究所碩士論文,未出版,臺北市。 施志和(2004)。整合性照護的初步成效評估---以中區氣喘收治個案為例。長庚大學醫務管理學研究所碩士論文,未出版,桃園縣。 徐世達(2008) 。氣喘病的致病機轉。2008年8月14日,取自 http://www.asthma.idv.tw/contents/essay84.htm 郭珮君(2005)。健康保險支付政策對於病人醫療費用之影響--以加入氣喘論質計酬方案病人為例。義守大學管理研究所碩士論文,未出版,高雄縣。 張雪芬(2002)。論質計酬試辦計畫成效初探-以肺結核疾病為例。中國醫藥學院醫務管理研究所碩士論文,未出版,臺中市。 郭壽雄(主編)(2003)。氣喘、棄喘200問答集。臺北市:臺大醫院胸腔內科。 黃齡儀(2002)。氣喘連續性照護疾病管理成效評估之初探-以高屏分局為例。高雄醫學大學公共衛生學研究所碩士在職專班論文,未出版,高雄市。 葉麗靖(2003)。高屏地區區域醫院全民健保氣喘疾病管理模式之質性探討。高雄醫學大學行為科學研究所碩士論文,未出版,高雄市。 臺灣氣喘諮詢委員會(2007)。臺灣氣喘診療指引,根據2006年GINA編修。2008年8月14日,取自http://www.taiwanasthma.com.tw/download_04.htm 劉貞娟、翁慧卿、蔡魯(2006)。氣喘疾病管理在醫療資源耗用、臨床指標改善與自我照護能力的影響。福爾摩沙醫務管理雜誌,2,36-46。 韓揆(1994)。醫療品質管理及門診服務品質定性指標。中華公共衛生雜誌,13,35-53。 羅健銘,陳素秋,賴允亮,林家瑾,陳建仁(2007)。住院癌末病患照護型態對住院醫療費用與住院天數之影響。臺灣公共衛生雜誌,26,270-282。 英文: Afifi, A. A., Morisky, D. E., Kominski, G. F., & Kotlerman, J. B. (2007). Impact of disease management on health care utilization: Evidence from the 'Florida: A Healthy State (FAHS)' Medicaid Program. Prev Med, 44(6), 547-553. Blaiss, M. S. (2005). Asthma disease management: a critical analysis. Ann Allergy Asthma Immunol, 95(5 Suppl 1), S10-16. Bodenheimer, T. (2000). Disease management in the American market. BMJ, 320(7234), 563-566. Bernard, S. (1997). The role of pharmaceutical companies in disease management. In W. E. Todd & D. Nash (Eds.), Disease management: A systems approach to improving patient outcomes (pp. 179-180). Chicago: American Hospital Association. Card, D., & Sullivan, D. (1988). Measuring the effect of subsidized training programs on movements in and out of employment. Econometrica, 56(3), 497-530. Chou, Y. J., Yip, W. C., Lee, C. H., Huang, N., Sun, Y. P., & Chang, H. J. (2003). Impact of separating drug prescribing and dispensing on provider behaviour: Taiwan's experience. Health Policy Plan, 18(3), 316-329. Cochran, W. G., & Rubin, D. B. (1973). Controlling Bias in Observational Studies: A Review. Sankhy?: The Indian Journal of Statistics, Series A, 35(4), 417-446. Crain, E. F., Weiss, K. B., & Fagan, M. J. (1995). Pediatric asthma care in US emergency departments. Current practice in the context of the National Institutes of Health guidelines. Arch Pediatr Adolesc Med, 149(8), 893-901. D'Agostino, R. B., Jr. (1998). Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med, 17(19), 2265-2281. de Asis, M. L., & Greene, R. (2004). A cost-effectiveness analysis of a peak flow-based asthma education and self-management plan in a high-cost population. J Asthma, 41(5), 559-565. Death from asthma in two regions of England. British Thoracic Association. (1982). Br Med J (Clin Res Ed), 285(6350), 1251-1255. Delaronde, S., Peruccio, D. L., & Bauer, B. J. (2005). Improving asthma treatment in a managed care population. Am J Manag Care, 11(6), 361-368. Disease Management Association of America. (2007). 2007 Annual Report. Retrieved July 14, 2008, from http://www.dmaa.org/pdf/DMAA_2007_Annual_Report.pdf Disease Management Association of America (n.d.). The top six challenges in disease management. Retrieved July 14, 2008, from http://www.dmaa.org/research_documents.asp Donabedian, A. (1980). The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press. Epstein, R. S., & Sherwood, L. M. (1996). From outcomes research to disease management: A guide for the perplexed. Ann Intern Med, 124(9), 832-837. Erickson, S. R., & Kirking, D. M. (2004). Variation in the distribution of patient-reported outcomes based on different definitions of defining asthma severity. Curr Med Res Opin, 20(12), 1863-1872. Franco, R., Santos, A. C., do Nascimento, H. F., Souza-Machado, C., Ponte, E., Souza-Machado, A., et al. (2007). Cost-effectiveness analysis of a state funded programme for control of severe asthma. BMC Public Health, 7, 82. Gallefoss, F., & Bakke, P. S. (2001). Cost-effectiveness of self-management in asthmatics: A 1-yr follow-up randomized, controlled trial. Eur Respir J, 17(2), 206-213. Gruber, J. (1994). The incidence of mandated maternity benefits. Am Econ Rev, 84(3), 622-641. Hintze, J. L. (2007). NCSS user’s guide I.Kaysville, Utah: NCSS. Huang, J. L. (2005). Asthma severity and genetics in Taiwan. J Microbiol Immunol Infect, 38(3), 158-163. Huber, D. L. (Ed.). (2005). Disease management: A guide for case managers. St. Louis, MO.: Elsevier Saunders. Institute for the Future. (2003). Disease management: Weaving disease management into the fabric of patient care. In C. Grosel, M. Hamilton, J. Koyano J., & S. Eastwood (Eds.), Health and health care 2010: The forecast, the challenge (2nd ed., pp. 299-310). Princeton, NJ: Jossey-Bass. Joffe, M. M., & Rosenbaum, P. R. (1999). Invited commentary: Propensity scores. Am J Epidemiol, 150(4), 327-333. Jones, M. A. (2008). Asthma self-management patient education. Respir Care, 53(6), 778-784; discussion 784-776. Jowers, J. R., Schwartz, A. L., Tinkelman, D. G., Reed, K. E., Corsello, P. R., Mazzei, A. A., et al. (2000). Disease management program improves asthma outcomes. Am J Manag Care, 6(5), 585-592. Kao, C. C., Huang, J. L., Ou, L. S., & See, L. C. (2005). The prevalence, severity and seasonal variations of asthma, rhinitis and eczema in Taiwanese schoolchildren. Pediatr Allergy Immunol, 16(5), 408-415. Kauppinen, R., Sintonen, H., & Tukiainen, H. (1998). One-year economic evaluation of intensive vs conventional patient education and supervision for self-management of new asthmatic patients. Respir Med, 92(2), 300-307. Kauppinen, R., Sintonen, H., Vilkka, V., & Tukiainen, H. (1999). Long-term (3-year) economic evaluation of intensive patient education for self-management during the first year in new asthmatics. Respir Med, 93(4), 283-289. Kauppinen, R., Vilkka, V., Sintonen, H., Klaukka, T., & Tukiainen, H. (2001). Long-term economic evaluation of intensive patient education during the first treatment year in newly diagnosed adult asthma. Respir Med, 95(1), 56-63. Lahdensuo, A., Haahtela, T., Herrala, J., Kava, T., Kiviranta, K., Kuusisto, P., et al. (1998). Randomised comparison of cost effectiveness of guided self management and traditional treatment of asthma in Finland. BMJ, 316(7138), 1138-1139. Levy, M. L., Robb, M., Allen, J., Doherty, C., Bland, J. M., & Winter, R. J. (2000). A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. Respir Med, 94(9), 900-908. Linden, A., Berg, G. D., & Wadhwa, S. (2007). Evaluation of a medicaid asthma disease management program. Dis Manag, 10(5), 266-272. Lu, C. Y., Ross-Degnan, D., Soumerai, S. B., & Pearson, S. A. (2008). Interventions designed to improve the quality and efficiency of medication use in managed care: a critical review of the literature - 2001-2007. BMC Health Serv Res, 8, 75. National Health Information (1999). 1999 disease management directory and guidebook. Atlanta, GA: National Health Information. Masoli, M., Fabian, D., Holt, S., & Beasley, R. (2004). The global burden of asthma: Executive summary of the GINA Dissemination Committee report. Allergy, 59(5), 469-478. National Heart Lung and Blood Institute (1996). National Asthma Education and Prevention Program Task Force on the Cost Effectiveness, Quality of Care, and Financing of Asthma Care. Retrieved July 14, 2008, from http://www.nhlbi.nih.gov/health/prof/lung/asthma/ast_cost.htm Neri, M., Migliori, G. B., Spanevello, A., Berra, D., Nicolin, E., Landoni, C. V., et al. (1996). Economic analysis of two structured treatment and teaching programs on asthma. Allergy, 51(5), 313-319. Ng, D. K., Chow, P. Y., Lai, W. P., Chan, K. C., And, B. L., & So, H. Y. (2006). Effect of a structured asthma education program on hospitalized asthmatic children: A randomized controlled study. Pediatr Int, 48(2), 158-162. Radzwill, M.A. (2002). Integration of case and disease management- Why and how? Dis Manage Health Outcomes,10(5),277-289. Rosenbaum, P. R., & Rubin, D. B. (1985). Constructing a Control Group Using Multivariate Matched Sampling Methods That Incorporate the Propensity Score. The American Statistician, 39(1), 33-38. Standard outcome metrics and evaluation methodology for disease management programs. American Healthways and Johns Hopkins Consensus Conference. (2003). Dis Manag, 6(3), 121-138. Steuten, L., Vrijhoef, B., Van Merode, F., Wesseling, G. J., & Spreeuwenberg, C. (2006). Evaluation of a regional disease management programme for patients with asthma or chronic obstructive pulmonary disease. Int J Qual Health Care, 18(6), 429-436. Sullivan, S., Elixhauser, A., Buist, A. S., Luce, B. R., Eisenberg, J., & Weiss, K. B. (1996). National Asthma Education and Prevention Program working group report on the cost effectiveness of asthma care. Am J Respir Crit Care Med, 154(3 Pt 2), S84-95. The Global Initiative for Asthma (2004, May). Global Burden of Asthma. Retrieved July 14, 2008, from http://www.ginasthma.org/ReportItem.asp?l1=2&l2=2&intId=94 The Global Initiative for Asthma (2006, December). Pocket guideline for asthma management and prevention. Retrieved July 14, 2008, from http://www.ginasthma.org/Guidelineitem.asp?l1=2&l2=1&intId=37 The Global Initiative for Asthma (2007, December). Global Strategy for Asthma Management and Prevention. Retrieved July 14, 2008, from http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=60 Todd, W. E.,&Nash, D. (Eds.).(1997). Disease management:A systems approach to improving patient outcomes.Chicago:American Hospital Association. Trautner, C., Richter, B., & Berger, M. (1993). Cost-effectiveness of a structured treatment and teaching programme on asthma. Eur Respir J, 6(10), 1485-1491. Ward, M. D., & Rieve, J. (1995). Disease management: Case management's return to patient-centered care. J Care Manage, 1(4),7-12. Weng, H. C. (2005). Impacts of a government-sponsored outpatient-based disease management program for patients with asthma: a preliminary analysis of national data from Taiwan. Dis Manag, 8(1), 48-58. Yang, B. M., Prescott, N., & Bae, E. Y. (2001). The impact of economic crisis on health-care consumption in Korea. Health Policy Plan, 16(4), 372-385. Yip, W., & Eggleston, K. (2001). Provider payment reform in China: the case of hospital reimbursement in Hainan province. Health Econ, 10(4), 325-339. Zitter, M. (1997). A new paradigm in health care delivery: Disease management. In W.E. Todd & D. Nash (Eds.), Disease management: A systems approach to improving patient outcomes (pp. 1-10). Chicago: American Hospital Association. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/41835 | - |
dc.description.abstract | 目的:
氣喘為全球最常見的慢性病之一,Global Initiative for Asthma(GINA)指出目前全球約有三億人口患有氣喘,預估到了2025年會額外增加約10億人。臺灣地區氣喘盛行率在這三十年間也正大幅上升中,顯示氣喘之高盛行率與嚴重性,也代表了氣喘防治的重要性日漸上升。中央健康保險局於2001年11月開始推動「全民健康保險氣喘醫療給付改善方案試辦計劃」,結合了「論質計酬」與「疾病管理」的概念出發,希望提升照護品質及增進病患自我照護的能力,長期來看有助於醫療費用的降低。本研究即探討「全民健康保險氣喘醫療給付改善方案試辦計畫」介入後的影響,以長期分析與全國性的角度來檢視此計畫結果面的品質,即以醫療資源的使用來當作指標,期能以實證分析結果提供醫療相關單位此氣喘疾病管理計畫之資訊與建議。 方法: 資料取自於中央健康保險局2002年至2006年的全國醫療申報檔,屬於次級資料分析。研究設計為準實驗設計,以加入氣喘醫療給付改善方案者為實驗組母體,未加入方案者為對照組母體,再以傾向分數方法(propensity score method)挑選出最終分析樣本,實驗組為714人,對照組為2142人。實驗組選取加入前一年及加入後三年、對照組則選取2003年至2006年之醫療利用資料,並以差異中之差異法(difference in difference)與複迴歸方法比較兩組醫療利用之差異。 結果: 實驗組在四年的觀察期間門診次數與費用在後測第一年有上升趨勢,其後第二年與第三年皆是下降。急診次數(四年共下降0.13次)與住院次數(四年共下降0.08次),即急性醫療利用方面隨著介入的時間增加是呈現下降的趨勢且兩者在後測的三年和前測相比皆有達到顯著差異。對照組之急診次數(四年共下降0.08次)與住院次數(四年共下降0.05次)之下降幅度都不若實驗組來的多。 在控制實驗組與對照組的前測差異後,實驗組在試辦計畫介入後第一年門診次數比實施前較對照組多2.89次,後測第二年為1.89次,後測第三年為1.57次,差異有縮小趨勢。同樣趨勢也反映在門診費用上(8880元、3602元、2402.3元)。在急性醫療利用方面,急診次數在控制實驗組與對照組的前測差異後,實驗組在試辦計畫介入後第一年急診次數比實施前較對照組少0.02次,後測第二年為少0.06次,後測第三年為少0.05次。住院次數在控制實驗組與對照組的前測差異後,實驗組在試辦計畫介入後第一年住院次數比實施前較對照組少0.02次,後測第二年為少0.02次,後測第三年為少0.03次。由急診次數和住院次數兩組差異中之差異得知在試辦計畫介入後實驗組比對照組較介入前在急性醫療資源的使用上並未明顯減少。在急診費用(5.47、-43.53、-32.03)、住院費用後測兩年(-84.5、-374.93)與住院日數(-0.11、-0.20、-0.11)方面是顯示實驗組使用較低的醫療資源。 探究影響氣喘醫療資源利用的因素,本研究發現實驗組在試辦計畫實施後比實施前之門診次數與費用都比對照組來的多,但有逐年下降的趨勢,且後測三年與前測相比均有達到統計上顯著水準。在急性醫療利用方面,急診次數與費用、住院次數、費用與住院日數皆是年代為主要之影響因素,以所有進行分析的實驗組與對照組來看,後測的三年都比前測來的低且都有達到顯著。與差異中差異的結果我們可知,氣喘醫療給付改善方案的介入實驗組比對照組並未明顯減少急診與住院次數,即使變化方向與本研究的假說相同,但未達統計上顯著差異。 結論: 由長期結果發現實驗組與對照組門診次數的差異有縮小趨勢。在急性醫療利用方面,氣喘試辦計畫的介入實驗組比對照組較介入前雖有較少急診與住院次數,但未明顯減少且未達顯著差異。從此計畫2001年開辦到2008年第五版的方案裡皆尚無針對任何品質表現提供獎勵措施,本研究建議可以對急性醫療利用提出實際獎勵措施,及加強執行面的稽查或檢舉方式,確保疾病管理照護的項目能確實落實,以有效降低急診與住院利用。建議未來可進行成本效果與效益分析與更為精準的評估疾病嚴重度。 | zh_TW |
dc.description.abstract | Objectives:
Asthma is one of the most common chronic diseases in the world. Global Initiative for Asthma (GINA) indicates that there is approximately thirty billion asthma patients in the whole world, and it will increase additionally one hundred billion in 2025. Likewise, the incidence of asthma in Taiwan has rapidly increasing in the past three decades. These facts show the high prevalence and seriousness of asthma and also signify the growing importance of preventing and treating asthma. The Bureau of the National Health Insurance (BNHI) implemented ’The Pay for Performance Program for Asthma’ in 2001, combining ’pay for performance ’ and ‘disease management’ mechanism. The program is to improve the quality of care and empower the patients to take care of themselves, which may reduce the medical expenditure in the long run. The main purpose of this study is to analyze the long-term effect of the ‘The Pay for Performance Program for Asthma’ on medical utilization and expenses. This study hypothesizes that the new payment program may reduce patient’s emergency visit or hospitalization. Methods: In this study, we used BNHI claim data during 2002 to 2006 and employed a quasi-experimental design. Asthma patients who were enrolled into the program were identified as the population of the experimental group, and those who had never been enrolled in this program were defined as the population of the control group. Then we use propensity score method to select our study groups from the populations. Finally, there were 714 patients who were enrolled into the program in 2003 being selected into the experimental group, and 2142 patients in the control group. The healthcare utilization data were identified for every patient a year before and 3 years after the enrollment for the experimental group, while the observation period were 2003 to 2006 for the control group. The data were analyzed by difference-in-difference method and multiple regression models to compare the difference of healthcare utilization between two groups. Results: During the four years, patients in the experimental group had a higher number of physician visit than that of the control group with a dramatic increase in the first year after enrollment and then declined gradually. For the patients in the experimental group, the number of ER visits decreased 0.13 visits and the number of hospitalization decreased 0.08 admissions within the four years, which were significantly greater than the figures for the patients in the control group with 0.08 and 0.05 respectively. The difference-in-difference analysis showed that, after controlling for the baseline patient characteristics in the model, the net differences of the number of physician visit were 2.89, 1.89 and 1.57 respectively between the two groups in the three years. The patients in the experimental group had fewer ER visits than the control group with net differences of 0.02, 0.06 and 0.05 respectively. The numbers of hospital admission were also lower in the experimental group with net differences of 0.02, 0.02 and 0.03 respectively. According to the result, we found that the pay-for-performance program had decreased the ER visit and admission for asthma; however differences were not statistically significant. Conclusions: According to the long-term observation, the pay-for-performance program had increased patient’s physician visit for asthma. We also found that the difference in the numbers of physician visits for asthma between the intervention and control groups had been lessened gradually in the successive years. Patients in the experiment group had fewer emergency visits or inpatient admissions than the control group after the intervention, but the differences were not statistically significant. Further study can focus on cost-effectiveness analysis and cost-benefit analysis for the pay-for-performance program with more appropriate measures for care outcome. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T00:33:41Z (GMT). No. of bitstreams: 1 ntu-98-R96845102-1.pdf: 849627 bytes, checksum: e5d891e181b96d97daf16253dab53f7a (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iii Abstract vi 目錄 ix 表目錄 xii 圖目錄 xiv 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 氣喘 4 第二節 疾病管理 13 第三節 國外疾病管理之實證研究 20 第四節 國內氣喘疾病管理計畫 24 第五節 國內氣喘疾病管理之實證研究 27 第三章 材料與方法 31 第一節 研究設計與假說 31 第二節 研究對象與材料 32 第三節 研究變項與操作型定義 34 第四節 資料處理 38 第五節 統計方法 45 第四章 研究結果 49 第一節 樣本描述性統計 49 第二節 分析樣本之醫療資源利用比較 50 第三節 分析樣本醫療利用之多變量分析 56 第四節 小結 61 第五章 討論 83 第一節 研究方法之討論 83 第二節 研究結果之討論 86 第三節 研究限制 91 第六章 結論與建議 98 第一節 結論 98 第二節 建議 100 參考文獻 102 附錄一 全民健康保險氣喘醫療給付改善方案試辦計畫第一版 108 附錄二 全民健康保險氣喘醫療給付改善方案試辦計畫第二版 123 附錄三 全民健康保險氣喘醫療給付改善方案試辦計畫第三版 137 附錄四 全民健康保險氣喘醫療給付改善方案試辦計畫第四版 141 附錄五 全民健康保險氣喘醫療給付改善方案試辦計畫第五版 147 附錄六 判定氣喘疾病嚴重度之藥物與醫令代碼 151 表目錄 表2 1 氣喘疾病嚴重度分類 6 表2 2 主要國家氣喘盛行率 12 表2 3 疾病管理結果面評估之種類 20 表2 4 國內氣喘疾病管理研究整理表 30 表3-1 氣喘疾病嚴重度分類 36 表3-2 研究變項操作型定義與資料來源 37 表3-3 迴歸模型 48 表4-1 研究母群體之描述性統計 64 表4-2 分析樣本之描述性統計 65 表4-3 研究母群體之獨立檢定 70 表4-4 分析樣本之獨立檢定 71 表4-5 分析樣本之配對檢定 72 表4-6 分析樣本實驗組與對照組氣喘病每人平均就醫次數及住院日數之前後差異 74 表4-7 分析樣本實驗組與對照組氣喘病每人平均醫療費用之前後差異 75 表4-8 影響氣喘前後測門診次數之因素以負二項式線性複迴歸分析結果 76 表4-9 影響氣喘前後測門診費用之因素以線性複迴歸分析結果 77 表4-10 影響氣喘前後測急診次數之因素以負二項式線性複迴歸分析結果 78 表4-11 影響氣喘前後測急診費用之因素以線性複迴歸分析結果 79 表4-12 影響氣喘前後測住院次數之因素以負二項式線性複迴歸分析結果 80 表4-13 影響氣喘前後測住院費用之因素以線性複迴歸分析結果 81 表4-14 影響氣喘前後測住院日數之因素以線性複迴歸分析結果 82 表5-1 實驗組醫療資源利用之比較 93 表5-2 實驗組與對照組醫療資源利用之比較 96 圖目錄 圖2 1 氣喘診療的三大循環要點 9 圖2-2 管理式照護的演進 14 圖3-1 樣本選取基準期與測量期間示意圖 34 圖3-2 傾向分數估計值分布圖 41 圖3-3 研究樣本選取流程圖 44 圖4-1 實驗組與對照組每人平均門診次數 66 圖4-2 實驗組與對照組每人平均門診費用 66 圖4-3 實驗組與對照組每人平均急診次數 67 圖4-4 實驗組與對照組每人平均急診費用 67 圖4-5 實驗組與對照組每人平均住院次數 68 圖4-6 實驗組與對照組每人平均住院費用 68 圖4-7 實驗組與對照組每人平均住院日數 69 | |
dc.language.iso | zh-TW | |
dc.title | 全民健康保險氣喘醫療給付改善方案長期影響評估 | zh_TW |
dc.title | Long-term evaluation of asthma disease management and pay-for-performance program under National Health Insurance in Taiwan | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 楊長興,翁慧卿 | |
dc.subject.keyword | 氣喘,醫療利用,疾病管理,論質計酬,品質, | zh_TW |
dc.subject.keyword | asthma,healthcare utilization,disease management,pay-for-performance,quality of care, | en |
dc.relation.page | 154 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-01-12 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 衛生政策與管理研究所 | zh_TW |
顯示於系所單位: | 健康政策與管理研究所 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
ntu-98-1.pdf 目前未授權公開取用 | 829.71 kB | 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。