請用此 Handle URI 來引用此文件：
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82301完整後設資料紀錄
| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 郭年真(Raymond N. Kuo) | |
| dc.contributor.author | Yi-Hsin Hsu | en |
| dc.contributor.author | 許譯心 | zh_TW |
| dc.date.accessioned | 2022-11-25T06:35:19Z | - |
| dc.date.copyright | 2021-11-09 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2021-09-06 | |
| dc.identifier.citation | Bailey, J. E., Pope, R. A., Elliott, E. C., Wan, J. Y., Waters, T. M., Frisse, M. E. (2013). Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain [Article; Proceedings Paper]. Annals of Emergency Medicine, 62(1), 16-24. https://doi.org/10.1016/j.annemergmed.2013.01.006 Bailey, J. E., Wan, J. Y., Mabry, L. M., Landy, S. H., Pope, R. A., Waters, T. M., Frisse, M. E. (2013). Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department? [Article]. Journal of General Internal Medicine, 28(2), 176-183. https://doi.org/10.1007/s11606-012-2092-7 Bible, J. E., Kadakia, R. J., Kay, H. F., Zhang, C. E., Casimir, G. E., Devin, C. J. (2014). Repeat spine imaging in transferred emergency department patients [Article]. Spine, 39(4), 291-296. https://doi.org/10.1097/BRS.0000000000000137 Carr, C. M., Gilman, C. S., Krywko, D. M., Moore, H. E., Walker, B. J., Saef, S. H. (2014). Observational Study and Estimate of Cost Savings from Use of a Health Information Exchange in an Academic Emergency Department. The Journal of Emergency Medicine, 46(2), 250-256. https://doi.org/https://doi.org/10.1016/j.jemermed.2013.05.068 Chen, R.-C., Lin, H.-C., Chu, D., Chen, T., Hung, S.-T., Kuo, N.-W. (2011). Physicians’ characteristics associated with repeat use of computed tomography and magnetic resonance imaging. Journal of the Formosan Medical Association, 110(9), 587-592. https://doi.org/https://doi.org/10.1016/j.jfma.2011.07.006 Chen, R. C., Chu, D. C., Lin, H. C., Chen, T., Hung, S. T., Kuo, N. W. (2012). Association of Hospital Characteristics and Diagnosis With the Repeat Use of CT and MRI: A Nationwide Population-Based Study in an Asian Country [Article]. American Journal of Roentgenology, 198(4), 858-865. https://doi.org/10.2214/ajr.11.6475 Cook, S. H., Fielding, J. R., Phillips, J. D. (2010). Repeat abdominal computed tomography scans after pediatric blunt abdominal trauma: missed injuries, extra costs, and unnecessary radiation exposure. Journal of Pediatric Surgery, 45(10), 2019-2024. https://doi.org/https://doi.org/10.1016/j.jpedsurg.2010.06.007 Emick, D. M., Carey, T. S., Charles, A. G., Shapiro, M. L. (2012). Repeat imaging in trauma transfers: A retrospective analysis of computed tomography scans repeated upon arrival to a Level i trauma center [Article]. Journal of Trauma and Acute Care Surgery, 72(5), 1255-1262. https://doi.org/10.1097/TA.0b013e3182452b6f Farach, S. M., Danielson, P. D., Amankwah, E. K., Chandler, N. M. (2015). Repeat computed tomography scans after pediatric trauma: results of an institutional effort to minimize radiation exposure. Pediatric Surgery International, 31(11), 1027-1033. https://doi.org/10.1007/s00383-015-3757-1 Frisse, M. E., Johnson, K. B., Nian, H., Davison, C. L., Gadd, C. S., Unertl, K. M., Turri, P. A., Chen, Q. (2011). The financial impact of health information exchange on emergency department care. Journal of the American Medical Informatics Association, 19(3), 328-333. https://doi.org/10.1136/amiajnl-2011-000394 %J Journal of the American Medical Informatics Association Gupta, R., Greer, S. E., Martin, E. D. (2010). Inefficiencies in a rural trauma system: The burden of repeat imaging in interfacility transfers [Article]. Journal of Trauma - Injury, Infection and Critical Care, 69(2), 253-255. https://doi.org/10.1097/TA.0b013e3181e4d579 Haley, T., Ghaemmaghami, V., Loftus, T., Gerkin, R. D., Sterrett, R., Ferrara, J. J. (2009). Trauma: the impact of repeat imaging. The American Journal of Surgery, 198(6), 858-862. https://doi.org/https://doi.org/10.1016/j.amjsurg.2009.05.030 Harvey L. Neiman Health Policy Institute. (2013). Repeat Medical Imaging: A Classification System for Meaningful Policy Analysis and Research. https://www.neimanhpi.org/policy-briefs/neiman-report-brief-2-repeat-medical-imaging-a-classification-system-for-meaningful-policy-analysis-and-research/ Hripcsak, G., Sengupta, S., Wilcox, A., Green, R. A. (2007). Emergency Department Access to a Longitudinal Medical Record. Journal of the American Medical Informatics Association, 14(2), 235-238. https://doi.org/10.1197/jamia.M2206 Ip, I. K., Mortele, K. J., Prevedello, L. M., Khorasani, R. (2012). Repeat Abdominal Imaging Examinations in a Tertiary Care Hospital [Article]. American Journal of Medicine, 125(2), 155-161. https://doi.org/10.1016/j.amjmed.2011.03.031 Jones, A. C., Woldemikael, D., Fisher, T., Hobbs, G. R., Prud'Homme, B. J., Bal, G. K. (2012). Repeated computed tomographic scans in transferred trauma patients: Indications, costs, and radiation exposure [Article]. Journal of Trauma and Acute Care Surgery, 73(6), 1564-1569. https://doi.org/10.1097/TA.0b013e31826fc85f Jung, H. Y., Vest, J. R., Unruh, M. A., Kern, L. M., Kaushal, R., Investigators, H. (2015). Use of Health Information Exchange and Repeat Imaging Costs [Article]. Journal of the American College of Radiology, 12(12), 1364-1370. https://doi.org/10.1016/j.jacr.2015.09.010 Kamat, A. B., Midgley, S., Kimbrell, K. (2015). Duplication of radiology imaging studies in the emergency department: what is the cost? Emergency Medicine Journal, 32(2), 144. https://doi.org/10.1136/emermed-2013-203136 Kuperman, G. J. (2011). Health-information exchange: why are we doing it, and what are we doing? Journal of the American Medical Informatics Association : JAMIA, 18(5), 678-682. https://doi.org/10.1136/amiajnl-2010-000021 Lammers, E. J., Adler-Milstein, J., Kocher, K. E. (2014). Does health information exchange reduce redundant imaging? Evidence from emergency departments. Med Care, 52(3), 227-234. https://doi.org/10.1097/mlr.0000000000000067 Lang, E., Afilalo, M., Vandal, A. C., Boivin, J.-F., Xue, X., Colacone, A., Léger, R., Shrier, I., Rosenthal, S. (2006). Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. Canadian Medical Association Journal. https://doi.org/10.1503/cmaj.050698 Lee, S. I., Saokar, A., Dreyer, K. J., Weilburg, J. B., Thrall, J. H., Hahn, P. F. (2007). Does radiologist recommendation for follow-up with the same imaging modality contribute substantially to high-cost imaging volume? [Article; Proceedings Paper]. Radiology, 242(3), 857-864. https://doi.org/10.1148/radiol.2423051754 Liepert, A. E., Bledsoe, J., Stevens, M. H., Cochran, A. (2014). Protecting trauma patients from duplicated computed tomography scans: the relevance of integrated care systems. The American Journal of Surgery, 208(4), 511-516. https://doi.org/https://doi.org/10.1016/j.amjsurg.2014.05.014 Liepert, A. E., Cochran, A. (2011). CT Utilization in Transferred Trauma Patients. Journal of Surgical Research, 170(2), 309-313. https://doi.org/https://doi.org/10.1016/j.jss.2011.06.018 Lin, J. H., Cheng, S. H. (2018). The impact of a medication record sharing program among diabetes patients under a single-payer system: The role of inquiry rate [Article]. International Journal of Medical Informatics, 116, 18-23. https://doi.org/10.1016/j.ijmedinf.2018.05.004 Moore, H. B., Loomis, S. B., Destigter, K. K., Mann-Gow, T., Dorf, L., Streeter, M. H., Ebert, G. M., Crookes, B. A., Leffler, S. M., O'Keefe, M. F., Freeman, K. (2013). Airway, breathing, computed tomographic scanning: duplicate computed tomographic imaging after transfer to trauma center. The journal of trauma and acute care surgery, 74(3), 813-817. https://doi.org/10.1097/ta.0b013e3182789399 Organization for Economic Cooperation and Development. (2020). Computed tomography (CT) exams. Retrieved from https://data.oecd.org/healthcare/computed-tomography-ct-exams.htm Organization, G. R. R. H. I. (2020年4月13日). About Rochester RHIO. https://rochesterrhio.org/ Park, H., Lee, S.-i., Hwang, H., Kim, Y., Heo, E.-Y., Kim, J.-W., Ha, K. (2015). Can a health information exchange save healthcare costs? Evidence from a pilot program in South Korea. International Journal of Medical Informatics, 84(9), 658-666. https://doi.org/https://doi.org/10.1016/j.ijmedinf.2015.05.008 Park, Y.-T., Han, D. (2017). Current Status of Electronic Medical Record Systems in Hospitals and Clinics in Korea. Healthcare informatics research, 23(3), 189-198. https://doi.org/10.4258/hir.2017.23.3.189 Quan, H., Sundararajan, V., Halfon, P., Fong, A., Burnand, B., Luthi, J. C., Saunders, L. D., Beck, C. A., Feasby, T. E., Ghali, W. A. (2005). Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care, 43(11), 1130-1139. https://doi.org/10.1097/01.mlr.0000182534.19832.83 Saef, S. H., Melvin, C. L., Carr, C. M. (2014). Impact of a health information exchange on resource use and Medicare-allowable reimbursements at 11 emergency departments in a midsized city. West J Emerg Med, 15(7), 777-785. https://doi.org/10.5811/westjem.2014.9.21311 Sung, J. C., Sodickson, A., Ledbetter, S. (2009). Outside CT Imaging Among Emergency Department Transfer Patients. Journal of the American College of Radiology, 6(9), 626-632. https://doi.org/https://doi.org/10.1016/j.jacr.2009.04.010 Tung, M., Sharma, R., Hinson, J. S., Nothelle, S., Pannikottu, J., Segal, J. B. (2018). Factors associated with imaging overuse in the emergency department: A systematic review. Am J Emerg Med, 36(2), 301-309. https://doi.org/10.1016/j.ajem.2017.10.049 Vest, J. R., Kaushal, R., Silver, M. D., Hentel, K., Kern, L. M. (2014). Health Information Exchange and the Frequency of Repeat Medical Imaging [Article]. American Journal of Managed Care, 20, ESP16-+. <Go to ISI>://WOS:000351003100003 Welk, B., Liu, K., Al-Jaishi, A., McArthur, E., Jain, A. K., Ordon, M. (2016). Repeated Diagnostic Imaging Studies in Ontario and the Impact of Health Information Exchange Systems. Healthcare quarterly (Toronto, Ont.), 19(1), 24-28. https://doi.org/10.12927/hcq.2016.24613 Young, A. J., Sadlermeyers, K., Wolfe, L., Marieduane, T. (2012). Repeat Computed Tomography for Trauma Patients Undergoing Transfer to a Level I Trauma Center. The American Surgeon, 78(6), 675-678. https://doi.org/10.1177/000313481207800621 內政部戶政司. (2020年10月). 人口統計資料. https://www.ris.gov.tw/app/portal/346 古乙岑. (2018). 探討低價值服務利用趨勢及影響因素 －以下背痛患者使用診斷性造影為例 (Publication Number 2018年) 國立臺灣大學]. AiritiLibrary. 石貴珊. (2020). 探討健保醫療資訊雲端查詢系統之醫療影像查詢與門診CT、MRI 30日、60日內重複檢查之相關性 (Publication Number 2020年) 中國醫藥大學]. AiritiLibrary. 吳潔人. (2019). 探討醫師開立低價值醫療利用之相關因素—以高階影像檢查為例 (Publication Number 2019年) 國立臺灣大學]. AiritiLibrary. 林佩璉. (2006). 高科技醫療儀器多次使用之相關因素探討-以電腦斷層掃描為例 (Publication Number 2006年) 亞洲大學]. AiritiLibrary. 林勤真. (2014). 台灣下背痛診斷性造影之過度利用趨勢-2002-2010 (Publication Number 2014年) 長榮大學]. AiritiLibrary. 衛生福利部. (2019年9月). 中華民國107年醫療機構現況及醫院醫療服務量統計 衛生福利部中央健康保險署. (2013年7月29日). 全民健康保險特定檢查資源共享試辦計畫. 衛生福利部中央健康保險署. (2019年12月). 中華民國107年全民健康保險統計. 衛生福利部中央健康保險署. (2020年3月27日). 健保醫療資訊雲端查詢系統使用者手冊. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82301 | - |
| dc.description.abstract | 研究背景：隨著醫療費用逐年攀升，其中檢查費用占率高達四分之一，又以電腦斷層掃描與核磁共振檢查費用占大宗，若能避免不必要的重複檢查有助於提升醫療資源使用效率。 研究目的：探討健保醫療資訊雲端查詢系統與90日內重複執行電腦斷層掃描或核磁共振檢查的關係。 研究方法：本研究為回溯型多年期橫斷研究，使用健保署「全民健康保險保險人資訊整合應用服務中心」資料庫進行次級資料分析，納入2017年1月1日至2019年12月31日所有門急診就醫資料、且過去90日內曾有執行電腦斷層掃描或核磁共振檢查者，作為本研究對象，若當次門急診就醫有執行電腦斷層掃描或核磁共振檢查者，則視為「重複影像檢查」，使用羅吉斯迴歸分析，在控制病患特性、醫師特性、院所特性及時間趨勢後，探討健保醫療資訊雲端查詢系統與90日內重複執行電腦斷層掃描或核磁共振檢查的關係。 研究結果：2017-2019年「門診病患執行電腦斷層掃描檢查」、「急診病患執行電腦斷層掃描檢查」、「門診病患執行核磁共振檢查」、「急診病患執行核磁共振檢查」重複率分別為0.70%、7.11%、0.42%、0.42%。在控制病患特性、醫師特性、院所特性及時間趨勢後，病患在門診就醫的情況下，相較於醫師完全沒有查詢者，僅預先批次下載檢查報告者(OR=1.032-1.156)、透過線上查詢檢查報告但無調閱影像者(OR=1.305-1.427)及有調閱影像者(OR=2.732-3.522)，均會增加重複執行電腦斷層掃描或核磁共振檢查的機會；但在急診就醫的情況下，相較於醫師完全沒有查詢者，僅預先批次下載檢查報告者(OR=1.343)會增加重複執行核磁共振檢查的機會，而透過線上查詢檢查報告但無調閱影像者(OR=1.237)及有調閱影像者(OR=1.99)，則會增加重複執行電腦斷層掃描檢查的機會。 結論：此研究發現在控制病患特性、醫師特性、院所特性及時間趨勢後，健保醫療資訊雲端查詢系統的使用與90日內重複執行電腦斷層掃描或核磁共振檢查間呈現顯著正相關，可能與政策介入有關，醫師若在開立前有調閱過去的檢查報告或影像，則可避免重複檢查費用遭致核扣。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-25T06:35:19Z (GMT). No. of bitstreams: 1 U0001-0509202104370700.pdf: 3490209 bytes, checksum: 5ad3cfd3bda107ef9c67769a77af1faf (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 口試委員會審定書 I 致 謝 II 摘 要 III Abstract V 目 錄 VII 圖目錄 IX 表目錄 X 第壹章 緒論 1 第一節 研究背景與動機 1 第二節 研究目的 4 第貳章 文獻探討 5 第一節 醫療資訊交換系統的介紹與使用情形 5 第二節 重複影像檢查的測量 11 第三節 影響重複影像檢查的相關因素 19 第四節 醫療資訊交換系統與重複影像檢查的關係 28 第五節 文獻總結及評論 36 第參章 研究設計與方法 38 第一節 研究設計與架構 38 第二節 研究假說 39 第三節 研究對象 40 第四節 資料來源與處理流程 41 第五節 研究變項與操作性定義 49 第六節 統計分析方法 70 第肆章 研究結果 72 第一節 研究對象之描述性統計 73 第二節 研究對象之雙變項分析 91 第三節 研究對象之多變項分析 117 第伍章 討論 156 第一節 研究結果討論 156 第二節 假說驗證 171 第三節 研究限制 172 第陸章 結論與建議 173 第一節 結論 173 第二節 建議 175 第柒章 參考文獻 176 附 錄 181 | |
| dc.language.iso | zh-TW | |
| dc.subject | 重複檢查 | zh_TW |
| dc.subject | 電腦斷層掃描 | zh_TW |
| dc.subject | 核磁共振 | zh_TW |
| dc.subject | 醫療資訊交換系統 | zh_TW |
| dc.subject | 健保醫療資訊雲端查詢系統 | zh_TW |
| dc.subject | magnetic resonance imaging | en |
| dc.subject | NHI-MediCloud System | en |
| dc.subject | health information exchange system | en |
| dc.subject | duplicate medical imaging procedures | en |
| dc.subject | computer tomography | en |
| dc.title | 探討使用健保醫療資訊雲端查詢系統與重複醫學影像檢查的關係 | zh_TW |
| dc.title | Association between the Use of National Health Insurance’s MediCloud System and Duplicate Medical Imaging Procedures | en |
| dc.date.schoolyear | 109-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 鄭守夏(Hsin-Tsai Liu),李純馥(Chih-Yang Tseng) | |
| dc.subject.keyword | 健保醫療資訊雲端查詢系統,醫療資訊交換系統,重複檢查,電腦斷層掃描,核磁共振, | zh_TW |
| dc.subject.keyword | NHI-MediCloud System,health information exchange system,duplicate medical imaging procedures,computer tomography,magnetic resonance imaging, | en |
| dc.relation.page | 183 | |
| dc.identifier.doi | 10.6342/NTU202102992 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2021-09-07 | |
| 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 |
| dc.date.embargo-lift | 2022-12-31 | - |
| 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 | |
|---|---|---|---|
| U0001-0509202104370700.pdf 未授權公開取用 | 3.41 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。