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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 張睿詒(Ray-E Chang) | |
| dc.contributor.author | Hsiao-Jou Chen | en |
| dc.contributor.author | 陳筱柔 | zh_TW |
| dc.date.accessioned | 2022-11-25T07:47:06Z | - |
| dc.date.available | 2025-01-20 | |
| dc.date.copyright | 2022-02-18 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2022-01-21 | |
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/82577 | - |
| dc.description.abstract | "背景：血液透析病患族群有高齡、多重共病症與多重併發症之特徵，在科別診察十分棘手。為了提高照護品質、降低醫療成本，世界各國提出跨科別偕同照護的方法，但臺灣尚未有針對透析病人的跨科別照護模式。 目的：探討臺灣血液透析病人於醫療科別的需求與利用情形，期許能發展臺灣本土化之跨科別協同照護模式。 方法：本研究為橫斷性混合研究，研究對象包括血液透析病人與臨床醫師。質性研究為立意取樣之個人深度訪談，招募有血液透析病人照護經驗醫師共6名，瞭解以醫師觀點的血液透析病人臨床常見狀況、照護所需合作科別及科別偕同照護困難；量性研究使用2015年臺灣全民健保資料庫，研究樣本為持續12個月的血液透析病人，分析變項為血液透析病人的科別使用次數；資料探勘關聯分析採Apriori演算法，資料集之分組基線為月份和是否有糖尿病，分析目標為時間單位每位病患之就醫科別項目集，藉以瞭解以病人為觀點的科別就醫潛在關聯情形。 結果：符合篩選條件共49,995名血液透析病患有24,500(49.0%)名女性、21,097(42.2%)名患有糖尿病、26,281(52.6%)患有高血壓、加權共病症指數中位數(標準差)為4.0 (1.9)。在看診次數一年累計描述性統計結果，內科(17.4%)、腎臟內科(17.0%)、心臟內科(7.6%)、眼科(6.55%)、家醫科(4.72%)使用大於其他科別；關聯分析每三個月的結果下，內科(43.8%)、腎臟內科(42.5%)、心臟內科(28.6%)、眼科(26.1%)、急診(19.4%)、家醫科(16.2%)之關聯規則遠大於其他科別。對醫師訪談結果進行質性分析，獲得以醫師為觀點的照護所需醫療科別為心臟內科(83.3%)、心臟外科(83.3%)、神經科(66.7%)、腸胃內科(50.0%)、骨科(33.3%)、內分泌科(33.3%)、外科(33.3%)；照護所需之非醫療科別為營養師(66.7%)與復健師(66.7%)。在如何達成科別照護模式的訪談部分，目前遇到的困難為基層診所難以經營以及轉診病患資料零散，在照護改善則為機構層級的轉診合作與溝通平台建立。 結論：不論是以病人常見就診觀點或是以醫師的臨床照護觀點，心臟內科、外科系統、全科醫師皆佔有重要的地位。基層醫生在科別轉診上所遇到的困難，可能會間接影響病人的急診使用情形。政府應特別顧及基層透析診所在科別偕同照護模式的建立與需求。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-25T07:47:06Z (GMT). No. of bitstreams: 1 U0001-2001202216475900.pdf: 5702215 bytes, checksum: f2339b4b3ff728cdff46c5c396c2412f (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | 口試委員會審定書 i 誌謝 ii 中文摘要 iii Abstract v 目 錄 vii 表目錄 x 圖目錄 xii 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 末期腎臟疾病與血液透析 4 第二節 腎臟疾病病症與血液透析病人之日常照護需求 6 第三節 偕同照護與美國ESRD病患照護模式之演進 11 第四節 各國在腎臟病患的照護情況 21 第五節 資料探勘與Apriori關聯分析介紹 27 第三章 研究方法 29 第一節 研究設計 30 第二節 研究對象 32 第三節 資料蒐集 35 第四節 研究變項與操作型定義 37 第五節 分析方法 39 第六節 研究倫理 41 第四章 研究結果 42 第一節 質性研究訪談結果 42 第二節 量性研究描述性統計結果 57 第三節 量性研究資料探勘關聯分析結果 63 第五章 討論 79 第一節 研究方法討論 79 第二節 綜合結果統合 80 第三節 研究結果討論 81 第四節 研究限制 87 第六章 結論與建議 88 第一節 結論 88 第二節 建議 89 參考文獻 90 附錄 98 附錄一、CEC照護模式之品質測量標準原文版 98 附錄二、門急診處方及治療明細檔之就醫科別對照表 99 附錄三、IRB審查通過證明 100 附錄四、受訪者同意書 104 附錄五、訪談大綱 108 | |
| dc.language.iso | zh-TW | |
| dc.subject | 探索性研究 | zh_TW |
| dc.subject | 混合研究方法 | zh_TW |
| dc.subject | 末期腎臟疾病 | zh_TW |
| dc.subject | 血液透析 | zh_TW |
| dc.subject | 多科別 | zh_TW |
| dc.subject | 偕同照護 | zh_TW |
| dc.subject | Apriori演算法 | zh_TW |
| dc.subject | 關聯規則 | zh_TW |
| dc.subject | Mixed Methods | en |
| dc.subject | Exploration study | en |
| dc.subject | Association rules | en |
| dc.subject | Apriori algorithm | en |
| dc.subject | Coordinated care | en |
| dc.subject | Multi-specialists | en |
| dc.subject | Hemodialysis | en |
| dc.subject | ESRD | en |
| dc.title | 血液透析病人多科別偕同照護模式之初探 | zh_TW |
| dc.title | Exploration of a multi-speciality coordinated care model in HD patient | en |
| dc.date.schoolyear | 110-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 許志成(Yuen-Wen Ku),王宗曦(Liang-jung Lin) | |
| dc.subject.keyword | 混合研究方法,末期腎臟疾病,血液透析,多科別,偕同照護,Apriori演算法,關聯規則,探索性研究, | zh_TW |
| dc.subject.keyword | Mixed Methods,ESRD,Hemodialysis,Multi-specialists,Coordinated care,Apriori algorithm,Association rules,Exploration study, | en |
| dc.relation.page | 109 | |
| dc.identifier.doi | 10.6342/NTU202200121 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-01-21 | |
| 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 | 2025-01-20 | - |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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