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  • 學位論文

以就醫流向為基礎劃定急重症醫療區域

Construction of emergent care areas based on patient flow

指導教授 : 林文德

摘要


目的:本研究以急重症就醫流向為基礎劃分急重症之醫療次區域,並探討過去9 年間民眾急重症跨區就醫流向的變化。 方法:利用2001年全民健康保險資料庫200萬人特殊需求檔為分析主檔,樣本 以8%比例隨機抽出,鄉鎮市區投保人數少於五千人則全部納入,以避免保險對象較少的地區樣本過少的問題。本研究以被保險人基層醫療利用次數最多之地區定義為人口所在居住地,來分析民眾急重症就醫流向;急重症醫療利用急診的部分以美國紐約大學急診緊急分類系統做為急重症的判定依據,以及急性心肌梗塞、急性心血管疾病和生產的住院資料;以民眾急重症就醫流向及鄉鎮市區距離兩項參數,利用群集分析(Clustering Analysis) 之平均連結法劃分急重症醫療次區域。最後利用本研究劃分之醫療次區域為地區單位,分析2009年急重症跨區就醫的情形。 結果:以急重症就醫流向為基礎共劃分出49個醫療次區域。2001年至2009年 整體急重症跨區就醫比例平均從38.1%降至37.6%,但差異並不顯著,第三四分位數和第一四分位數的比值,2001年為2.16,2009年為增加為2.21;2009年急重症跨區就醫比例最高地區為竹東次區域的70%,最低為宜蘭次區域的10%。 結論:急重症跨區就醫比例沒有明顯的下降,反而有擴大的趨勢,整體跨區就醫 比例高的地區仍然較高;急重症跨區就醫比例較高之醫療次區域內並非沒有急重醫療照護,但各醫療區內所提供之急診照護是有差異的;然急重症跨區就醫比例較高之次區域不一定地區資源缺乏。以急重症就醫流向做為劃分地理區域的方法並做為醫療資源分配的依據,或許更能滿足區域內居民的醫療需求,以避免跨區就醫造成的病情耽擱,本研究的研究結果提供劃分醫療區域的另一思考方向。 關鍵字:急重症、醫療次區域、群集分析、跨區急診

並列摘要


Objective: This study partitioned emergent sub-medical regions based on patient flow, and explored emergent cross-region patient flow changes over the previous nine years. Method: This study used 2 million special needs files from the 2001 National Health Insurance database as the main data for analysis. Among these files, 8% were randomly selected. Townships with fewer than 5,000 insured people were entirely included to avoid the problem of insufficient sample size for regions with a low number of insured people. We defined an area of residence as the location where the insured had the most frequent basic level medical care, and then used this definition to analyze emergent patient flow in the population. Emergency department (ED) utilization for emergent care was used to identify emergent emergency department conditions according to the New York University algorithm and hospitalization data regarding acute myocardial infarction, acute cardiovascular diseases, and childbirth. Based on emergent patient flow and township and city distances, a cluster analysis average linkage method was used to partition emergent sub-medical regions. Utilizing these sub-medical regions as regional units, this study analyzed cross-region emergent care visits for 2009. Result: Forty-nine sub-medical regions were partitioned based emergent patient flow. Overall average cross-region emergent care from 2001 to 2009 declined from 38.1% to 37.6%, but the difference was not significant. The ratio of the third quartile (Q3) to the first quartile (Q1) ratios increased from 2.16 in 2001 to 2.21 in 2009. The Zhudong sub-region exhibited the highest cross-region emergent care ratio in 2009 (70%), and the Yilan sub-region showed the lowest ratio (10%). Conclusion: The cross-region emergent care proportion has not significantly decreased, and instead has shown an increasing trend. Regions that displayed high overall cross-region medical visit proportions continue to maintain these ratios. Emergent care services exist in sub-regions with higher cross-region emergent care proportions, but variations in ED services provided in each medical care region can occur. Using emergent patient flows to partition geographical regions and to serve as references for medical care resource allocation can satisfy the medical care needs of people in these sub-regions. This can mitigate delayed treatment caused by cross-region medical care. These study results provide an additional perspective for the partitioning of medical care areas. Key words: Emergent, Sub-medical region, Clustering Analysis, Emergent cross-region

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