醫院重大事件與急診醫療服務量相關性探討－以某區域醫院爲例

Association of Hospital Major Events and Service Volume of Emergency Department-Evidence of One Regional Hospital

陳聲平(Sheng-Pyng Chen) ； 王德芳(Te-Fang Wang) ； 佘振興(Jenn-Shing Sher) ； 蘇忠仁(Chung-Jen Su) ； 陳俊芳(Chun-Fang Chen) ； 楊銘欽(Ming-Chin Yang)

《醫務管理期刊》 9卷1期 (2008/03) Pp. 66-82

https://doi.org/10.6174/JHM2008.9(1).66

摘要

Objectives: In the face of major flooding and hospital changes in becoming a SARS exclusive hospital after 2000, the hospital encountered difficulties in operation. Emergency service volume was also showing a trend of decline. Outside the SARS incident, the purpose of this study is to better understand what types of incidents are prone to influence the operation of emergency services, to provide administrators with a reference for analysis and decision making.
Methods: Statistical analysis and comparison of relevant variables on the volume of various kinds of medical services based on pre and post variation of relevant variables of medical service volume (except for the month that incidents occurred) for the period between 1999 and 2005.
Results: Taking the hospital as an example, natural disasters do not greatly impact emergency medical service volume (p＞O.O5). After further analysis, the increase of competitors in medical environment and the inclusion of soldiers in health insurance have a more significant impact on the service volume of surgical ER and emergency as well as critical cases (540±74vs 445±73, 524±63vs 409±43, p＜O.O5). Policy intervention and the change in health insurance payment system had a greater influence on medical ER and lighter medical cases (p＜O.O5). The number of soldiers who seek emergency treatments is the major decisive factor in emergency medical service volume (p＜0.01). The SARS incident and adjustment of patient co-payment indeed was a major impact on emergency medical service volume. Nevertheless, amid major incidents, veteran emergency treatment volume showed the smallest change.
Conclusions: Preliminary results show no significant impact before and after NARI Typhoon. However, after the establishment of nearby new medical centers, the inclusion of soldiers in the Health Insurance, hospital transformation to become a SARS exclusive hospital, and the increase of health insurance co-payment, some of variables relating to medical service volume showed significant statistical variance.

關鍵字

急診醫療服務量 ； 重大事件 ； 給付制度 ； 嚴重急性呼吸道症候群 ； 部分負擔

並列摘要

Objectives: In the face of major flooding and hospital changes in becoming a SARS exclusive hospital after 2000, the hospital encountered difficulties in operation. Emergency service volume was also showing a trend of decline. Outside the SARS incident, the purpose of this study is to better understand what types of incidents are prone to influence the operation of emergency services, to provide administrators with a reference for analysis and decision making.
Methods: Statistical analysis and comparison of relevant variables on the volume of various kinds of medical services based on pre and post variation of relevant variables of medical service volume (except for the month that incidents occurred) for the period between 1999 and 2005.
Results: Taking the hospital as an example, natural disasters do not greatly impact emergency medical service volume (p＞O.O5). After further analysis, the increase of competitors in medical environment and the inclusion of soldiers in health insurance have a more significant impact on the service volume of surgical ER and emergency as well as critical cases (540±74vs 445±73, 524±63vs 409±43, p＜O.O5). Policy intervention and the change in health insurance payment system had a greater influence on medical ER and lighter medical cases (p＜O.O5). The number of soldiers who seek emergency treatments is the major decisive factor in emergency medical service volume (p＜0.01). The SARS incident and adjustment of patient co-payment indeed was a major impact on emergency medical service volume. Nevertheless, amid major incidents, veteran emergency treatment volume showed the smallest change.
Conclusions: Preliminary results show no significant impact before and after NARI Typhoon. However, after the establishment of nearby new medical centers, the inclusion of soldiers in the Health Insurance, hospital transformation to become a SARS exclusive hospital, and the increase of health insurance co-payment, some of variables relating to medical service volume showed significant statistical variance.

並列關鍵字

emergency medical service volume ； major incidents ； payment system ； Severe Acute Respiratory Syndrome ； SARS

參考文獻

陳聲平、蘇忠仁、王德芳(2006)。社區醫院之急診部門在新制醫院評鑑中的因應。台灣醫界。49，169-172。

Chen WK,Jung JJ,Cheng YC(2005).Payment and emergency medical service in Central Taiwan.Mid-Taiwan Journal of Medicine.10,99-106.

Robert MW,Patricia K,Jonathan SA(1998).Reorganizing an Academic Medical Service: Impact on Cost, Quality, Patient Satisfaction, and Education.JAMA.279,1560-1565.

Gupta. YP,D. Chin(1994).Organizational Life Cycles: A Review and Proposed Directions for Research.The Mid-Atlantic Journal of Business.30,269-293.

蔡瑛瑛、曾惠明、尹章義(2006)。新興傳染病對人類之影響與醫療機構的因應之道。醫院雜誌。39，8-19。