急診檢傷分類、病患結構與醫療資源耗用之相關研究

A analysis of the relationship between the triage of Emergency Department, patient structure and medical resource use

陳曉恩(Hsiao-En Chen)

指導教授 ： 詹前隆

元智大學/資訊學院/資訊管理學系/碩士(2007年)

摘要

急診求診人口越來越多、疾病型態日益多元化、複雜化，為急診醫療環境共同對的趨勢。影響急診人數增加的原因中，除了人口本身的成長外，尚有一部份是因為非緊急病患大量增加，如何找出適當方法抒解擁擠的急診部門，使真正需要急診的病患得到最適切的照顧。
檢傷為急診的第一個關卡，『檢傷分類』主要目標為選擇病患，其目的為把『適當的人，在適當的時間內，將其放在適當的地方，使用適當的資源』。本研究將針對急診的病患進行現況探討，瞭解及分析檢傷分類與病患結構及醫療資源耗用等之相關性，並進一步探討醫院層級間檢傷分類、病患結構及醫療費用之分布，期望能提供政府衛生當局在醫療費用審查、未來健保政策修訂等獲醫療院所急診相關單位人力訓練及配置等之參考依據。
研究目的簡述如下：
一、描述急診醫療資源利用及醫療資源分佈之現況
將急診申報資料分不同急診型態，再針對各急診型態進行相關因素分佈描述，瞭解各急診型態的醫院特質與病人特性，以及各急診型態的醫療資源利用情形。
二、分析檢傷分類與醫院層級、醫療費用之相關性。
針對不同檢傷級數、與不同層級間醫院之相關性分析，及針對不同醫院層級與醫療費用之相關性分析，探討不同檢傷級數間，疾病診斷之分布及相關性。
研究方法：研究材料採用2004年7月至2005年6月間健保資料庫「門診處方及治療明細檔」、「醫事機構主檔」進行分析。
結果：本研究顯示整個急診件數以檢傷分類級數第三級者件數最高，而醫療費用則以檢傷分類級數第二級者佔率最高，在不同的醫院層級仍是以檢傷分類三級者佔率最高、其次依序為檢傷二級、一級及四級，而各層級檢傷四級的佔率介於0~1%之間。 若以不同醫院屬性及層級分析同一級檢傷分類級數之醫療費用可發現：不同醫院屬性及層級而同一級檢傷費用差異甚大。檢傷第一級各屬性層級醫院平均醫療費用（不含診察費）介於2,163~7,567點/人次；檢傷第二級各屬性層級醫院平均醫療費用（不含診察費）介於1,221~3,614點/人次；檢傷第三級各屬性層級醫院平均醫療費用（不含診察費）介於646~1,884點/人次；檢傷第四級各屬性層級醫院平均醫療費用（不含診察費）介於324~1,236點/人次。各級檢傷分類級數醫療費用均呈現顯著相關，表示檢傷級數越嚴重，其每人次醫療費用越高。醫院層級與醫療費用呈現顯著相關，表示醫院層級越高，每人次醫療費用越高。從性別及年紀來看，男性費用比女性高，年齡越大者費用越高。顯示國人男性對急診醫療的需求比女性高，且耗費醫療資源比女性多。2.醫院屬性及層級來看，私立醫院急診醫療費用較公立醫院高；而在層級部份：急診醫療費用以醫學中心最高，區域醫院次之，地區醫院最低。
結論：就醫療經濟學上論述：醫療因具有專業不對等之情形，故若在費用給付係採論量計酬制或其他具有誘因之幾付制度者，易產生「誘發需求」之現象。現有健保給付制度係以檢傷級數作為診察費給付之依據，檢傷級數較急迫之患者幾付較高，係可能導致為何檢傷各級數之分布與各層級醫療院所屬性差異甚大之原因。故現行的檢傷分類制度是否真能反映實際需求，建議應可再重新審視檢討。急診疾病診斷別案件數最高的前四項依序排列為：1.損傷及中毒；2.診斷欠明；3.呼吸道疾患；4.消化系統疾患；且不同檢傷分類級數之急診疾病分布：檢傷第一級疾病診斷別案件數最高為「呼吸道疾患」；檢傷第二級疾病診斷別案件數最高為：「損傷及中毒」；檢傷第三級疾病診斷案件數最高為：「呼吸道疾患」。由於急診醫療首要目的為確保病患能得到適當之醫療處置，如何能在有限的時間及人力提供給病患適當之醫療，在此前提人員須有完整之教育訓練。不同的疾病所需提供之醫療照護不一，故此可作為人員教育訓練課程擬定之依據。

關鍵字

檢傷分類,急診

並列摘要

The bigger population for emergency treatment and the diversity and complication of the type of diseases are the joint trends of emergency treatment environment. Besides the growth of population ,the reason which affects the increase of the population for emergency treatment is partly because the huge increase of non-emergency patients. So we have to find an appropriate way to release the cram of the emergency department to let the patients who indeed need emergency treatment get the most appropriate care.
The triage for the patients is the first border checkpoint of the emergency treatment；the main goal of the triage for the patients is to choose patients and the purpose is to use adequate resources on right people in right way at right time. The purpose of the research is to discuss the status quo of the emergency Patients、to understand and analyze of the relationship between the triage of Emergency Department, patient structure and medical resource use . I hope it could be the reference to the government .
The purpose of the research :
一、 To describe the status quo of the use of the resources of the emergency treatment and the distribution of the medical resources. Classify the data of the emergencies into different types and then describe the distribution of the process of the emergency 、understand the characteristic of the patients and the hospitals and the use of the medical resources.
二、 To analyze the relationship between the triage of Emergency Department, patient structure and medical resource use.
Method: A cross-sectional study was conducted by using claim data of NHI from July 2004 to Jun 2005.
Result:: the research shows that triage of the most emergency cases are of the third class and the medical expenditures are of the second class . In different hospitals are most of the third class , and then are the second 、the first、and the fourth class. And the percentage of the fourth class of the triage of the emergency treatment patients is between 0%~1%. If we analyze different levels of hospitals and grades of the patients , we’ll find out the divergence is quite large in the same grade of different levels of hospitals. The average medical expenditures of the first class (the fee of a physician is not included) is between 2,163~7,567 points/per case ; the average medical expenditures of the second class (the fee of a physician is not included) is between 1,221~3,614 points/per case ; the average medical expenditures of the third class (the fee of a physician is not included) is between 641~1,884 points/per case ; The average medical expenditures of the fourth class (the fee of a physician is not included) is between 324~1,236 points/per case . The grade of the patients and the medical expenditures are highly relevant, which shows if the grade is higher , the expenditures will be higher . Also , the level of the hospital and the medical expenditures are highly relevant, too. It shows that if the level of the hospital is higher , the fare will be higher, too. If we analyze from the point of ages and sexes , we’ll find out that male’s expenditures is higher than female’s ; the expenditures of older ones is higher than the younger ones’ . It shows that the need of emergency treatment and the drain of medical resources for males are higher than females. If we analyze from the level of the hospital , we’ll find out that the expenditures of private hospitals is higher than the expenditures of public ones. Finally we’ll also find that the expenditures of the emergency treatment of the medical center is the most , and then is the regional hospital and last is the local hospital.
Conclusion: from the point of medical economy : Because we have the situation of the profession is not equal ,so if the pay is fee for service , the problem of the lure of the need will appear. Now the pay of the health insurance physician fee is according to the triage class of the emergency treatment patients and which will cause the distribution of the class is not average . So the system of the triage of the emergency treatment patients may not reflect the real situation of the practical medical need . We suggest the system can be reexamined. The most 4 emergency disease are 1: damages and poisonous. 2: the unknown diseases. 3: respiratory problems. 4: digestion system problems. The most cases of the first class triage of emergency treatment patients are respiratory problems; the most cases of the second class triage of emergency treatment patients are damages and poisonous cases ; the most cases of the third class triage of emergency treatment patients are respiratory problems , too. Because the main purpose of the emergency treatment is to make sure all patients can get the appropriate treatments , how to provide these in limited time and human resources is the one we have to care from thorough education training. Different patients need different treatments and this could be the basis of human education training courses.

並列關鍵字

triage

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