住院病人醫療服務供給之探討~以某醫學中心為例

摘要目的　　本研究目的旨在探究某醫學中心的住院病人：人口學特徵、來源分佈、就診科別、就診方式、疾病結構趨勢變化、影響住院病人人次之供給因素，進而提供醫院管理者規劃服務區域內之醫療供給方向。方法　本研究對象為某醫學中心2002~2005年住院病人，有效樣本281,048人次，資料包括住院病人之基本屬性（性別、年齡、職業、居住縣市、婚姻狀況、教育程度）及就醫經驗（住院科別、就診方式）在住院天數及住院次數之分析。研究者運用套裝統計軟體SPSS for Windows 10.0 版進行描述性及推論性統計。結果住院病人基本屬性之性別（P<0.0001）、婚姻狀況（P<0.0001）、年齡（P<0.0001）、教育程度（P<0.0001）、職業（P<0.0001）及居住縣市（P<0.0001）與住院次數，均達顯著相關；住院病人就醫經驗之住院科別（P<0.0001）、就診方式（P<0.0001）與住院次數，均達顯著相關。住院病人基本屬性之性別（t=-9.27，P<0.0001）、婚姻狀況（t=16.59，P<0.0001）、年齡（F=578.70，P<0.0001）、教育程度（F=39.05，P<0.0001）、職業（F=115.28，P<0.0001）及居住縣市（F=3.36，P<0.0001）在平均住院天數，均達顯著差異；住院病人就醫經驗之住院科別（F=987.97，P<0.0001）、就診方式（t=31.96，P<0.0001）在平均住院天數，均達顯著差異；另住院病人之住院科別與居住縣市在住院天數，達顯著之交互作用 (F=5.66，P<0.0001)；不同住院科別的住院病人人次與醫師人數，達顯著相關（P<0.0001）。依ICD-9-CM分成18類疾病別，分析某醫學中心之住院人次供給高於高高屏澎住院人次者，前五項依序為：腫瘤、需要醫療服務之其他原因、神經系統及感覺器官之疾病、循環系統疾病及精神疾患。討論與建議經由研究分析，建議醫院於服務區域內之整體發展計劃為：規劃成立癌症治療中心，提升癌症病人治療的醫療品質；透過資訊網路系統，結合服務、教學與研究，推展以醫學中心為基礎的完整精神醫療服務；規劃成立心臟照護中心，以全人照護之理念，提供心臟血管醫療照護，達成完整的全人醫療照護服務目標。

關鍵字

住院病人；醫療服務；醫療供給

並列摘要

Abstract Objectives The purpose of this research was to carry out a detailed study of the inpatients of a medical center in terms of: demographic characteristics, origin distribution, distribution amongst departments for consultation, consultation methods,tendency of change in the condition of the disease, and supply factors influencing the time spent on in-patients. This study then provides hospital management with a plan outlining directions for the provision of medical treatment in the service area. Methods The subjects of this research were the in-patients of a medical center between the years 2002 and 2005,numbering 281,048 effective samples.The data collected included all basic in-patient attributes (gender, age, occupation, county or city of residence, marital status, level of education), consultation experience (department distribution, method of consultation), and an analysis of the number of days and number of times of hospitalization. The researcher used the statistical analysis software SPSS for Windows, Version 10.0, to analyze the data. Results The correlations found between the basic in-patient attributes and the number of times of hospitalization were: gender (P<0.0001), marital status (P<0.0001), age (P<0.0001), level of education (P<0.0001), occupation (P<0.0001), and county or city of residence (P<0.0001). The correlations between the in-patients’ consultation experience and the number of times of hospitalization were: department distribution (P<0.0001), and method of consultation (P<0.0001). The discrepancies between the in-patients’ basic attributes and their number of days of hospitalization were: gender (t=-9.27, P<0.0001), marital status (t=16.59, P<0.0001), age (F=578.70, P<0.0001), level of education (F=39.05, P<0.0001), occupation (F=115.28, P<0.0001) and county or city of residence (F=3.36, P<0.0001). The discrepancies between the in-patients’ consultation experience and the number of days of hospitalization were: department distribution (F=987.97, P<0.0001), and method of consultation (t=31.96, P<0.0001). In addition, for the number of days of hospitalization, a correlation was found between the department and the county or city of residence: department * county or city of residence (F=5.66, P<0.0001). A correlation was also found between the time spent on in-patients in different departments and the number of doctors (P<0.0001). Categorized into 18 different kinds of diseases using ICD-9-CM, analysis of the medical center’s in-patients supplies to be higher than Kao-Kao-Ping-Pen district is hospitalized the people. The first five items in order are: tumors, needing medical service for other reasons, diseases of the nervous system or sensory organs, diseases of the circulatory system, and mental disorders. Conclusion and Suggestion As a result of the research analysis, it is suggested that in the service area, the hospital implements an integrated development plan as follows: make a plan to establish a cancer treatment center to improve the quality of the medical treatment of cancer patients; make use of the internet to integrate service, education and research in order to promote the medical center to provide basic holistic medical service; plan the establishment of a cardiac care center with the idea of taking care of the whole person, and providing medical treatment and care for heart and blood vessels, in order to reach the goal of providing integrated holistic medical treatment, care and service.