運用健保資料庫建構小兒急診再返之預測模式

Constructing the Prediction Model of Pediatric Patients Return Visits to the Emergency Department using the National Health Insurance Database

李海微(Hai-Wei Li)

指導教授 ： 胡雅涵 ； 陳志成

國立中正大學/管理學院/資訊管理系醫療資訊管理研究所/碩士(2015年)

摘要

目的：醫院急診中最常見的問題為病患再返急診，再返診的族群中又以兒童為醫療中的高醫療風險族，因此本研究使用小兒初次急診資料，找出主要影響急診後72小時內再返診的因素。
方法：本研究使用全民健康保險研究資料庫的2005年百萬抽樣歸人檔，採用邏輯斯迴歸方法找出影響再返的重要因素和分類與迴歸樹(CART)技術定義出高風險群組。
結果：小兒急診就醫總人次共323,960，其中19,929急診人次為有再返診，急診再返率為6.15%。在邏輯斯迴歸結果發現病患月齡、過敏疾病、檢傷分類、疾病診斷類別、大量液體點滴注射、檢查、專科證照、醫院層級、就醫平假日、就醫季節、急診前一星期內有出院及前一年的急診就醫次數為小兒急診再返的影響因素。其中若星期六看急診的小兒年齡為2歲(含)以下，且不具有以下疾病診斷類別，包含感覺器官疾病、妊娠、生產及產裖期之併發症、皮膚及皮下組織之疾病、骨骼肌肉系統及結締組織之疾病、損傷及中毒、意外傷害及非意外傷害，以及前一年急診次數為一次，其72小時再返急診率最高。

關鍵字

全民健保資料庫 ； 小兒急診 ； 再返急診 ； 分類與迴歸樹

並列摘要

Objectives: Patients return visit to the emergency department is the most common situation in the emergency department (ED). Pediatric patients are high-risk medical group among all the patients. Thus, this study aims to figure out the factors which influence pediatric patients return visits to the ED within 72 hours using the data of children’s first visit record of the ED.
Methods: We analyzed the Longitudinal Health Insurance Database data in 2005 derived from the National Health Insurance Research Database (NHIRD). Multivariable logistic regression analysis were performed to determine factors associated with return visits and a classification and regression tree (CART) technique to identify high-risk groups.
Results: Of 323,960 eligible pediatric patients, 19,929 (6.15%) returned within 72 hours. Factors associated with return visits included Age, Allergic disease, Triage, Diagnostic Category, Intravenous infusion, Laboratory Examination, Specialist license, Hospital Level, Day of the week, Season, Whether the patient had been discharged from the hospital within the last 7 days, Number of ED visits in the previous year. Children younger than 2 years who visited on Saturday, diagnoses not belonging to the diseases of the sense organs, complications of pregnancy, childbirth, and the puerperium, diseases of the skin and subcutaneous tissue, diseases of the musculoskeletal system and connective tissue, injury and poisoning, external causes of injury, and used the ED for 1 time in the previous year had the highest probability of returning to the ED within 72 hours.

並列關鍵字

NHIRD ； Pediatric emergency care ； Return visits to the Emergency Department ； Classification and regression tree

參考文獻

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