交通事故及其健康資訊異質資料庫應用研究

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姓名

李明德(Ming-der Li) 查詢紙本館藏

畢業系所

機械工程學系

論文名稱

交通事故及其健康資訊異質資料庫應用研究
(Applied research of traffic accident and heterogeneous database of health information)

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摘要(中)

每年因為道路交通事故所造成的人命及經濟損失相當嚴重，也會影響到國家的經濟發展。道路交通事故相較於其他疾病，透過立法或是外在實體環境的改善，便立獲得相當顯著的成效。如立法院通過騎乘機車強制配戴安全帽，不但頭部受傷的車禍人數明顯下降，而且因車禍造成的死亡人數及受傷嚴重度，亦有所改善。但當原本健康的身體受到傷害後，即便透過各項醫學科技的治療，可能無法完全恢復到原本的身體機能，因而產生健康受損的人口。除影響個人的生活起居外，影響層面將擴及家庭與社會，進而造成國家社會的負擔。當傷害發生後，並無法改善受傷的事實，要去思考的是如何避免傷害的發生。
以往對於健康評估的研究大都採用問卷訪談的方式進行，受限於主客觀因素，常不易進行大範圍及大樣本的調查，且受訪者的態度還會影響問卷填寫資料的準確性。為得到更客觀及大範圍的研究用資料，本研究嘗試透過異質資料庫的整合，針對「道路交通事故資料庫」、「死因資料庫」及「全民健保資料庫」利用身分證號進行確定性連結，再利用連結後的資料進行一系列的分析研究。
研究的第一部份是，界定與事故有關的死亡及就醫資料，分別針對門診及住院資料，利用就醫距事故天數、就醫次數、住院天數、就醫科別及醫療金額等，訂定出與事故相關的就醫資料，並以此為基礎進行後續的相關研究。在完成與車禍相關的死亡與就醫資料定義後，在此基礎下分別進行「交通事故及醫療服務利用的區域差異」及「汽車與機車在道路因素上的存活風險」的研究。研究結果發現，在不同的區域不但有不同的醫療資源可及性，因此在送醫時緊急醫療系統提供者，在不同地區便會做出不同的送醫判斷，也就造成不同的醫療結果。同樣的，汽機車在不同等級的道路上發生事故時，會因為受傷嚴重度、醫療資源等，而有不同的醫療結果，此些都是本論文所要深入探討的。
雖然政府不斷進行道路工程的改善或是透過立法，希望能降低事故的發生，但是交通事故還是無法完全避免。因此如何結合更多的資源，減低事故發生後對於事故當事人的傷害，是需要持續不斷努力改善的工作。

摘要(英)

The road traffic accidents caused a lot of economic losses and lives every year is very serious problem. That is also influence the economic developments of the country. Comparing to other diseases, the road traffic accidents are easier had significantly improvement through prevention with the external environment or legislation. For example, passing the legislative of riding motorcycles to wear helmets mandatory, not only the number of head injuries in traffic accidents decreased, but also the number of deaths caused by accidents and the severity of injuries has also been improved. However, the original health after the injury may not be fully restored to the original function of the body even if treated through the medical science technology, resulting in damage to the health of the population. Those people besides affected the individual daily lives, the impact level will be extended to family and society, and thus the burden of the state. Therefore the important is thinking about how to avoid the occurrence of injury with the road traffic accidents.
Previous research for the health assessment questionnaire is used to conduct interviews, often difficult to carry out large-scale and large sample surveys. The attitudes of the respondents also affect the accuracy of the questionnaire information. In order to get more objective and extensive research data, this study try to integrate the heterogeneous database including “The police-reported road traffic accidents data”, “vital registration data” and “National Health Insurance database”, using the ID number to link confirmedly and then analysis this series of linked data.
The first part of the study is to define accident-related deaths and medical treatment information, respectively. For the patient and inpatient data, the use of that days away from accident to seek medical treatment, the number of days of hospitalization on the medical and health care payments, etc, to stand up the accident treatment-related information as the basis for the follow-up research. After completion of the accident-related deaths and the definition of medical information, the subjects of “Difference in urban and rural accident characteristics and medical service utilization for traffic fatalities in less-motorized societies” and “Survival hazards of road environment factors between motor-vehicle and motorcycles” had been study respectively on this basis. The results showed that in different regions have different health care resources and the emergency medical system providers in different areas of the hospital will make different judgments, this is caused by different medical results. Similarly, the traffic accidents on different degrees of the road have different medical treatment results because of the severity of injuries and medical resources. This is the major object in this study.
Although the government has been the improvement of road works or legislation to reduce accident, but traffic accidents can not be totally avoided. Therefore combination more and more resources to reduce the accidents and decrease the accident injury clients are the need for continuous efforts to improve work for the future.

關鍵字(中)

★ 醫療保健
★ 事故因素
★ 資料連結
★ 存活分析

關鍵字(英)

★ Data linkage
★ Medical care
★ Survival analysis
★ Accident factors

論文目次

中文摘要 I
英文摘要 III
誌謝 V
目錄 VII
表目錄 X
圖目錄 XII
第一章前言 1
1.1 疾病與意外對健康的影響 1
1.2 健康狀況的評估方式與指標 3
1.3 健康資訊的來源資料庫 5
1.4 異質質料庫的重要課題 6
1.5 研究目的 7
1.6 研究方法 7
1.7 研究流程及各章內容 8
第二章文獻回顧 11
2.1 異質資料庫系統(HDBS) 11
2.1.1 資料庫系統的發展演進 11
2.1.2 資料異質性的問題 12
2.1.3 異質資料庫的整合 15
2.1.4 資料實體異質性的相關研究 24
2.1.5 HDBS的系統評估 28
2.2 健康醫療的異質資料庫系統 30
2.2.1 國外交通事故相關資料庫整合研究 30
2.2.2 連結記錄的商用軟體 31
2.2.3 CODES、WADLS及VAED 31
2.3 損傷之健康指標的相關研究 32
2.4 就醫時間框 32
第三章研究方法 35
3.1 基本的異質性問題 35
3.2 名詞定義 40
3.3 資料整合平台的建立 41
3.4 相關資料的淨化與處理 45
3.4.1 道路交通事故資料庫 46
3.4.2 死因資料庫 50
3.4.3 健保資料庫 53
第四章車禍死亡者的醫療成本分析 59
4.1 門診與住院時間框之探討 59
4.1.1 純門診就醫時間框之探討 60
4.1.2 事故發生後第一次門診分析 62
4.1.3 門診科別 64
4.1.4 住院時間框之探討 69
4.1.5 住院科別 73
4.2 車禍受害者的資料處理與分類 74
4.3 車禍死亡者的醫療成本分析：純急診者 80
4.3.1 車禍死亡者的基本背景資料 80
4.3.2 醫療成本的文獻回顧 81
4.3.3 分析結果 83
4.3.4 討論 86
第五章不同地域或道路別上醫療與存活風險之探討 91
5.1交通事故及醫療服務在不同地域之差異 91
5.1.1研究資料與定義說明 91
5.1.2研究分析內容說明 95
5.1.3結果與討論 102
5.2汽、機車在不同道路別上的存活風險 105
5.2.1研究資料與定義說明 106
5.2.2研究分析內容說明 108
5.2.3結果與討論 115
第六章結論與未來研究 121
6.1 結論 121
6.2 未來研究 125
參考文獻 127

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指導教授

鄭銘章(Ming-Chang Jeng)

審核日期

2009-7-22

推文