醫師人力與醫療結果之分析－以週末及夜間急診為例

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鄒永駿(Yong-Jun, Zou) 查詢紙本館藏

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產業經濟研究所

論文名稱

醫師人力與醫療結果之分析－以週末及夜間急診為例

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摘要(中)

醫院的人力資源在一天或是一週內都不是均等分配的，而病患一定都希望不論在任何時段就診都可以享有最充分的醫療資源並獲得最好的結果，因此本文檢視病患是否因就醫時段不同而得到較差的醫療結果。本研究使用2000年及2005年百萬人次抽樣檔，時間擷取2010年至2013年，以心肌梗塞、阻塞性中風、出血性中風及氣胸等急診病患作為觀察對象，7日內死亡率、30日內死亡率、60日內死亡率、醫療費用及30日內再住院率為觀察指標，探討急診病患是否因週末或夜間進入急診室而得到較差的醫療結果。

在控制醫院固定效果後，實證結果發現隨著觀察疾病不同，在醫學中心及非醫學中心的觀察結果也會不同，而台灣急診室普遍存在夜間效應，週末效應並不明顯。

摘要(英)

The medical manpower sufficiency varies among different time slots of a day. Patients hope that they can get sufficient medical resources whenever we need medical care, so this article aims to explore whether admission to an emergency care unit during off-hours or weekend is associated with a worse outcome. In this study, we extracted the emergency care cases of patients with AMI, ischemic stroke, hemorrhagic stroke and pneumothorax from 2010-2013 National Health Insurance database. We used 7-day, 30-day and 60-day mortality rate, as well as the medical expenditures and 30-day readmission rate as treatment outcome to examine whether patients are more likely to have worse outcomes if they go to the emergency room on weekends and midnight.

After controlling for hospital heterogeneity via fixed effects, the empirical results showed that worse outcomes did not associate to medical centers and non-medical centers. In Taiwan, midnight effect existed and weekend effect was not significant.

關鍵字(中)

★ 急診室
★ 週末
★ 夜間
★ 醫師人力

關鍵字(英)

★ emergency room
★ weekend
★ midnight
★ medical manpower

論文目次

中文摘要 I
Abstract II
致謝 III
目錄 IV
表目錄 VI
第一章前言 1
第一節研究背景 1
第二節研究重要性 3
第三節研究目的 4
第二章文獻回顧 5
第一節醫療人力配置與醫療結果 5
第二節週末假日就醫與醫療結果 6
第三節週末及夜間就醫與醫療結果 9
第三章資料來源與研究方法 12
第一節資料來源 12
第二節實證模型 13
第三節變數說明 14
第四章實證結果 18
第一節敘述性統計 18
第二節週末效應實證結果 29
第三節夜間效應實證結果 33
第四節綜合結果整理 40
第五節急診擁塞之醫學中心的週末效應與夜間效應 42
第五章結論 44
第一節結論 44
第二節研究限制 45
參考文獻 46
附錄腦震盪與外傷性顱內出血之估計結果 56

參考文獻

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指導教授

蔡偉德(Wei-Der, Tsai)

審核日期

2017-7-19

推文