醫院手術室效能影響因素與效能評估方法之發展

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姓名

陳姵君(Pei-Chun Chen) 查詢紙本館藏

畢業系所

企業管理學系

論文名稱

醫院手術室效能影響因素與效能評估方法之發展
(A Study of Performance Indicators and Influence Factors in the Surgical Rooms of Hospitals)

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摘要(中)

台灣自全民健保實施後，民眾選擇就醫的第一考量不再是成本，而是轉向能夠提供最高品質、最佳醫療服務的醫療機構。因此，醫院管理的重點漸漸由早期所強調的醫療品質，進一步延伸至經營品質的概念。由於醫院手術室擁有精密且昂貴設備，且其所擁有的設備資源占全醫院預算的9~10%（Viapiano. et al. 2000），所以本研究致力於手術室的績效改善，找出手術室的績效指標與影響手術室績效的因素。
資料來源為台灣某醫學中心之手術室資料，運用迴歸分析及決策樹為基礎的分析方法進行分析及比較。以迴歸分析找出關鍵影響因素，發現全身麻醉且手術複雜度較高的病患，其手術費可能較高，且麻醉費、手術時間及手術時間的變異，會隨著手術項目個數的平方成長。此外，使用決策樹中的分類樹方法，找出預測績效指標的重要影響因素，手術費、麻醉費及手術時間最重要的影響因素皆為是否全身麻醉，而手術時間的變異程度之最重要的影響因素則為手術複雜度。院方可依此作為排程順序的考量，或是後續醫療品質及流程優化的重點。

摘要(英)

After the implementation of Taiwan’s national health insurance system, people choosing hospitals by its quality and service instead of expenditure. Recently, the hot topics in hospital management have changed from medical quality to management quality. Because there are delicate and expensive devices which occupied 9% to 10% of the budgets over the hospital in surgical rooms, this paper focus on the performance improvement of the surgical rooms, aiming on finding the factors that influence the performance.
We used both regression and decision tree methods to analyze data from one of the medical centers in Taiwan and compared the results. By the regression method, we discovered that general anesthesia patients with more procedures might bring more surgery revenue. In addition, by using classification and regression tree (C&R tree) to find the most important factor when predicting performance, we found that whether general anesthesia patients is the most important factor predicting surgery revenue, anesthesia revenue, and surgery duration time, while the complexity of the surgery affects the variance of surgery the most. The results provided could be the reference of surgery scheduling and sequencing, or process optimization for better healthcare quality.

關鍵字(中)

★ 手術室
★ 效能評估
★ 迴歸分析
★ 決策樹
★ 分類樹

關鍵字(英)

論文目次

一、緒論 1
1-1 研究背景 1
1-2 研究動機與目的 1
1-3 論文結構 2
二、相關研究 3
2-1 醫院品質與成本 3
2-2 手術室排程 4
三、研究模型之發展 10
3-1 手術室病患就醫過程分析 12
3-2 資料前處理 13
3-3 以迴歸分析為基礎的方法 14
3-4 以決策樹為基礎的方法 16
四、實證結果與分析 18
4-1 個案醫院簡介 18
4-2 分析結果 18
五、結論及建議 38
5-1 模型結果比較 38
5-2 實務貢獻 38
5-3 研究限制 39
5-4 未來研究方向建議 40
參考文獻 41
附錄 44
一、適合度檢定 44
二、多變量方法 44
三、迴歸分析 46

參考文獻

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指導教授

呂俊德(Jun-Der Leu)

審核日期

2013-1-9

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