| 摘要: | 隨著交通工具不斷更新與進步，交通事故逐年增加，顏面骨折因其發生率高及重大成本支出，為全球公共衛生面臨最大挑戰之一。為因應DRG支付方式導入，瞭解顏面骨折病患醫療資源耗用情形及其影響因素，提供經營管理者建立有效的經營模式。本研究目的藉由醫學中心之顏面骨折病患醫療資源耗用情形做分析比較，以瞭解不同病患特性、外傷特性及疾病因素在醫療資源耗用上有無差異及探討醫療資源耗用是否受到病患特性、外傷特性及疾病因素的影響。 本研究為回溯性次級資料研究，以某醫學中心疾病分類資料庫及外傷登錄資料庫之出院主診斷ICD-9-CM前三碼編列為802之患者為研究樣本為主，符合分析樣本數計816筆。使用統計方法包括獨立樣本t檢定、單變量變異數分析（one-way ANOVA）及複迴歸分析（Multiple Regression）。 研究結果影響顏面骨折醫療資源耗用的因素包括：損傷嚴重度、顏面骨折型態、麻醉方式、手術次數及疾病複雜度。 最後本研究建議，醫院管理者必需針對會影響顏面骨折醫療資源耗用的因素包括：損傷嚴重度、顏面骨折型態、麻醉方式、手術次數及複雜度，建議醫院經營者應利用醫院之資料庫將上述影響因素放入迴歸預測模式，以建構自己的成本模式。針對損傷嚴重度重度以上耗用醫療資源最高的病患採取個案管理，以控制成本。針對上下顏面骨折，且入院診斷三個以上耗用醫療資源為高的病患，建立標準化作業程序(SOP)，以控制成本。
With the developing of transport, traffic accidents increases every year, because of the high incidence of facial fractures and significant costs, as one of the greatest challenge of the public health. In response to DRG payment import, understand the medical resource utilization situation for the facial fracture patients and its influencing factors, providing managers establish an effective business model. The purpose of this study analyzes the facial fracture patients consume health care resources in the Medical Center and compared the situation to do, in order to analyze the differences of medical resource utilization in the different patient’s condition, trauma characteristics and disease factors. This study is a retrospective study of secondary data. 816 facial fracture patients are collected from Kaohsiung Chang Gung Memorial Hospital medical center disease classification information database and trauma registry database of primary ICD-9-CM diagnosis code (802). The statistical methods includes T-test, univariate analysis of variance (one-way ANOVA), multiple regression analysis (Multiple Regression).The result showed the significantly relationship between the medical resources consumed facial fractures and the severity of injuries, facial fracture patterns, anesthesia, surgery number and complexity of the disease.Finally, this study suggests that hospital administrators would affect facial fractures necessary for medical resource utilization factors include: the severity of injuries, facial fracture patterns, anesthesia, surgery number and complexity, the proposed hospital operators should use the hospital's database the above factors into regression prediction model to construct their own cost model. Consumption of medical resources for injury severity in patients with severe than take up case management to control costs. For the upper and lower facial fractures, and admission diagnosis of medical resources consumed three or more patients for high establishing standardized operating procedures (SOP), in order to control costs. |
