醫院肺炎住院照護成效之研究：以參與醫院品質績效量測指標系統之病患為例

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標題:	醫院肺炎住院照護成效之研究：以參與醫院品質績效量測指標系統之病患為例 Effectiveness of inpatient’s quality of Care with pneumonia: Sampling from the hospital quality performance measurement index system
作者:	呂雪箐
貢獻者:	醫務管理系郭彥宏
關鍵字:	醫療品質醫院品質績效量測指標住院風險因子肺炎 Healthcare quality P4P Pay-for-performance Pneumonia hospital related risk factors
日期:	2017
上傳時間:	2018-01-11 11:41:47 (UTC+8)
摘要:	目的：肺炎是一個常讓人忽略且是常見的疾病，近年在國人十大死因中的排名更逐年上升，本研究旨在探討肺炎病人的住院之相關風險因子與照護成效之影響因素，期望能將研究結果運用在臨床上，提供醫院未來對於肺炎病人之臨床處置之建議。方法：本研究採取病歷回溯研究方式，研究場域為南部某區域教學醫院，研究對象為該院18歲以上且胸部X光有浸潤、診斷為肺炎之住院病人。收案期間為2015年7月至2016年6月，有效樣本共515位。統計方法包括，百分比、平均數之描述性統計，及卡方檢定、二元邏輯斯迴歸分析等進行推論性統計。此研究計畫經該院人體試驗委員會審核通過，其IRB編號為B-16-K011。結果：樣本數共515位，男性281位、女性234位，男性平均年齡為70.64±16.824歲（19至100歲）、女性平均年齡為72.88±17.997歲（20至101歲），經Logistic regression後，得知其存活死亡與肺炎住院各項因素之影響因子為，65歲以上族群之死亡勝率為65歲以下族群之2.467倍、罹患癌症與沒有罹患癌症的族群相比之死亡勝率為4.689倍、有罹患糖尿病比沒有罹患糖尿病族群之死亡勝率為1.984倍，且CRP值在10mg/dl以上之死亡勝率為CRP值在10mg/dl 以下族群的2.458倍；二元邏輯斯迴歸之存活率預測：每增加1歲，其存活率減少4.8%、CRP每增加1 mg/dl，其存活率減少6.6%、沒有罹患癌症者，其存活勝算為5.602倍、而沒有罹患糖尿病者，其存活勝算為2.398倍。結論：本研究結果發現，年齡增加是導致肺炎存活勝算呈現些微比例降低的因素之一，而罹患癌症或罹患糖尿病的病人確實會明顯降低其存活率，並隨著肺炎病人CRP值的上升，其存活率亦隨之些微降低。 Objective Pneumonia is a commonly existed disease which often overlooked. In recent years, its ranking in the top ten causes of death in Taiwan increased year by year. This study was designed to investigate the hospital-related risk factors for pneumonia patients and the factors that affect the effectiveness of medical care. It is expected that the findings will be used clinically and will provide advices on the future clinical treatment of pneumonia patients. Methods The study is designed as a retrospective study by patients’ medical charts. The research field is set on a regional teaching hospital in southern Taiwan. At entry patients, above 18 years old, with chest X-ray infiltration, and were diagnosed with pneumonia inpatients. A totally 515 participants finished the investigation during July 2015 to June 2016. Statistical methods were used including descriptive statistics of percentage, average, analytical statistics of chi-square test and binary logistic regression analysis. This study has been registered in the clinical trial (B-16-K011). Results Of the valid 515 participants, it include 281 male patients with averagely 70.64±16.824 years old and 234 female patients with averagely72.88±17.997 years old. With the binary logistic regression analysis, we have findings described as below. The odds ratio of patients aged ≥65 is 2.467 times higher than <65 group; the odds ratio of patients with cancer diagnosed postive is 4.689 times higher than thoes negative; the odds ratio of patients with DM diagnosed postive is 1.984 times higher than thoes with negative; CRP value ?10 mg/dl has 2.458 times of odds ratio than <10 group. Furthermore in survival analysis, the survival rate was reduced by 4.8% for each 1 year on age; the survival rate decreased by 6.6% for every 1 mg / dl CRP increase; the survival rate was 5.602 times higher with cancer diagnosed negative; and 2.398 times of survival rate is higher with DM diagnosed negative. Conclusions Increased age is one of the most important risk factors that slightly lead to a reduction in the survival rate of pneumonia patients, and patients with cancer or diabetes do significantly reduce their survival rate. Finally, with the increase in CRP levels of pneumonia patients, the survival rate also decreased.
關聯:	電子全文公開日期：2022-08-14，學年度：105，74頁
显示于类别:	[醫務管理系(所)] 博碩士論文

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