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| 題 名 | Research on Acute Myocardial Infarction in the Context of the Accreditation System: The Moderate Effect of Hospital Ownership and Level=評鑑制度下急性心肌梗塞健保資源運用之研究--醫院權屬與層級之調節效果 |
|---|---|
| 作 者 | 施乃菁; 莊懿妃; 陳盈志; 陳珮恩; 楊智傑; | 書刊名 | 台灣急重症醫學雜誌 |
| 卷 期 | 9:3 2024.09[民113.09] |
| 頁 次 | 頁85-94 |
| 分類號 | 415.3161 |
| 關鍵詞 | 急性心肌梗塞; 經皮冠狀動脈介入性治療; 醫院緊急醫療能力分級評定; 醫院權屬別; Acute myocardial infarction; Percutaneous coronary intervention; Emergency medical treatment capacity accreditation; Hospital ownership; |
| 語 文 | 英文(English) |
| 中文摘要 | 台灣衛生署健保局於 2002 年實施醫院總額支付制度導致醫院的收入成長受到 限制,醫院經營者藉由維持符合醫院評鑑基本標準的醫師人力以管控成本加以因 應。另方面,衛生福利部為改善急重症病患醫療品質,自 2007 年進行醫院緊急醫 療能力分級評定,規定不同層級醫院須符合全國急救責任醫院之輕中重度等級要 求,例如醫院層級為醫學中心者須通過重度級急救責任醫院條文之評定。醫院經 營者陷入成本管控與維持評鑑要求之兩難。 急性心肌梗塞(Acute Myocardial Infarction, AMI)是心臟疾病中最嚴重的急症, 緊急皮冠狀動脈介入性治療(Percutaneous Coronary Intervention, PCI)能有效治療 AMI 患者及降低其死亡率。PCI 有急作與常規兩種,此兩種治療有不同的術後醫 療資源的投入,這將影響醫院經營成本與健保資源的運用。此外,急作 PCI 的比 例是通過醫院緊急醫療能力分級評定的重要指標之一。 醫院權屬別被視為影響醫院表現的重要因子之一,醫學中心層級的定位是醫院 經營者營運的目標之一,因而,醫院權屬別與醫院層級是影響醫院資源運作決策 的重要因子。本研究利用全民健保資料庫全國性次級資料,從 AMI 病患執行 PCI 的時效深入探討醫院緊急醫療處理能力分級評定實施前後醫院急作 PCI 比例,以 及術後住院費用及健保資源使用情形之差異,以檢視評鑑制度對醫院營運及健保 資源運用之影響。 本研究使用統計方法之卡方檢定、T 檢定以及變異數分析處理七年健保資料, 並以 2010 年為區分點分成評定前與評定後進行差異分析。政府實施醫院緊急醫療 能力分級評定確實達到全面提升各種不同權屬別及層級醫院急性心肌梗塞病患接 受緊急介入性治療的比例。醫院權屬別與醫院層級對醫院緊急醫療能力分級評定 確實有調節效果。評鑑對醫院常規與急作治療當次住院天數差異有明顯的影響; 床位壅擠的醫院為提升床位利用率,提高 PCI 急作比例為一確實可行的方法。 |
| 英文摘要 | In 2002, Taiwan implemented a global budget payment system, which restricted the income growth of hospitals. However, since 2009 to improve the quality of medical care for acute and severe patients, the Ministry of Health and Welfare has conducted emergency medical treatment capacity accreditation, requiring hospitals of different levels to meet the requirements. Therefore, hospital operators face a dilemma between cost control and maintaining accreditation requirements. Acute myocardial infarction treatment via percutaneous coronary intervention, whether urgent or routine, influences postoperative medical resource allocation, impacting hospital costs and insurance utilization. Additionally, the proportion of urgent PCI indicates emergency medical treatment capacity accreditation. Hospital ownership could affect hospital performance. In this study, we use the secondary data of the National Health Insurance Research Database (NHIRD) to conduct investigations of the timeliness of PCI for patients with AMI before and after the accreditation of the emergency medical treatment capacity and examine the impact of the accreditation on the operation of the hospital and usage of health insurance resources. Ownership and accreditation levels moderately affect emergency medical treatment capacity accreditation. Public hospitals have a significant response to the emergency medical treatment capacity accreditation, while regional hospitals have a more significant response to the emergency medical treatment capacity accreditation. |
本系統中英文摘要資訊取自各篇刊載內容。