• 沒有找到結果。

第五章 結論與建議

第二節 建議

一、對健保局管理者

(一) 本系統目前操作介面仍屬繁瑣造成操作流程不順暢,故建議系統 應盡量朝簡化操作介面,符合人性化及易於使用為改善方向;系統 異常處理方面目前異常之排除仍須透過人工電話連繫處理,並經由 承辦人員轉資訊人員,故建議應增加多管道,包含增加意見交流區

,或建立專屬異常處理 E-MAIL 帳號,由專責資訊人員隨時開啟 接收處理,即時排除異常。

(二)本系統開發建置之相關經驗及執行成效,可做為爾後健保局開發建

置類似系統之參考模式,亦可將本系統推廣至其他分局或技術分享 使用。

二、對醫院管理者

因登錄人員常常異動或不固定,造成登錄資料標準不一或不熟稀系 統登錄作業,影響資訊品質,應加強對內管理。

三、對未來研究者

(一)本研究短期間目標只為瞭解呼吸器照護患者流向,管控醫療費用,

往後若能朝醫療品質之方向,收集更多醫療上的指標,做為醫療上 臨床分析,相信更有價值。

(二)本研究分析資料來源為健保資料庫,因醫院申報醫療費用可以有二 年申報期限,且部份醫院申報呼吸器照護醫療費用採切帳申報,有 二個月申報一次,甚或半年申報一次,因此部份申報資料並未完整

。爾後,研究可朝更長期之申報資料進行分析。

參考文獻

AACP Consensus Conference(1993), Mechanical ventilation . Chest, 104, 1833-1859.

Adams, A. B., Whitman, J., & Marcy, T. (1993), Survays of long-term ventilatory support in Minnesoda: 1986 nd 1992. Chest, 103(5), 1463-1469.

Bailey, J. E. and S. W. Pearson(1983) , “Development of a Tool for Measuring and Analyzing Computer User Satisfaction,” Management Science, Vol.29 No.5, May , pp.

530-545.

Baroudi, J. J., Olson, M. H., & Ives, B. (1986), An empirical study of the impact of user involvement on system usage and information satisfaction. Communications of the ACM, 29(3), 232-238.

Choe, J.M.(1996), “The Relationship among Performance of Accounting Information Systems, Influence Factors, and Evolution Level of Information Systems,” Journal of Management Information Systems (12:4), pp.215-239.

Clini, E., & Vitacca, M. (1994), From intermediate intensive unit to home care. Monaldi Archives for Chest Disease, 49(6), 533-536.

Cohen, I. L., & Booth, F. V. (1994), Cost containment and mechanical ventilation in the United Stated. New Horizens, 2(3), 283-290.

Christie, H. A. & Goldstein. L. S.(1999), Respiratory failure and the need for ventilation support. In C.L.Scanlan., R.L.Wilkins & J.K.Stoller (Eds.), . EGAN’S Fundamentals of Respiratory Care (7

th pp. 819-830). St.Louis: Mosby-Year Book Inc .

Daly RJ, Rudy EB, Thompson KS, et al(1991), Development of a special care unit for chronically ill patients. Heart Lung 1991: 20: 45-52.

Dasgupta, A., Rice, R., Mascha, E., Litaker, D., & Stoller, J. K. (1999), Four-year

experience with a unit for long-term ventilation (respiratory special care unit) at the Cleveland Clinic Foundation. Chest, 116(2), 447-455.

Davison, E.J, and Chismar, W.G.(1999), “Planning and Managing Computerized Order Entry:

A Case Study of IT-Enabled Organizational Transformation,” Top Health Manage

(19:4), pp.47-61.

Debons, A., W. W. Ramage and J. F. O’Brien(1978), “Effectiveness Models of Productivity”

in L. F. Hanes and C. H. Kriebel(eds.), “Research on Productivity Measurement Systems for Administrative Services: Computing and Information Services,” Vol.1, July , NSF Grant APR-20546.

Del, B. C., Morelli, A., Bassein, L., Fasano, L., Quarta, C. C., Pacilli, A. M., & Gunella, G.

(1995), Severity Scores in respiratory intensive care: APACHE II predicted mortality. Respiratory Care, 40(10), 1042-1047.

Esteban A, Alia I, Ibanez J, Benito S, Tobin MJ.(1994), Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. The Spanish Lung Failure

Collaborative Group. 106:1188-93.

Esteban A. Anzueto A. Alia I. Gordo F. Apezteguia C. Palizas F. Cide D. Goldwaser R. Soto L. Bugedo G. Rodrigo C. Pimentel J. Raimondi G. Tobin MJ.(2000) How is

mechanical ventilation employed in the intensive care unit? An international utilization review. American Journal of Respirator & Critical Care Medicine. 161:1450-1458.

Gracey, D. R., Naessens, J. M., Krishan, I., & Marsh, H. M.(1992), Hospital and

posthospital survival in patients mechanically ventilatied for more than 29 days. Chest, 101(1), 211-214.

Henry, J. W. & Stone, R W. (1994), A structural equation model of end user satisfaction with a computer based medical information system. Information Resources Management Journal, 7(3), 21-33.

Horst HM, Mouro D, Hall-Jenssens RA, Pamukov N.(1997), Decrease in ventilation time with a standardized weaning rocess. Arch Surg ,133:483-8; discussion 488-9.

Indihar, F. J. (1991), A 10-year report of patient in a prolonged respiratory care unit.

Minnesota Medicine, 74(4), 23-27.

Ives, B., Olson, M. H. and J. J. Baroudi(1983), “The Measurement of User Information Satisfaction,” Communications of the ACM, Vol.26 No.10, pp. 785-793.

Kettinger, W. J. and C. C. Lee(1994), “Perceived Service Quality and User Satisfaction with the Information Services Function,” Decision Sciences, Vol.25 No.6, pp. 737-766.

Kollef, M.H., O’Brien, J. D., & Silver, P. (1997), The impact of gender on outcome from mechanical ventilation. Chest, 111(2), 434-441.

Kollef MH, Shapiro SD, Silver P, et al.(1997), A randomized, controlled trial of protocol-directed versus physician-directed weaning from mechanical ventilation. Crit Care Med 25:567-74.

Latrino, B., McCauley, P., Astiz, M. E., Greenbaum, D., & Rackow, E. C. (1996), Non-ICU care of hemodynamically stable mechanical ventilated patients. Chest, 109(6), 1591-1596.

Leatt P, Leggatt S G(1997), Governing integrated health delivery systems: meeting accountability requirements. Healthcare Management Forum ; 10(4), 12-25.

Leister, D. Z., & Batterden, R. A. (1992), The evolution of a long-term ventilator unit.

Journal of Nursing Administration, 22(5), 46-50.

Lesnik, I., Rappaport, W., Fulginiti, J., & Witzke, D. (1992), The role of early

tracheostomy in blunt, multiple organ trauma. American Surgeon, 58(6), 346-349.

Li, E. Y.(1997), “Perceived Importance of Information system Success Factors: A Meta Analysis of Group Differences,” Information & Management, pp.15-28.

Lundberg, J. A., & Noll, M. L. (1990), The long-term acute care hospital: a new option for ventilator-dependent individuals. AACN Clinical Issues in Critical Care Nursing, 1(2), 280-288.

McCarthy TP, Yaculak G, and Ringler B(1998), A review of 2487 mechanically ventilated patients: ventilator length of stay (VLOS), base costs, ICU distribution, and mortality, abstract. Respiratory Care , 43(2):113-118.

Modawal A. Candadai NP. Mandell KM. Moore ES. Hornung RW. HO MI., Tsevat J.(2002), Weaning success among ventilator-dependent patients in a rchabilitation Tacility.

Archives of Physiological Medical Rehabilitation. 83:154-157

Nava, S., Confalonieri, M. & Rampulla, C. (1998), Intermediate respiratory intensive care units in Europe: a European perspective. Thorax, 53(9),798-802.

Phelan, B. A. (2000), Tracheostomy timing and length of stay of patients requiring prolonged mechanical ventilation. Unpublished Dissertations. Columbia University.

Ponte, J. (1994), Indications for mechanical ventilation. Assisted Ventilation (2thed.).

Britain:Ltd, Plymouth.

Scheinhorn DJ, Chao DC, Stearn-Hassenpflug M, Wallace WA.(2001), Outcomes in post-ICU mechanical ventilation: a therapist-implemented weaning protocol. Chest 19:236-42.

Scheinhorn DJ. Hassenpflog M. Artinian BM. LaBree L. Catlin JL.(1995), Predietors of weaning after 6 weeks of mechanical ventilation. Chest.107:500-505.

Spicher, J. E. & White, D. P.(1987), Outcome and function following prolonged mechanical ventilation. Archives of Internal Medicine, 147(3), 421-425.

Stauffer JL, Fayter NA, Graves B, Cromb M, Lynch JC, and Goebel P(1993): Survival following mechanical ventilation for acute respiratory failure in adult men. Chest, Oct;

104: 1222 - 1229.

Thomas, P. M., Gergory, Y., & Brian, R. (1998), A review of 2,487 mechanically ventilated patients: Ventilator length of stay (VLOS), base costs, ICU distribution, and mortality. Respiratory Care, 43(2), 114-118.

Treacy, M. E.(1985), “An Empirical Examination of A Causal Model of User Information Satisfaction,” Unpublished Paper, Center for Information Systems Research, Sloan School of Management, MIT, Cambridge, MA.

于煥中、吳清平、葉秀逸、王如華(2000),以護理觀點談呼吸照護中心成立的初步經 驗,中華民國重症醫學雜誌,2(1),91-99。

王鳳葉(2003),呼吸器脫離評估項目與呼吸器脫離結果之相關性探討,臺北醫學大學

高雄榮總 ( 2005),呼吸加護病房,2005 年 9 月 5 日刊登,

附錄一

、TEL1)及 E-MAIL 帳號(E_MAIL)等,本資料檔由醫院自行登錄,

以利平時連繫之用。

D.長期依賴呼吸器照護醫師支援時段檔(LTINS_SUP):儲存欄位有醫事機 構代號(HOSP_ID;關聯欄位)、醫師 ID(PRSN_ID;關聯欄位)、醫師 姓名(PRSN_NAME)、支援日期(SUP_DATE)、支援時段(SUP_TIME

)、專科別(DOC_TYPE)及登錄時間(EXE_DATE)等,本資料檔之來

、患者姓名(NAME)、入院日(IN_DATE)、患者來源(SOURCE_CODE

)、患者來源處所名稱(SOURCE_NAME)、病床種類(BED_TYPE)、

病 床 號 (BED_NO )、 是 否 有 氣 切 ( ON_TYPE )、 氣 切 起 日 ( TRAC_BEG_DATE)、轉出日期(OUT_DATE)、轉出原因(OUT_REASON

)、醫師 ID(PRSN_ID;關聯欄位)、呼吸治療師 ID(RSP_ID;關聯欄

代號(HOSP_ID;關聯欄位)、呼吸治療師 ID(RSP_ID;關聯欄位)、

呼吸治療師姓名(RSP_NAME)、是否有證照(RSP_QUALIFY)、兼任

或專任(RSP_WORK)、執業起日(RSP_BEG_DATE)、執業迄日(

RSP_END_DATE)及登錄時間(EXE_DATE)等,本資料檔由使用者自 行登錄。

M.長期依賴呼吸器照護患者呼吸器使用檔(LTINS_RSPDETAIL):儲存有 記錄流水號(SEQ_NO;關聯欄位)、呼吸器使用起日(RSP_BEG_DATE

)、呼吸器使用迄日(RSP_END_DATE)及登錄時間(EXE_DATE)等

,本資料檔由使用者自行登錄,以流水號來與「呼吸器患者資料檔」做 連結,一個流水號可能有多個呼吸器使用起迄日期。

L.長期依賴呼吸器照護患者 RSI 檢測結果檔(LTINS_RSI):儲存欄位有流 水號(SEQ_NO;關聯欄位)、是否檢驗(RSI_CHECK_YN)、檢驗值(

RSI_CHECK_DATA)、檢驗日期(RSI_CHECK_DATE)及登錄時間(

EXE_DATE)等。本資料檔由使用者自行登錄,以流水號來與「呼吸器 患者資料檔」做連結,一個流水號可能有多個呼吸器照護RSI 檢驗值。

附錄二

※醫院間互轉率:轉出(或轉入)醫院呼吸器使用個案占醫院收治全部呼 吸器使用個案之比率。

公式=

※非醫學中心及RCC 轉入比率:醫院收治之患者非由醫學中心及 RCC 轉 入之呼吸器患者個案占醫院收治全部呼 吸器使用個案之比率。

公式=

使用呼吸器之個案由他院轉入本院(或 由本院轉出至他院)之個案數

使用呼吸器總個案數

使用呼吸器之個案非由醫學中心及非由 RCC 轉入本院之個案數

使用呼吸器總個案數

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