中國醫藥大學機構典藏 China Medical University Repository, Taiwan:Item 310903500/32409
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(2) ठ!!ᖴ! ! २Ӄךाᖴᖴ೭ٿԃٰόᘐ࿎ߦǵႴᓰךǴ٠Ъ๏ךӭวᆶᏢಞ ᐒڑޑউԴৣǴӧΒԃભਔҁགྷᚆ໒Ꮲਠѐୖує૽ግךޑǴӭ ᖝԴৣࠆޑངᆶቨǴ٬ךӧԴৣޑፌፌᝀࠀύӣډᏢਠஒፕЎӳӳֹ ԋǴࡐޑᖴᖴԴৣǼԴৣᕴࢂ௦ڗԾҗ໒ࡰޑܫᏤБԄǴ٠ਔ๏ך дᝊࡌޑǴᡣૈךӧࡐܺݗޑύᏢಞǵԋߏǴᗨฅࡕٰԴৣᚆ ໒ύ୯Ǵӭޑᡂ٬ךᏼЈፕЎૈցᝩុǴՠ೭ΨࢂЬޑӼ௨Ǵᡣך Ԗᄪ۩ૈӢԜளٿډՏԴৣࡰޑᏤǴӧፕЎኗቪၸำύٿՏԴৣϐε ԋǴ٠ᏢಞٿՏԴৣ௵᎒ࡘޑԵǵᝄᙣޑᡄᒠղᘐǴ௲ךᕇؼӭǴу ७གᐟǼ!! ௗךाགᖴᙔ۸ַԴৣǴ࠼ޑாᕴࢂᇥாখٰύ୯Ԗӭόዕ Ǵाፎॺךӭӭх఼ǴՠࢂॺךՖځԖ۩ૈಡ᠋ாޑ௲ᇧǴ٬ॺך ᏢಞډாޑᙦޕǴாࡑΓೀ٣ޑБԄΨࢂ࣬ךޑܺٵǴό ೀ٣༝ᑼǵઢё௧ǴךӧᆶாፕፕЎԖӭόᔉਔǴாΨϝࢂک ᝰёᒃޑນךёаୖԵব٤ၗٰᏢಞǴԶךനགᖴாࢂޑӧኗቪፕ Ўޑനࡕ೭ࢤਔ໔Ǵாᗋᜫཀԏࣁך২٠ಒЈࡰᏤǴ٠ૈᔅշךӵය ֹԋፕЎǴ٬ࢂךҗ૱གᖴǶ! ךᗋाձགᖴഋЎཀԴৣჹךӧीБय़ޑ༇ࡰᏤǴךѐࠄ ໒פԴৣਔᕴࢂૈགډڙԴৣዋ෴ޑ௲ᏢוǴ٠ЪుགܺٵǴόᆅࢂ বԛѐፎ௲ԴৣीୢᚒдᕴࢂऐЈᆶངЈൻൻ๓ᇨǶԢՃঢ়Դ ৣࢂךᏢಞբࣴ௴ޑزᆾԴৣǴԴৣ௲๏ޑךϪךԿϞϝڙҔคጁǴ ёаᇥֹૈךԋፕЎǴΨࢂӭᖝΑਔԢԴৣऐЈӦࣁך൚Πਥ୷Ǵ܌ аךाձགᖴԢԴৣǼԶֺଣߏӧനࡕޑᆙाᜢᓐᜫཀਔ໔ᔅշך অׯमЎᄔाǴࣗԿԆډΜᗺωӞఁᓓǴᖴᖴாჹॺךፕЎࠔ፦עޑᜢǴ Ԗாޑाω٬ךԖଓޑΚǴךᝩុոΚᆒᆒޑǼ! ᖴᖴύ୯ۂۊϐৎॺۂۊޑഉךଆזޑၸєғࢲǴᖴᖴ҇௵ۊ தฆ෯ྣ៝ך٬္ךѦᅈΑࢲΚǴᖴᖴᒘছ௨ᆶߙᙍ௨ޑлॺۂۊ ᙖӭᛗᔅշךǴᖴᖴન३ߓ࠰ᆶךଆᛗǴᗋԖךёངޑӕᏢ ॺޑഉՔǴགᖴգॺεৎǼ!. നࡕǴᖴᖴݿ༰٬ૈךคࡕ៝ϐኁǴЈࣴزǴᖴᖴᏢॺഉךᛗǴ ΨᖴᖴࢲޑךΚՔӧ܌زࣴךය໔ޔᔅշךᙯӣᡫ္ǵࡠൺךӧࣴز ύჹЬޑངᆶ٦ڙǴЪႴᓰךǵךןǴഉךᛗᔅշ׳ךངЬǴᖴᖴ գǴգǵЬޑךکৎΓࢂޑךǵंޑךǴբߥޑךៈǵЇᏤןکǼ !!!!!!!!!!. !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!Ꮲғ!ጯ!ޱٵᙣ !!!!!!!!!! 2010.6.8!.
(3) ύЎᄔा ࣴزҞޑǺ୯ሞࣴزᡉҢᙴଣៈΓྣៈੰΓኧၸӭஒගଯᙴᕍ॥ ᓀǴΓܭྗѦӭྣ៝ՏੰΓǴځΕଣ 30 ϺϣԝΫᆶٰόϷཟ௱ޑ ᐒࣣቚуԿ 7%ǶѠፁғவ 2003 ԃଆΨӚྣៈीฝǴаග ϲྣៈࠔ፦ǶҁࣴزҞࣁޑፓ୯ϣᙴଣៈΓΚଛݩǴᙖԜ уΕྣ୍៝ܺࢂցࣁቚੰΓྣៈࠔ፦ϐଛБԄǶ ࣴزБݤǺፓፁғ97ǵ98ԃࡋӄೢྣៈीฝύǴ5ৎ၂ᒤᙴଣޑΟঁ ၂ᒤੰک܊ϖঁߚ၂ᒤੰ܊ϐੰ܊ǴճҔੰ܊ൔ߄ǴଞჹៈΓΚଛ ǵੰΓᝄख़ࡋᆶՐଣੰΓ่݀Ǵᢀෳੰޑ܊ӚձԿঁٿДǴ ٠ճҔ႟ᑩΝ݊ᘜኳࠠՉჴϩǴаᔠຎៈೌמಔӝኳԄ ȐNurse Skill Mix ModelȑჹੰΓྣៈ่݀ޑቹៜǶ ่݀ǺӣԏៈΓڐշ༤ቪϐੰ܊ൔ߄1572ҽǴԖਏୢڔ1471ҽǶ а8ѨᇤวғᕴΓԛᑽໆៈྣៈ่݀Ǵวගଯៈπਔǵቚуៈ Γኧё෧Ͽॄय़ྣៈ่݀วғኧǴԶቚуीฝငҺྣ୍៝ܺКٯǴ ٠҂ᡉ෧Ͽॄय़٣ҹǴёૈࢂीฝငҺྣ୍៝ܺ܌՞КٯၸեᏤठǶ ่ፕǺၨଯޑៈπਔϷၨӭޑៈΓኧԖշܭ෧Ͽॄय़ྣៈ่݀Ǵ ᡉҢӧៈΓΚଛύǴៈΓࣁόё܈લޑΓΚၗྍǴᔈᙖගଯៈ Γኧफ़եॄय़ྣ่៝݀ǴԶගϲྣៈࠔ፦Ƕ ᜢᗖӷǺៈೌמಔӝǵੰΓྣ่៝݀ǵៈΓΚଛǵྣ୍៝ܺ.
(4) Abstract Aims: Studies have shown concerns of hospital under staffing of nurse care for patients and the increase of medical risk. One nurse less than the standard care ratio, the likelihood of mortality and the odds of failure-to-rescue may increase for 7% within 30-day admission. The Department of Health (DOH) in Taiwan implemented several nursing care programs to improve the care quality. This study aimed to investigate the nursing manpower among hospitals, and to explore whether the affiliation of additional lay care giver improved patient care quality. Methods: We conducted a comparison study between 3-study wards and 5 non-study wards in 5 hospitals for “the total nursing health care program of DOH”. We used the nursing station reports to observe the nursing manpower deployment, patient severity, and patient outcome for one or two month. In the meanwhile, we used the zero-inflated Poisson regression model to conduct empirical analysis, and to check the effect of nursing skill mix model on patient care outcome. Result: A total of 1471 eligible questionnaires were collected from nurses and analysed. We measuring the nursing care outcome by measuring the 8 job-related mistakes. We found that raising work hours and number of nurses had reduced the negative patient outcomes. On the other hand, the lay care givers could not decrease negative outcomes. Conclusion: In the ward with more nurses and more work hours, the negative outcomes are decreased. Nurses are important manpower to improve the quality of care. We should enhance the number of nurse besides keeping the.
(5) original to reduce negative outcome, and improve care quality. Key words: nursing skill mix, patient care outcome, nursing manpower deployment, care giver.
(6) ؾᙕ. Ҟ ᒵ ύЎᄔा. (।ԛ). मЎᄔा Ҟᒵ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ I ߄ԛ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ III კԛ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ IV. ҁЎ. ಃകǵᆣፕ ಃǵࣴزङඳᆶࣴزᐒ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 1 ಃΒǵࣴޑزख़ा ܄ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 6 ಃΟǵࣴزҞ ޑǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 8 ಃѤǵࣴزୢᚒᆶࣴزଷ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 9 ಃϖǵӜຒࣚ ۓǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ10. ಃΒകǵЎ ಃǵʳ ӄೢྣៈीฝϐ࣬ᜢࣴز ಃΒǵʳ ៈೌמಔӝ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ11. ಃΟǵʳ ྣ୍៝ܺ૽ግ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ14 ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ21. ಃѤǵʳ ੰΓྣៈࠔ፦ϐෳໆ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ23. I.
(7) ؾᙕ. ಃΟകǵࣴزБݤᆶᡯ ಃǵʳ ࣴࢎزᄬ. (।ԛ). ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ26. ಃΒǵʳ ࣴزᡂϐᏹբࠠۓက. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ28. ಃΟǵʳ ࣴزीᆶࣴزᡯ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ31. ಃѤǵʳ ࣴزπڀᆶࣴزჹຝ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ32. ಃϖǵʳ ၗԏၸำ ಃϤǵʳ ၗीᆶϩ. ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ35 ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ36. ಃѤകǵ่ࣴ݀ز ಃǵʳ ඔॊ܄ीϩ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ41 ಃΒǵʳ ᘜीϩ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ49. ಃϖകǵፕᆶ่ፕ ಃǵʳ ፕ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ59 ಃΒǵʳ ࣴزज़ ڋǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ68 ಃΟǵʳ ่ፕᆶࡌ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ70. ୖԵЎ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ73 ߕᒵǵ!ੰ܊ൔ߄!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ79! ߕᒵΒǵ!ጓዸᛛ!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ80! ߕᒵΟǵ!௶ॊी߄!ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ82!. II.
(8) ؾᙕ. ߄ Ҟ ᒵ ߄ԛ. (।ԛ). ക ߄1. ЎύӚྣៈᇶշΓΚϐπբᙍೢКၨ ǾǾǾǾǾǾǾǾǾ 20. ߄2. ᏹբࠠۓက ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 28. ߄3. ࣴزᒧڗϐᙴଣ܄ၗ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 35. ߄4. 97ǵ98 ԃӚ܄ϐϩѲϩ ………………………………47. ߄5. ࣴزಔᆶჹྣಔϐྣៈ่݀Кၨ ……………………………… 48. ߄6. ٣ҹᓎϩѲ …………………………………………………… 50. ߄7. ीኧኳࠠຑ่݀ …………………………………………….... 52. ߄8. ӚᡂჹੰΓྣៈࠔ፦ϐቹៜ ………………………………… 55. ߄9. ӚᡂჹྣៈѨ௳ԛኧޑቹៜ ………………………………… 56. ߄ 10. Ӛᡂ٬ྣៈ٣ҹวғϐ࣬ჹ॥ᓀ …………………………… 58. III.
(9) ؾᙕ. კ Ҟ ᒵ კԛ. (।ԛ). ക კ1. ࣴࢎزᄬკ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 27. კ2. ࣴࢬزำკ ǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾǾ 32. კ3. ᘜኳࠠෳ၂ຑ ……………………………………………… 53. IV.
(10) ಃകǵᆣፕ! 2003ԃѠчᣁࡹ۬܌ՉϐȨӄೢྣៈኳԄȩࡹǴϷࡕٰፁғៈ ྣៈೀ܌ՉϐȨӄೢྣៈኳԄȩ Ǵࢂࣁගϲᙴᕍྣៈࠔ፦ǵ෧ ϿੰৎឦӢྣ៝ੰΓԶፎଷϷငҺ࣮ៈٰϐᔮॄᏼǴ܈෧Ͽߚ ΓΚрΕᙴଣԶԋଣϣགࢉǴ೭ᅿуΕៈᇶշΓΚǴӵྣ៝ܺ ୍ޑៈೌמషӝྣៈኳԄǴςԋࣁҔаᔆံៈΓΚόޑىᖿ ༈Ǵՠόӕय़ӛޑቹៜΨᒿϐౢғǴуΕྣ୍៝ܺࢂցૈׯ๓ΓΚ όىୢᚒǴ܈ٰ׳εፂᔐᆶॄय़ቹៜǴࣁࡹჴࡼаٰᔈϩ ޑख़ाୢᚒǶаΠҁകϩࣁΟǴϩձࢂࣴزङඳᆶᐒǵࣴزҞޑϷ ࣴزୢᚒᆶଷǶ. ಃǵࣴزङඳᆶࣴزᐒ ୯ϣៈΓΚόىݩ ҇୯64ԃԿ73ԃ໔ǴៈΓࢬѨऊࣁ35%Ǵ75ԃਔǴ45%ޑᙴᕍ ଣ܌ᚆᙍଯܭ15%[1]Ǵ90ԃԿ93ԃ໔ޑៈΓᚆᙍύǴԖ1/ 3ࢂҗ ཥៈΓ܌ଅ[2]ǴЬाࢂӢᙴଣ܄፦ᆶࡹޑቹៜǴԶᕴᚐႣᆉ ჴࡼԿϞǴᙴᕍଣ܌ӧ଼ߥ๏бࡋڋΠε൯෧ϿៈΓΚǴᡏៈΓ ΚٮሡѨᑽǴуޣཀଯᅍǴ٬ளៈΓޑᖒၗᆶڙ܍ځᓸΚ όԋК[ٯ3]ǴԶៈᏢਠΓኧᗨቚуǴՠჴሞΕᖏπբਔ໔ӭ. 1.
(11) ӧ1~2ԃջᚆᙍ[4]ǶਥᏵύ҇୯ៈৣៈγϦӄ୯ᖄӝ2010ԃ2Д ៈΓीǴѠҞሦԖៈৣᆶៈγྣΓኧऊԖ21ΓǴჴሞ ΓኧࠅѝԖ59.56% [5]ǶΓΚሌՉፓҭᡉҢǴѠԖ79%ޑៈΓ གྷᙯǴ60%όགྷᏼҺៈᙍ[6]ǴԶჹ୯ϣӦભаᙴଣՉୢڔ ፓΨளډǴ2001ԃៈΓᕴᚆᙍࣁ22.19% Ǵ2003ԃࣁ26.43% Ǵ 2004ԃࣁ28.02% Ǵ2005ԃ߾ࣁ32.10%ǴԖԃᚹϲޑᖿ༈ [2, 7-8]ǶѠ ៈΓπբໆεǵᓸΚख़ࠅ҂ૈӧᖒၗǵӦՏᕇளᔈԖޑ൧ख़Ǵ ٬ៈΓᚆ໒ҁ୯܈ᚆ໒ҁќᒉଯ൩Ǵՠ୯ϣៈΓΚόޑىୢᚒ ϝ҂ᕇளׯ๓Ǵ٩ᏵፁғीǴ୯ϣᙴᕍᐒᄬៈΓѳ֡Γྣ៝7 ډ13ӜੰǴࢂགྷॶ4Γޑ७ӭ[9-11]Ǵёـៈ࣬ᜢࣽسғΓ ኧᗨӭǴӧᖒၗǵπբॄᆶᓸΚᅿᅿӢનቹៜΠǴჴሞϐៈ ΓϝᡉόىǶ ᙴᕍࠔ፦ޑቹៜ όޑᙴ٣ΓΚଛᆶੰΓຳॹǵᒀየǵᙴᕍ౧Ѩᙴᕍޟޑวғ ஏϪ࣬ᜢǴΨёૈፂᔐᡏᙴᕍࠔ፦[12]ǶԶຬਔǵຬໆπբޑៈΓǴ όҁ଼يநᝄख़ڙཞǴޔ׳ௗ܈໔ௗԋੰΓՐଣਔ໔ߏۯǵٳว ੱǵԝΫᆶёႣٛϐཀѦ٣ҹቚуǴቹៜᙴᕍࠔ፦[13]Ƕך୯Ծ1995 ԃՉӄ଼҇ߥаٰǴӚᙴᕍᐒᄬӧ၀ЍбࡋڋΠǴӢᔼᓸΚᆶԋҁ ԵໆǴ٬ྣៈфૈҗ੯ੰྣៈࣁЬঁޑਢៈᙯԶᡂԋᖱπբਏϷ. 2.
(12) ϩπޑфૈ܄ៈ[14]Ǵՠख़ፄޑ܄ៈπբᆶ؈ख़ޑπբᓸΚததቹៜ ៈΓޑπբᅈཀࡋǴठ٬ៈᚆᙍୃଯ[2, 15-16]Ƕᚆᙍᆶࢬ ଯԋ҂ᅈԃޑཥΓଯၲ1/ 3ǴځჹπբޑόዕǴΨ ᜤխቹៜྣ៝ࠔ፦[2]Ƕࣁගϲྣ៝ࠔ፦Ǵӕਔှ،ႣᆉᆙᕭԋޑΓΚ όىୢᚒǴऍ୯ޭቺ୷εᏢߕᙴଣӧ1988ԃ൩ਏݤൈݯႥᙴଣᆶ نᖻํၲયґᅟᙴଣ[17]Ǵ٬Ҕ34ՏคྣϐៈᇶշΓΚ༤ံ17Տࣽ ៈৣϐᙍલՉྣៈ୍ܺǴคྣϐៈΓΚᖒၗၨեǴૈϩᏼៈΓ ޑᚳεπբໆǴӢԜᙴଣаቚငԜΓΚᇶշࣽៈৣǴቚуྣៈΓ ΚǶ ៈኳԄᄽᡂ ᒿᙴᕍᕉნޑᡂǴៈኳԄΨᒿϐׯᡂǴԐයޑៈኳԄࢂаф ૈ܄ៈϷঁਢៈࣁЬǴՠځલᗺࢂៈΓऩӧՉៈπբਔ ௗੰΓǴ߾คݤගੰٮΓᡏ܄ǵೱុྣޑ܄ៈǴࢂܭԋಔៈߡܭ 1960ԃ҃යวр[14]ǴவаπբࣁύЈྣޑៈኳԄᙯᡂࣁаੰΓࣁύ ЈǴஒៈΓϷੰΓϩಔǴಔҗៈΓǵៈǵៈғಔ ԋǴҗڀԖሦᏤૈΚϐៈΓᏼҺಔߏǴሦӄಔπբΓӅӕֹԋ ಔϣੰΓϐៈीฝǴᗨςၨڀᡏ[܄18]ǴՠӢੰΓኧӭЪៈΓ௦ ΟڋǴԶคݤගੰٮΓঁձ܄ǵೱុޑ܄ៈǹࣁԜǴӄೢៈ໒ۈ Չ[14]ǶӄೢៈྣޑៈኳԄวԾऍ୯ǴࢂҗՏޑۓڰӄೢΓॄ. 3.
(13) ೢੰΓྣៈǴගٮᡏ܄ǵೱុ܄ǵڐፓ܄ǵঁձ܄ϐྣៈǴ٬ੰΓӧ ֹޑៈຑᆶៈीฝΠǴௗڙаੰΓࣁύЈྣޑៈ୍ܺ[14]Ƕӧኻ ऍ୯ৎᙴଣϣԖόӕቫભǵྣޑៈΓǴхࡴຏнៈγǵៈγ ϷៈշǴڙၸ૽ግޑៈշёՉࢌ٤୷ҁπբٯӵᙌيǵ ܡङ܈ᔔᐙǴՠϝҗຏнៈγॄӄೢҺǴ߈ԃٰᎃ߈୯ৎВҁǵཥу ڵΨаֹ๓ޑӄೢៈڗжၸѐाৎឦ੮ଣڐշྣៈࡋڋޑǶཥуڵክ ەᆕӝᙴଣޑӄೢៈǴᄇۭჴࡼೖ࠼ࡋڋǴ٬ଣϣགࢉᐒफ़եǵੰ ΓΨளډкϩҶ৲ǴԜѦǴуΕྣ୍៝ܺࡕǴޑىៈΓΚ٬Γ ѳ֡ྣៈੰኧ0.73[10]Ƕ୯ϣࣴزҭᡉҢǴчࢌჴࡼៈೌמష ӝϐᙴᏢύЈϣǴڙೖϐъኧаៈΓᇡࣁྣ୍៝ܺૈϩᏼៈ ΓϐπբॄǵЪԖշܭගϲᡏៈ୍ܺࠔ፦[19]Ƕ٠Ԗշܭ٬ៈ ΓԖ׳ӭਔ໔ྣ៝ख़ੱ[ޣ17]ǶಷΓҭࡰрǴೌמషӝኳԄύ ଛ15%ϐྣ୍៝ܺёᡉफ़եੰΓຳॹ[19]Ƕӄೢៈྣៈےޑԑ ӧගੰٮঁӼӄᆶᡏྣៈޑ൩ᙴᕉნǴݯᕍၸำޑៈπբҗៈ ΓຑੰΓࡕݩރǴஒӚੰΓ܌ሡៈϩଛ๏ӚቫભϐៈΓ ග୍ܺٮǴৎឦό੮ଣྣ៝ੰΓǴΨόбፎ࣮ៈπڐշྣៈ [20]ǶӄೢៈྣៈኳԄޑՉǴΏࣁफ़եៈѨᇤǵ෧Ͽଣϣགࢉǵ ෧ᇸៈΓπբॄǵගϲπբγǴԶ෧ϿੰՐଣϺኧǵफ़ե ᙴᕍԋҁǴᆢۓำࡋޑᙴᕍࠔ፦Ƕ. 4.
(14) ӄೢៈኳԄᑫଆ 2003ԃSARSࣝᛈวǴѠчѱፁғֽࣁ෧ϿৎឦӢྣ៝ੰΓԶ੮ଣ ܈ငߚᙴᕍΓȐ࣮ៈȑڐշྣៈǴԶགࢉ੯ੰ٬ࣝጭۯǴѾၗ ΒሹΕྣ୍៝ܺϐ૽ግϷྣ៝πբϐǴԶԾ၀ԃࡋ7ДଆӧѠч ѱҥᖄӝᙴଣϘངǵύᑫǵکѳǵ۸ֵǵܴϖଣȨѠчѱҥᙴ ଣՐଣੰΓӄೢྣ៝၂ᒤीฝȩ Ǵჴࡼխ࣮ៈڋǴࢂࣁനԐჴࡼȨӄೢ ៈྣៈࡋڋȩϐӦǶВখ่ޑ״ՉࡹଣፁғಃϖයᙴᕍᆛȨӄ Γ଼நྣៈीฝȩ ǴीฝයำԾ2005 ԃ1ДԿ 2008 ԃ12ДǴҞࢂޑၲډ ගϲᙴᕍྣៈࠔ፦ǴࡌᄬӄΓ଼நྣៈᡏسϐᜫඳ[21]Ƕය໔ፁғ҇ܭ ୯95ԃૼہᒤȨ95ԃࡋӄೢៈኳԄ၂ᒤीฝȩ ǴᒦᒧԖཀᜫϐᙴଣ Չ၂ᒤीฝǴځीฝϣࣁୖԵ٠٩Ᏽ୯ϣѦЎ่݀ǴुۓՐଣ ੰΓៈᇶշΓΚϷഉੰΓᆅೕጄࡕǴ٠၂ᒤϐǴԶௗٿԃ Ȩ96ԃࡋǵ97ԃࡋӄೢྣៈࡋڋਢीฝȩϷԿȨ98ԃࡋӄೢྣៈ ᇶᏤीฝȩޑՉǴᆶӕਔѠчѱࡹ۬ፁғֽՉޑȨ96ԃࡋǵ97ԃࡋ ӄೢྣ៝ीฝȩࣣ٬ҔៈᇶշΓΚаᅈىԖϐྣៈΓΚሡǹЬा ԖΟεҞޑǺှ،ៈΓΚόىୢᚒǵගϲੰৎឦᅈཀࡋϷׯ๓ᙴᕍ ࠔ፦Ǵ೭سӈޑीฝᇥܴៈᇶշΓΚޑ٬Ҕςᆽ༈ࡑวǴճҔᇶշ ΓΚڐշՉၨֹྣޑៈςࣁШࣚᖿ༈Ǵՠ܌ځٰޑӚय़ਏࢂࣴ ޣزвಒϩޑǶ. 5.
(15) ྣ୍៝ܺ 2003-2009ԃ೭Ύԃ໔ǴӄೢྣៈीฝܭӚ၂ᒤᙴଣϐԖΓΚύу Εྣ୍៝ܺаϩᏼៈΓπբॄ[22]Ǵගٮڀޣᡏ܄ǵೱុ ܄ǵڐፓ܄Ϸঁձྣޑ܄ៈ୍ܺ[14]Ǵځύྣ୍៝ܺࢂၸਡЈፐำǵ ӣᙟҢ௲ᆶᖏჴಞΟҽϐ૽ግǴڀഢྣ୍៝ܺ࣬ᜢࡓݤǵΓሞ ྎ೯מѯǵ୷ҁғڮቻຝᢀෳаϷ੯ੰቻӂϐᇡᆶೀޕǹӆᙖ җჴሞᢀነǵᏹբᗯ१ϷڐշҔᛰǵؑࢱϷֿᆅమዅǵΓπ֎ڥ מѯǴനࡕӧᖏჴಞύගٮޣӝྣޑǴ٠ڐշᎎǵࢱᐙǵ׳ ՊϷα๚ྣ៝ᆶङࡪነ[23]Ƕ่૽ਔਡЈᏢࣽፐำᆶჴಞϐрৢၲԭ ϩϐΖΜаǴЪֹԋ܌ԖӣᙟҢ௲ፐำϷᖏჴಞፐำޣǴۈёୖу ԋᕮԵਡǶԵຑϷޣǴҗ૽ግൂՏਡว่ܴਜ[24]Ƕܴྣ୍៝ܺ ڀԖۓำࡋޑૈΚǶ. ಃΒǵࣴޑزख़ा!܄ ᙴᕍᕉნӸӧӭ॥ᓀǴऍ୯ԃԝܭᙴᕍॄय़٣ҹ(adverse event, AE)ޑΓኧǴۚ୯҇ΜεԝӢύಃΖՏǴᇻଯܭԃҬ೯ཀѦ٣ࡺԝΫΓ ኧǴΨଯр٢ᕎکང(AIDS)ޑԝΫΓኧ[25]ǶBrennan Γ ܭ1991 ԃճ Ҕੰᐕৎቩ[ݤ26]Ǵҗ૽ግԖનޑᙴৣǵៈγϷੰᐕϩৎǴ၁ಒᔠ ຎ 3 ӭҽՐଣੰΓੰᐕǴวऍ୯ફऊԀՐଣੰΓύวғ AE ޑᐒࣁ 3.7%Ǵځύ 13.6%ᏤठԝΫǴԶԖ 58% ޑAE ࢂёႣٛॄޑय़٣ҹ 6.
(16) (preventable adverse event, PAE)ǶੰΓӼӄ࣬ᜢޑԖӜຒύǴAE ࡰᙴ ᕍᆅᏤठޑ্٣ҹǴԶߚ੯ੰߏۯ܈Րଣਔ໔ǹԶ౧Ѩ(negligence) ࢂࡰᙴৣගྣޑٮៈࠔ፦ၨӕᏆ໔යఈྗեǴᒱᇤ(error)߾ࡰݱᙴৣ Չᙍ୍ǵບᘐǵࡼՉᛰݯނᕍਔౢғϐၸѨ[26]ǴPAE ߾ࢂࡰёႣٛǵё ᗉխॄޑय़٣ҹǹӧҁࣴزύǴៈΓΚόىᏤठੰΓྣៈࠔ፦ޑफ़ե ࢂࣁ PAEǴՠ᠙ܭ୯ϣᙴᕍࡋڋᙯᡂǴӄ଼҇ߥՉǴᕴᚐࡋڋჴࡼǴ ᕭ෧ៈΓΚаӢᔈᡂॠࣁ୯ϣᙴᕍᐒᄬதᄊǴៈΓӭъЍᡏΚ ՉᆒஏޑៈྣៈπբǴ౧ѨΨӢԶౢғǴӧჴޑႣᆉᓸΚΠǴޔ ௗ෧ϿױᜢғԝޑៈΓΚჴԖόەǴӢԜуΕၨեΓ٣ԋҁ ୍ܺ៝ྣޑǴаڐշೀեೌמቫय़πբࡕǴྣៈࠔ፦ׯޑᡂΜ ϩख़ाǶ ЎύࡰрǴៈΓӧ୷ҁ ޑ4 ՏੰΓаѦǴቚуྣ៝Տੰ ΓǴੰΓ 30 ϺϣԝΫޑ॥ᓀᆶٰόϷཟ௱ޑയᆉࣣቚу 7%Ǵऩவ 4 Տ ੰΓቚуԿྣៈ 6 ՏǴ߾ੰΓԝΫޑ॥ᓀஒቚу 14%ǴऩቚуԿ 8 Տ߾ ॥ᓀଯၲ 31%[27]ǴᡉҢៈΓΚόى๏ੰΓޑᙴᕍ॥ᓀཱུځёᢀǴΨ ჹៈΓٰཱུεޑπբᓸΚǴ٬ϐيЈॿੲǶӄೢྣៈीฝύǴӧ ԖΓΚଛΠуΕྣ୍៝ܺǴჴࡼៈೌמషӝǴϩᏼៈΓπ բॄǴ٬ៈΓΚၗྍ׳кျǴჴࡼΎԃࡕޑϞϺǴ׆ॺךఈૈᙖԜ кျޑΓΚଛǴεໆࣴزᆶՉޑΕǴଛੰྣ୍៝ܺ. 7.
(17) ࢂցჹੰܭΓྣៈࠔ፦Ԗ҅ӛཀကǴΨයࣰჹԜᜪीฝޑԋ݀ΨԖ׳ ӄय़ޑຑᆶࡌǶ ୯ϣҞჹܭៈೌמషӝᆶੰΓྣ៝ࠔ፦ϐ࣬ᜢࣴزሥӭǴՠҁࣴ ز٬Ҕϐੰ܊ൔ߄җៈΓڐշ༤ቪǴаࣁൂՏǴвಒǵ࠼ᢀ ޑΑှੰΓྣៈǴளډซӵੰᐕၗ၁ಒǵቪჴޑൔǴᙖԜҁ ࣴزளаᢀჸӚៈࠔ፦ࡰǴ٠ຑੰΓྣៈࠔ፦ǴჹܭВ ࡕׯ๓ៈΓΚόىϐ࣬ᜢࡹۓڋޑΨཱུୖڀԵሽॶǶ. ಃΟǵࣴزҞ!ޑ !. ៈΓΚޑቚуёаගϲੰΓྣៈࠔ፦ǴՠӧԖࡹΠǴᙴᕍᐒᄬ. คॄݤᏼቚငៈΓΚϐΓ٣ЍрǴ୷ܭԋҁਏޑԵໆǴуΕྣ ୍ٰ៝ܺՉၨեೌמቫय़ޑπբǴঃऩྣ୍៝ܺуΕࡕҭёගϲ ྣៈࠔ፦Ǵ߾ԜៈੰᚈគࡹޑॶளᘉεՉǶ! !. !. ҁࣴޑزҞޑЬाԖٿεϩǺ! 1. Αှ୯ϣϖৎᙴଣϐੰ܊ϣៈΓΚଛϷៈೌמಔӝݩǶ! 2. ϩԜϖৎᙴଣჴࡼៈೌמಔӝჹੰ܊ϣੰΓྣៈࠔ፦ϐቹៜǶ! 3. ගр҂ٰៈΓΚଛϐࡹࡌǶ!. 8.
(18) ಃѤǵࣴزୢᚒᆶࣴزଷ! ǵʳ ࣴزୢᚒ! )* Ьाࣴزୢᚒ(Primary Research Problems)Ǻ! ჹҁࣴزύϖৎᙴଣԶقǴੰ܊ϣྣ୍៝ܺޑଛǴࢂցշܭ෧Ͽ ੰϐॄय़ྣៈ่݀Ǵගϲៈྣៈࠔ፦ǻ! ! )Β* ԛाࣴزୢᚒ(Subordinate!Research Problems)Ǻ! ЎύׯᡂੰΓྣៈࠔ፦ޑӚቹៜӢηԖব٤ǻ! ੰ܊ϣྣ୍៝ܺޑଛǴૈցϩᏼៈΓޑπբॄǻ! ! Βǵʳ ࣴزଷ! )* ៈΓΚкىਔੰΓྣៈࠔ፦ၨଯǶ! )Β* ੰ܊ύྣ୍៝ܺޑуΕૈϩᏼࡽԖៈΓϐπբॄǶ! )Ο* ྣ୍៝ܺޑуΕԖշܭ෧Ͽ၀ੰੰ܊Γϐॄय़ྣៈ่݀ǵගϲྣ ៈࠔ፦Ƕ!. 9.
(19) ಃϖǵӜຒࣚ!ۓ ҁࣴزύЬाӜຒۓကӵΠǺ! ǵʳៈΓǺᙴଣύڙၸៈ૽ግǴЪሦԖፁғਡวྣޑ ࣽៈৣǵៈৣǵៈγǶ! ΒǵʳៈೌמಔӝǺӧᙴଣྣޑៈი໗ύуΕᇶշៈΓ୍ܺ៝ྣޑ Ǵ٬ੰΓӧՐଣය໔܌ޑԖྣៈπբҗៈΓᆶྣ୍៝ܺॄ ೢǴৎឦคሡॄᏼྣៈπբǶ! Οǵʳྣ୍៝ܺǺуΕྣៈი໗ύǴॄೢՉၨեೌמቫय़πբϐ୍ܺ ΓǴៈπբϝҗࡽԖៈΓॄೢǴՠྣ୍៝ܺёϩᏼ ྣੰΓ१ǵమዅੰΓيᡏπբǶ! Ѥǵʳੰྣៈ่݀ǺЬाࡰੰӧྣៈၸำύǴวғ܌ޑԖ଼நॄय़่ ݀Ǵҁࣴزύх֖ᓸየǵຳॹǵᆅၡྖಥǵҶլǵ๏ᛰ౧Ѩǵيᡏ ऊ״ǵԝΫϷ CPR ΓԛΖǶ! ϖǵʳៈྣៈࠔ፦Ǻӧੰྣៈ่݀ύǴёᘜೢܭៈΓޣஒफ़եៈ ྣៈࠔ፦ǴӢԜҁࣴزύаӭёᘜೢϐੰ่݀ࣁᑽໆៈ ྣៈࠔ፦ϐࡰǴӵ܌ӈǶ!. 10.
(20) ಃΒകǵЎ! !. ҁകஒჹࣴزύޑѤεख़ᗺՉЎӣ៝Ǵϩձࢂಃӄೢྣៈी. ฝϐ࣬ᜢࣴزǵಃΒៈೌמಔӝǵಃΟྣ୍៝ܺ૽ግǵϷಃѤ ੰΓྣៈࠔ፦ϐෳໆѤҽǶ! !. ಃǵӄೢྣៈीฝϐ࣬ᜢࣴ!ز ѠៈวёϩࣁΟঁਔයǹനԐӧѠᏼҺᙴᕍྣៈπբޑǴࢂ ՋБ௲ٰѠᙴᕍ࠹௲ޑѦᝤៈγǴӴॺόගٮᙴᕍྣៈǴӕਔᗋ૽ ግрӭѠៈγǴ೭ਔයޑៈγ࠹ڙ௲γቹៜǴදၹڀԖںǵ፦ ᐆᆶбрᆒઓǴԶ 1895 ԃҘϱᏯݾᏯ௳ࡕѠപᡣ๏ВҁǴ1898 ԃВ ҁΓӧѠ໒ۈៈ૽ግǴՠന߃Μԃѝ૽ግӧѠޑВᝤៈγǴϐࡕ໒ ܫѠᝤζ܄ௗ૽ڙግǴՠៈγғӧᙴଣύӦՏଯܭᚇאǴჹҺՖΓ ाߥ൧ལǴ೭٬Ӵॺӧԋࣁ҅ԄៈγࡕϝࢂᒍᒍǴЪਔៈγᗋ ѸᔅᙴғᔔҜᎠǴԋៈγॺᝄख़ԾڒǴ1945 ԃВݯਔය่ࡕ״Ǵ ៈγӭϡЪזೲวǴჹᙴᕍྣៈޑଅό۹ຎǴՠӭԃ௲Ꮲ ࣬Զٰڒޑ༾ᄊࡋǴ٬ៈΓ࣬ܺሦՠӭъલЮሦᏤ፦ [28]Ƕ ԶៈኳԄӧԐයࢂафૈ܄ៈȐFunction NursingȑϷঁਢៈ ȐCase MethodȑࣁЬǴфૈៈࢂаπբࣁύЈޑៈБԄǴπբ. 11.
(21) Γॄೢࢌޑπբӵ๏ᛰǵᎎǴၨ࣪ΓΚՠคݤჹੰΓ ᡏޑ܄ៈྣៈǴੰΓΨคݤளډଯࠔ፦ǵೱុྣޑ܄ៈǹঁਢៈ ߾ࡰՏੰ܌ሡޑៈǴֹӄҗՏៈΓॄೢֹԋǴՠӧځ ය໔ࣁੰΓीฝǵՉៈπբǴคݤගֹٮޑғǵЈǵޗ Бय़ޑᡏ܄ៈीฝǴЪៈΓΠࡕ൩ଶЗග୍ܺٮǴӢԶคݤ ډೱុ܄ៈǹډΑ 1960 ԃаࡕǴៈᅌϯǴ٠ᄽᡂрϩ πϐԋಔៈǴஒៈΓϷੰΓϩಔǴಔៈΓύԖៈΓǵ ៈǵៈғǴҗಔϣၗుޑៈΓᏼҺಔߏϩଛπբǴՠҗ ੰܭΓኧӭЪϩΟྣៈǴคݤၲঁډձ܄ᆶೱុ܄ៈǴԶౢғӄ ೢៈኳԄǴӄೢៈڀԖᡏ܄ៈीฝǵගٮೱុ܄ៈྣៈǵঁ ձ܄ៈ୍ܺǵЪӄೢៈΓॄೢੰΓᆶځдᙴᕍΓྎޑ೯ᆶڐ ፓǴӢԜᗋڐڀፓ܄ៈфૈǴёᇥࢂॊӚኳԄϐᓬᗺܭ[ي14]Ƕ ᠙ܭ୯ϣᙴᕍࡋڋᙯᡂǴ1995 ԃଆӄ଼҇ߥՉǴ2001 ԃՋᙴ୷ቫᕴᚐ Ѝбࡋڋჴࡼ[29]ǴӧԜᔼచҹΠӚᙴᕍᐒᄬय़ჹԋҁᓸΚǴคόᆃΚ फ़եӚ໒ЍǴځύ२ځፂޑ൩ࢂΓ٣໒ЍǴԶៈΓΚ೯த՞ӄଣ ޑъаǴ൩ԋࣁӃڙፓޑჹຝ[30]Ǵៈπբࠠᄊҗ੯ੰྣៈࣁ Ьᙯࣁख़ຎਏᆶਏޑфૈ܄ៈǴՠ؈ख़ޑπբᓸΚǵख़ፄЪᅥ࿗ ޑៈπբத٬ៈΓπբԋ൩ᆶᅈཀࡋफ़եǴᚆᙍϷࢬϲ ଯǴԜѦǴӧៈΓϩଛ๏ՏੰΓޑៈπਔόӭޑΠǴৎឦ. 12.
(22) ܈੮ଣഉੰǵ܈ငፎ܌όၚ࣮ޑៈྣՐଣৎΓǴჹޣϷৎឦ ԋᔮǵғᆶЈཱུεॄǴӧᙴଣय़ᖏΓΚόىᆶԋҁज़ޑڋᚈ ख़ᓸΚǴৎឦङॄॊӚᅿख़ᏼޑݩύǴᅽᙴଣǵៈΓᆶৎឦ ΟБϐӄೢྣៈीฝోܭౢғǶ ࣁӢᔈΓαԴϯϷཥᑫࢉੰჹѠޑፂᔐǴፁғԾ 2005 ԃ 1 Д ଆԿ 2008 ԃ 12 ДЗǴȨӄΓ଼நྣៈीฝȩ ǴЬाࢂӢԴϯᆶ১༈ ဂϐਸᙴᕍྣៈሡǴԶᑈཱུػӚਸྣៈᡏسϐΓΚᆶᙴ ٣୍ܺᐒᄬǴΨуமࣽᙴৣ૽ግǵࡌᄬޗᙴᕍፁғᡏسǴߦᙴᕍ ၗྍӝϩѲǴ٠аੰΓࣁύЈǴပჴഉੰᆅǴයૈගϲ଼நྣៈࠔ ፦ǵࡌᄬӄΓ଼நྣៈᡏ[س21]ǹӕਔӧ 2005 ԃΨՉΑȨߦ଼҇ நྣៈࠔ፦ीฝȩǴीฝύଞჹៈΓΚଛϷځᆅࡼՉుΕ ǴࢂࣁӄೢៈኳԄϐख़ाୖԵǴ2006 ԃଆǴፁғՉȨӄೢ ៈኳԄ၂ᒤीฝȩ ǴԿϞςᗌΕಃѤԃǴය໔ΨԖȨӄೢៈኳԄ၂ᒤ ीฝຑሽࣴزȩϷȨፄӝԄៈྣៈीฝਢȩᆶځӕਔՉǴ Ȩӄೢៈ ኳԄ၂ᒤीฝȩЬाࢂୖԵ୯ϣѦЎǴ٠ᏵаुۓՐଣੰΓៈᇶշ ΓΚϷഉੰΓᆅೕጄࡕǴՉៈᇶշӝբޑӄೢៈ[31]Ƕ ӄೢៈྣ៝ޑҞޑӧܭගੰٮঁӼӄᆶᡏྣៈޑ൩ᙴᕉ ნǴݯᕍၸำҗៈΓຑੰΓࡕݩރǴஒӚੰΓ܌ሡៈϩଛ๏ ӚቫભϐៈΓග୍ܺٮǴৎឦό੮ଣྣ៝ੰΓǴΨόፎ࣮ៈ. 13.
(23) πڐշྣៈ[20]Ƕӧኻऍ୯ৎᙴଣϣԖόӕቫભǵྣޑៈΓǴ хࡴຏнៈγǵៈγϷៈշǴڙၸ૽ግޑៈշёаॄೢ Չࢌ٤୷ҁπբٯӵᙌيǵܡङ܈ᔔᐙǴՠϝҗຏнៈγॄӄೢҺǴ ߈ԃٰᎃ߈୯ৎВҁǵཥуڵΨаֹ๓ޑӄೢៈڗжၸѐाৎឦ੮ଣ ڐշྣៈࡋڋޑǶԶҞ୯ϣՉޑࢂ߾җྣ୍៝ܺගٮৎ୍Ϸ Вதғࢲᆶيᡏྣ୍៝ܺޑǴՠੰྣ៝ϐᇶշ୍ܺሡӧៈΓࡰᏤ ΠՉǴЪ୍ܺځύόளੋϷᙴᕍϷៈՉࣁ[24]Ǵᙖаှ،ៈΓΚό ޑىୢᚒǴ٠ӕਔගϲޣৎឦᅈཀࡋϷੰ൩ᙴϐᙴᕍࠔ፦[22]Ƕ. ಃΒǵៈೌמಔӝ! !. ҁύៈೌמಔӝϐۓကᆶҗٰǴ٠ӣ៝ៈೌמಔӝύǴྣ. ୍៝ܺϐڮӜᆶۓက࣬ᜢЎǶ! ǵៈೌמಔӝ Ӛ୯ៈΓΚอલࢂ໒ۈՉៈೌמಔӝޑচӢǴԶ଼நྣៈႣᆉ ޑᕭ෧Ψॐ٬ᙴᕍᐒᄬ໒ۈ൨եሽޑៈඹжΓΚǴჹܭεϩ଼ந ྣៈಔᙃ଼܈நᡏسԶقǴၲ҅ډዴྣޑៈΓΚಔӝࢂЬाࡷޑᏯ[27]Ǵ ԶៈೌמಔӝࢂࡰҗӚᅿόӕቫભޑΓӅӕՉੰྣៈǴаၲډ ΓΚ٬Ҕޑനεਏૈ[32]Ǵ೯தҔٰඔॊಔᙃύᙍՏǵભձ܈πբޑష ӝǴΨёᇥࢂಔᙃύӢӚπբ܌ሡԶԖޑೌמ܈ࢲޑಔӝ[33]Ǵٯӵ. 14.
(24) ݯ֎ڥᕍৣǵނݯᕍৣǵៈৣǵྣ୍៝ܺΓϐ่ೌמӝǴᙖಔ ӝೌמᆶπբૈΚǴаቚྣៈޑਏᆶਏ[34]Ƕ Ԑӧ 1988 ԃǴऍ୯ޭቺ୷εᏢ௲Ꮲᙴଣ൩ӢᔈៈৣΓΚၗྍᆙ ᕭǴՉៈγᘉቚኳԄȐnurse extender modelȑ Ǵа 34 ӜៈγշȐnursing assistant, NAȑ༤ံ 17 ՏៈৣޑᙍલǴࢂៈೌמಔӝჴՉޑӃ[ٯ17]Ƕ 1989 ԃ Ball ΓΨගрࡌ[35]Ǵៈγॺϼӭਔ໔ӧߚៈγᙍೢޑπ բǴٯӵࣁੰΓᎎǴ೭٤πբёаҬ๏եભձΓٯӵ଼நྣៈշ Ȑhealth care assistant, HCAȑٰೀǴៈγёаݙՉ׳ޑៈ πբǴ೭ΨࢂៈೌמಔӝёϐೀǶࣴزΨჴǴៈᇶշȐnursing extender, NEȑёаቚуៈৣπբޑᜐሞሽॶᆶғౢΚǴ٬дॺૈݙ ੰܭྣៈࢲޑǴЪ٬дॺᘍಥߚៈπբ[ॄޑ36]ǶNEs ӧៈ ߐௗڙόډԃ૽ޑግࡕǴёаॄೢᔅੰࢱᐙǵӧੰሡाᙯບ܈ௗ ڙᔠਔଌдॺډӚߐǴΨॄೢଌᓓځдྣៈπբǴՠдॺޑਔᖒ ၨៈৣϿ 20~45%ǴᙴଣճҔ೭ኬೌמޑಔӝٰೀեྣೌמៈπբ٠ ڋΓ٣Ⴃᆉ[37]Ƕ ೌמಔӝȐskill mixȑࢂࡰӧៈৣᅱ࿎ΠǴҗคៈྣϐΓ Ȑunlicensed assistive personnel, UAPȑՉեೌמቫय़୷ޑҁៈπ բǴٯӵᙌيǵܡङǴᙖаڋᙴଣǴѳᑽΓፓࡋ[38]ǶBuchan ΓΨӧ 2001 ԃஒϐۓကࣁჴࡼྣۓៈਔ܌ሡाගٮ๏ੰΓೌמޑಔ. 15.
(25) ӝ[33]Ǵх֖ӚΓ໔ޑೌמҬඤǶΨёᇥࢂࣁΑගੰٮྣៈǴԶ ѸԖޑόӕΓ่ޑӝ[39]ǶMcKenna ӧፕೌמಔӝ೭ঁЇଆݾޑ ୢᚒਔගр[40]Ǵೌמಔӝࢂࡰ٬Ҕӝᆶ҂ӝៈγՉྣៈπբǶ Sterns Γ߾ࢂаԖྣޑៈΓගٮ๏ޑޣᕴྣៈਔኧԭϩКٰ ᑽໆៈೌמಔӝޑำࡋ[41]ǴٯӵៈৣǵჴಞៈγᆶޔௗྣៈՐ҇ޑ ঁΓྣៈշȐpersonal care aide, PCAȑ܈ៈγշЋȐnursing aideȑගٮ ྣޑៈਔኧǶम୯ЬाۓڋៈǵշౢϷ଼நว࣬ᜢݤзޑम୯ύѧ ڐȐUnited Kingdom Central Council, UKCCȑӧ 2000 ԃගрǴៈ ೌמಔӝջճҔόڀៈྣޑᔅշޣǴӵ଼நྣៈշǴٰЍජៈ ৣՉ୷ᘵྣៈޑπբȐٯӵၨᡏΚޑπբǴᙌيǵܡङȑ ǶΨԖ ᏢޣஒϐۓကࣁΓڀၗਜޑКٯǵૈΚǵᡍޕکНྗǴѸ ၲྣډៈ܌ाޑྗ[42]ǶGibbs Γ߾ᇡࣁભձಔӝȐgrade mixȑ ࢂӚભձΓኧޑಔӝ[43]ǴԶೌמಔӝࢂॊӚભձΓϐೌמᆶᡍ ޑಔӝǶAtkinson ߾ࢂᇡࣁೌמಔӝࢂӧԖྣǵԖೌמᆶ҂ၸ૽ግ ޑΓ໔ڗளѳᑽ[44]Ƕ୯ϣբमΓஒៈೌמಔӝኳԄǴۓကࣁ٬ Ҕៈγᆶྣ୍៝ܺȐnursing aidȑӕՉྣៈࢲǴځύྣ୍៝ܺ ࢂҗך୯ፁғᖐᒤޑៈྣៈ૽ግᇡǴၸ 100 ঁλਔޑፐำ֖ჴ ಞ૽ግࡕਡว[45]Ƕፁғޑനե૽ግਔኧࣁ 90 λਔǴՠӚ૽ግൂՏё ٩୍ሡाቚӈϩࣽ૽ግፐำᆶਔኧ[24]Ƕ. 16.
(26) Βǵྣ୍៝ܺ ӧࢤޑЎύǴᏢޣ٬ҔΑӭᅿόӕӜຒٰж߄ៈೌמషӝύ όё܈લޑៈᇶշΓΚ—ྣ୍៝ܺǴӢԜӧҁࢤύஒଞჹόӕӜຒ ۓޑကǴՉКၨᆶǶ २ӃǴॺךӧЎύ࣮ ډ1990 ԃਔ[17]ǴPower ΓஒៈγշȐNAȑ ۓကࣁѝௗڙՏៈৣࡰҢՉπբǴԶ၀ៈৣჹៈγշՉ ޑπբॄೢǴӧ೭္ៈγշޑЬाπբԖڐշᗯ१ǵ؍ǵᢀჸғڮ ቻຝϷᏤᆅᔠȐ ߄ـ1ȑ ǹԶ଼நྣៈշȐHCAȑࢂࣁΑЍජ ៈγǴ٠ӧࡰځҢکᆅΠՉ”ߚៈ”πբ[46]Ǵ٬ៈγૈᙖҗдޑᔅ շǴ׳ܭݙೌמᆶྣៈ୍ܺ[47]ǴԶ଼நྣៈշޑπբࢂᆶྣ៝ ੰޑϷځৎឦᇥ၉ǵࣁੰ؍ǵᎎǴᆶੰǵৎឦϷៈᖄ๎Ǵ ᗯੰӞܿՋǵᆅځᛰނǵᅱෳ٠इᒵځӚ଼நࡰǴᔅੰऀՊ ܺ٠ྣៈαǴୖᆶੰྣៈޑፕǴڐշ௦Ոనځ܈дᔠᡏኬ ҁǴ٠ӼኃǵႴᓰੰϷځৎឦǴЪҁጇύբޣଞჹ HCA ᆶ NA բ КၨǴวޑޣٿπբϣ࣬ႜӕǴѝࢂ۶ԜӧӚπբ܌՞ޑКٯ Ԗόӕ[48]ǴௗΠٰޑៈᇶշȐNEȑΨԖᔅੰࢱᐙǵᒡଌੰ ᙯບي܈ᡏᔠᆶଌᓓᙍೢ[37]ǴՠঁΓྣៈշ൩Кၨୃӛߏܭයྣ ៈύۚޑৎ୍ܺۚ܈ৎ଼நշǴЬाࢂගٮ٤୷ᘵྣៈᆶྎ೯ڐ ፓ୍ܺǴٯӵيᡏຑکᔼᎦྣៈ[49-51]Ƕ. 17.
(27) ௗǴEdwards ۓကៈγշЋࣁёаࡼՉៈπբޑᇶշΓǴѝा ӧៈγޑҢጄ܈ᅱ࿎Π[52]ǴӧݯᕍൂՏύៈγշЋёаՉԖշܭ ݯᕍྣޑៈπբǴՠӕਔҁЎύբޣΨமፓкϩ૽ግޑख़ाǴԶ Carr-Hill ΨჴៈγշЋޑπբԋਏόᄆྍԾܭલЮ૽ግǴӢԜӧΠύॺך ஒଞჹך୯ྣ୍៝ܺ૽ޑግբᇥܴǶྣ୍៝ܺගٮޣৎ୍ǵВ தғࢲϷيᡏྣៈ୍ܺǴЪӧៈΓࡰᏤΠՉੰྣ៝ϐᇶշܺ ୍Ǵோ୍ܺځጄൎόૈԖᙴᕍϷៈՉࣁ[24]ǴԶਥᏵऍ୯ៈۓڐ ကǴคៈྣϐΓࢂڙၸ૽ግǵёௗڙៈৣࢴہǴӧៈৣ Πёගੰٮྣៈ୍ܺǵڐշՉᖏྣៈπբϐΓ[53]Ƕ ԿܭჴࡼៈೌמಔӝϐԋਏǴך୯чࢌჴࡼៈೌמಔӝϐᙴᏢ ύЈϣǴڙೖϐъኧаៈΓᇡࣁྣ୍៝ܺૈϩᏼៈΓϐπ բॄǵЪԖշܭගϲᡏៈ୍ܺࠔ፦[54]Ǵ٠Ԗշܭ٬ៈΓԖ׳ ӭਔ໔ྣៈख़ੱ[ޣ17]ǴࣴزҭࡰрǴೌמಔӝኳԄύଛ 15%ϐྣ៝ ୍ܺёᡉफ़եੰΓຳॹ[19]ǴҞӧऍ୯ςԖ 97%ޑᙴଣ٬Ҕྣ៝ ୍ܺբࣁᇶշΓΚ[55]ǴՠΨԖࣴࡰزрǴೌמಔӝྣៈኳԄჴࡼࡕǴ ᗨ٬ᡏྣៈࠔ፦ගϲǴՠΨԋៈΓπբᓸΚᡂεǵҬਔ໔ၨ ߏ[56]Ƕ ᗨฅЎύჹៈᇶշΓΚۓޑကόǴՠӧҁࣴزύаך୯Չࡹଣ ፁғۓကϐྣ୍៝ܺࣁៈೌמಔӝύޑᇶշΓΚǴॄೢՉၨե. 18.
(28) ೌמቫय़πբǴӵϩᏼྣੰΓ१ǵమዅੰΓيᡏǴៈπբ ϝҗࡽԖៈΓॄೢ[24]Ƕ. 19.
(29) ៈᇶշӧៈߐௗڙόډԃ૽ޑግࡕǴёаॄೢᔅੰࢱᐙǵ ଌᓓӧੰሡाᙯບ܈ௗڙᔠਔଌдॺډӚߐǴΨॄೢхಎαϷ ځдྣៈπբ[37]Ƕ. ӧߏයྣៈۚޑৎྣៈύத٬ҔঁΓྣៈշȐpersonal care aide ܈ personal care attendantȑ ǴΨԖᆀϐࣁۚৎ଼நշȐhome health aideȑ Ǵ. Ьाග୷ٮᘵྣៈǵྎ೯ᆶڐፓфૈ[49-51]. ѝाៈγගٮঁӝޑᄦኬ๏ៈγշЋǴӧݯᕍൂՏύៈγշЋёа வ٣Ԗշݯܭᕍྣޑៈπբ[52]. ගٮޣৎ୍ǵВதғࢲϷيᡏྣៈ୍ܺǴྣ୍៝ܺӧៈΓࡰᏤ ΠՉੰྣៈϐᇶշ୍ܺǴՠ୍ܺጄᛑόளੋϷᙴᕍϷៈՉࣁ[24]Ƕ. คៈྣϐΓࢂڙၸ૽ግǵёௗڙៈৣࢴہǴڐշՉᖏ ྣៈπբϐΓǴӧៈৣΠёගੰٮྣៈ୍ܺ[57]Ƕ. ៈᇶշ Ȑnursing extender, NEȑ. ঁΓྣៈշ Ȑpersonal care. aide, PCAȑ. ៈγշЋȐnurses’ aideȑ. ྣ୍៝ܺ Ȑnursing aidȑ. คៈྣϐΓ (unlicensed assistive personnel, UAP). 20. ଼நྣៈշޑрࢂࣁΑЍජៈγǴ٠ӧៈγࡰޑҢکᆅΠ܍ᏼ”ߚៈ ”ᙍೢǴ٬ៈγૈӧځᇶշΠǴԾҗޑගٮៈ૽ግύ፟ϒޑೌמᆶྣ ៈǹԶ଼நྣៈշޑЬाπբࢂࣁੰ؍ǵᅱෳӚ଼நࡰ٠ӼኃǵႴ ᓰੰϷځৎឦ[46-48]. ଼நྣៈշ Ȑhealth care assistant, HCAȑ. ё. ց. ё. ё. ց. ё. ёցՉៈπբ. ៈγշѝௗڙՏៈৣࡰҢǴԶ೭ՏៈৣӧӴ೭ঁձѸॄᆅ ៈγշᆶࢴہдҺՖπբޑೢҺǴៈγշޑЬाπբԖڐշᗯ १ǵ؍ǵα๚ៈǵᎎǵᢀჸғڮቻຝǵឲဉϷකᆅǵܘᆅ[17]Ƕ. ۓက. ៈγշȐnursing assistant, NAȑ. Ӝຒ. ߄ 1ǺЎύӚྣៈᇶշΓΚϐπբᙍೢКၨ. Americaऍ୯. Taiwan Ѡ. ୯. United Kingdom म. Baltimore Ѓᅟޑ ነ, Washington, D.C.Ⴅ. ୯. United Kingdom म. Lexington, Kentucky ޭቺ୷ ԀޑٌႥѱ. Ӧज़ۓ.
(30) ಃΟǵྣ୍៝ܺ૽ግ! ӧύǴॺךКၨΑЎύޑӚᜪྣៈᇶշΓΚǴᗨฅӧӜᆀ όᅰ࣬ӕǴՠࣣࡰܴࣁځග୍ܺ៝ྣٮϐڐշޣǴԶҁࣴزύ୯ϣ ៈೌמಔӝݩჹੰΓྣៈࠔ፦ϐቹៜǴӢԜ٬Ҕך୯Չࡹଣፁғ ۓကϐྣ୍៝ܺǴЪନΑدငྣ୍៝ܺคݤዴ૽ځۓግၸำѦǴी ฝငҺϐྣ୍ࣣ៝ܺၸȨྣ୍៝ܺ૽ግȩ ǴаΠҁஒ൩Ԝ૽ግբ ֹᇥܴǶ! ǵʳ ૽ግङඳᆶҞ!ޑ ӧߏයޑៈΓΚόىǵߏයྣៈΓΚሡΠǴך୯ፁғߦ ۚৎ୍ܺǵੰ୍ܺΓӝϐྣ୍៝ܺ૽ግǴࣁගܹྣៈ୍ܺࠔ ፦Ǵӝόӕ୍ܺޑ૽ግፐำࣁྣ୍៝ܺ૽ግፐำǴନёᙖԜගଯ ੰΓྣߏ܈ύЈՐ҇ϐྣៈࠔ፦Ǵҭё٬ॊӚ୍ܺ൩ѱϕ೯Ǵ ቚу୍ܺ൩ᐒǶྣ୍୍៝ܺܺޑҞԖৎ୍ϷВதғࢲྣៈܺ ୍ǵيᡏྣៈ୍ܺаϷӧៈΓࡰᏤΠՉੰྣៈ୍ܺǴՠ୍ܺځ ϣόளੋϷᙴᕍϷៈՉࣁǶॄೢග୍ܺ៝ྣٮ૽ግϐЬᆅᐒᜢǴ ӧύѧࣁϣࡹǵՉࡹଣፁғǴӧӦБࣁޔᗄѱǵᑜȐѱȑࡹ۬[24]Ƕ ૽ግჹຝ! ୖуҁ૽ግޣሡڀҁ୯୯ᝤǴ܈ሦԖπբϐѦᝤΓγǴЪԃᅈΜϤ ྃаǵ௲ػำࡋ୯҇λᏢаޣǴيᡏ଼நؼݩރӳЪคόؼ༐ 21.
(31) ӳϷࢉੰǴനख़ाࢂޑሡڀᏼҺྣៈ୍ܺπբוǴ಄ӝаచҹޣ ૽ୖڀۈၗ[24]Ƕ! Βǵʳ ࡼ૽ൂՏ! ٩ᏵՉࡹଣፁғϐ૽ግीฝჴࡼϦǴௗޔڙᗄѱǵᑜȐѱȑࡹ۬ ૼہᒤྣ୍៝ܺ૽ግीฝǴЪڀӝჴಞ૽ግޣ܌Ǵ܈ᆶӝჴ ಞ૽ግۓ܌ԖӝբीฝޣᔕۓीฝǴа૽ግϐਡЈፐำ܌ӧӦࣁྗǴ ଌӦޔᗄѱǵᑜȐѱȑࡹ۬ቩਡϐൂՏǶ! Οǵʳ ૽ግϣ! ૽ግϣεठϩࣁਡЈፐำǵӣᙟҢ௲ᆶᖏჴಞΟҽǴਡЈፐำ ЬाԖྣៈ୍ܺ࣬ᜢࡓݤǵৎ୍ೀচ߾ǵΓሞྎ೯מѯǵ୷ҁғڮቻ ຝǵᔼᎦᆶᑧ१аϷ੯ੰቻӂϐᇡᆶೀǹӣᙟҢ௲ϩ߾Ьाࢂ ᗯ१ϷڐշҔᛰǵؑࢱϷֿᆅమዅǵΓπ֎ڥמѯϐҢጄ௲ᏢǴ ᙖፐ௲ৣޑ௲ᏤǴሦୖ૽ᏢჴሞᢀነᏹբБԄǴԶӧಃΟҽ ޑᖏჴಞύගٮޣӝྣޑǴᖏჴಞϩନჴբҢ௲ύᏢಞӚ מѯǴᗋԖڐշᎎǵࢱᐙǵ׳ՊϷα๚ྣៈᆶङࡪነ[23]Ƕ! Ѥǵʳ ่૽ၗਡ!ۓ ਡЈᏢࣽፐำᆶჴಞϐрৢၲԭϩϐΖΜаǴЪֹԋ܌Ԗፐำ ޣǴۈёୖуԋᕮԵਡǶԵຑϷޣǴҗ૽ግൂՏਡว่ܴਜ[24]Ƕ!. 22.
(32) ಃѤǵੰΓྣៈࠔ፦ϐෳໆ ࠔ፦ޑෳໆሡाԖӭࡰբࣁෳໆπڀǴ1985 ԃऍ୯ଭٚើԀޑ ΎৎᙴଣࣁΑှӚԾᙴଣޑᖏԋਏǴҗଭٚើԀᙴଣڐڐշวȨᙴ ᕍࠔ፦ࡰीฝΰQuality Indicator ProjectΔQIPα ȩ Δၸۓයᅱෳࡰ൨ ࠔ፦ׯ๓ϐၡǴٿԃࡕऍ୯ӚԀуΕ၀ीฝǴ1992 ԃम୯Ӄа ߚऍ୯୯ৎуΕǴϷԿ 2009 ԃςԖ 17 ঁ୯ৎуΕǹך୯ӧ 2999 ԃਔǴ җიݤΓᙴଣຑ᠘ᄤᙴᕍࠔ፦ǴԖسޑஒԜीฝᏤΕ୯ϣᙴ ଣǴаȨѠᙴᕍࠔ፦ࡰीฝȐTaiwan Quality Indicator ProjectΔTQIPȑȩ ࣁीฝӜᆀǴ٠ᔈҔ܌ளၗᆶၗૻǴวҔܭ୯ϣࠔ፦ׯ๓ޑኳԄǴ ٠ගр 22 ෳໆࡰ[58]Ƕ ҁࣴزЬाୖԵ TQIP ϐӚࡰȐό֖ᆒઓࣽȑ ǴԌନځύࣁߐບ ੰΓဂǵ࡚ບ܈уៈੰࡰ܊ޣϷཥғ܈ٽౢࣽࡰǴᙹܭۓ࡚ ྣ܄ៈੰ܊ҔࡰޑǴӆᙖѠੰΓӼӄ೯ൔسϐीൔ߄ǴΑှ ᙴଣၨத೯ൔࡰޑҞԖব٤ǴӕਔୖԵ୯ϣѦЎύ܌ӈᖐϐࠔ፦ ࡰǴа಄ӝࣴزᢀჸҞޑȐៈೌמಔӝჹੰΓྣ៝ࠔ፦ϐቹៜȑ ࣁᚒǴቚմࣁӝෳໆੰΓྣៈࠔ፦ϐࡰǶ ନѐॊό಄ӝࣴزҞޑϷሡाࡕޣǴTQIP ࡰϝԖǺЋೌαགࢉ ᆶЋೌႣٛל܄ғન٬ҔǵՐଣԝΫǵЋೌԝΫǵߚीฝ܄ӆՐଣǵ ߐບೀࡕߚीฝ܄੮ଣǵߚीฝ܄ख़߇Ћೌ࠻ǵൂપેރ߷܄ᙅၰ 23.
(33) ೌЋೌԝΫǵ٬Ҕيᡏऊ״ǵຳॹࡰǵᙼᓉϷЗภೀǵᓸየǵЋ ೌࡕᓉેਵ༞Ϸޤਵ༞ϷႣٛӅ 12 ǹԶᢀჸ 2008 ԃԿ 2009 ԃѠੰ ΓӼӄ೯ൔسϐӄԃӚۑीൔ߄Ǵวᛰނ٣ҹǵੰΓຳॹᆶᆅၡ ٣ҹޑ೯ൔҹኧܴᡉଯځܭдӵЋೌǵᒡՈ٣ҹ[59-66]ǴԜѦǴऍ୯ ៈ௵གࡰ܄ΨаੰΓຳॹǵԖ্ੰޑΓຳॹǵᓸየǵៈΓᅈ ཀࡋǵВՏੰΓޑៈਔኧᆶྣៈԋಔӝբࣁຑៈ ϐࡰ[67]ǴԶуԀៈ่่݀ӝࡰ܄߾Ԗຳॹǵᓸየǵऊ״ǵៈਔ ኧ ྣ کៈ ೌ מಔ ӝ ǵ ຏ н ៈ γ ௲ ػำ ࡋ ᆶ ੰ Γ ᅈ ཀ ࡋ [68] Ǵ Needleman Γ߾ගрΠӈៈወӧ௵܄གࡰ[69]ǺֿၰགࢉǵҜጥᓸ የǵଣϣགࢉݹޤǵుᓉેਵ༞ᆶޤਵ༞ǵဉगၰрՈǵύѧᓉે سӝੱٳǵ௳ՈੱǵҶլ܈ЈၢଶЗǵЋೌੰΓϐٳวੱ֡ᆶៈ ΓΚஏϪ࣬ᜢǶ 1993 ԃѠчୱᙴᕍᆛύޑᙴᕍࠔ፦λಔǴමୖԵऍ୯ଭٚើԀᙴ ଣڐᙴᕍࠔ፦ࡰᆶѠчᄪ҇ᕴᙴଣޑᙴᕍࠔ፦ຑໆࡰǴࣴᔕр ᙴᕍࠔ፦ࡰǴҗѠчѱ 103 ৎελᙴଣǴϩձ൩၀ࡰϐख़ा܄ǵ Ҕ܄ϷҞၗϐё܄๏ϒլМϖભຑϩǴ่ࣴ݀زᡉҢǴ ଣϣགࢉวғᆶЋೌαགࢉϩձӚᙴଣᇡࣁࢂߚதख़ाᆶख़ा ЪҔܭຑ୯ϣᙴᕍࠔ፦ࡰޑ⫠ؼǴՠၗޑё҅܈܄ዴ܄ϝԖ ࡑᄮ[70]ǴӢԜᗨฅख़ाЪҔǴϝࢂόёޑၗǴคݤҔܭբࣁࠔ. 24.
(34) ፦ࡰǹԶӧҁࣴزύǴҗܭᢀჸҞࢂޑៈೌמషӝჹੰΓྣៈ ࠔ፦ϐቹៜǴԶགࢉޑวғคޔݤௗᘜೢܭៈΓ౧ѨǴࡺஒԜෳ ໆவҁࣴزύকନǴόаགࢉຑੰΓྣៈࠔ፦Ƕ ਥᏵॊࡰᆶЎǴҁࣴزа 8 ੰΓၨதวғޑ٣ҹǺᓸየǵຳ ॹǵيᡏऊ״ǵᆅၡྖಥǵҶլǵ๏ᛰ౧ѨǵԝΫϷࡼՉ CPR ϐੰΓኧǴ բࣁੰΓྣៈࠔ፦ϐෳໆࡰǴԶៈπբਔኧྣکៈೌמಔӝ߾ ࢂቹៜॊࡰϐԾᡂኧǹख़εੰՐଣΓኧ߾ࣁੰ܊ϣϐੰᝄख़ࡋ ࡰǶ. 25.
(35) ಃΟകǵࣴزБݤᆶᡯ! !. ҁകύЬाϩࣁࣴࢎزᄬǵࣴزᡂϐᏹբࠠۓကǵࣴزीᆶࣴ. زᡯǵࣴزπڀᆶࣴزჹຝǵၗԏၸำϷၗीᆶϩӅϤ ϩձᇥܴϐǶ! !. ಃǵʳ ࣴࢎزᄬ! ҁࣴز२ӃᢀჸᙴଣቫભᡂኧɡӄଣៈΓኧᆶӄଣੰኧǴϷϟ ܭᙴଣቫભᆶੰ܊ቫભ໔ޑៈΓ܄ǵྣ୍៝ܺ܄ǵੰΓ܄ ᡂኧǴ೭٤ᡂኧӧϐࡕޑϩύתᄽᜢᗖفՅǴࣴޣزஒᙖҗڋ೭٤ ᡂኧǴКၨࣴزಔᆶჹྣಔ໔ৡ౦Ǵࣴزಔύх֖ԖीฝငҺྣ୍៝ܺ ܊ੰޑǴᆶԖدငྣ୍៝ܺ܊ੰޑǴҗܭҁࣴޑزᢀෳൂՏࢂੰ܊Ǵ ӢԜԖྣ୍៝ܺ܊ੰޑǴคፕدင܈ीฝငҺǴࣣឦزࣴܭಔǴؒԖ ྣ୍៝ܺࣁ߾ޣჹྣಔੰ܊ǴനಖளрٿᅿӧόӕೌמಔӝΠޑ ៈྣៈ่݀Ǵࣴࢎزᄬკӵკ 3-1-1 ܌ҢǶ! !. 26.
(36) ᙴଣ!܄ ӄଣੰኧ! z ᙴ٣Γኧ! ¾ ៈৣ/ៈγ. ᙴଣቫભ. z. ! ៈΓ!܄. ྣ୍៝ܺ܄. ੰ܊ϣៈΓኧ! z ӄଣៈΓኧ z ៈπਔ. ੰΓ!܄. ीฝငҺ0دင z ྣ୍៝ܺΓ ኧ!. z. аख़εੰՐଣϐੰΓ! z ࣽձ! z ԃស>70!. z. z. ࣴزಔ case group )ӄೢྣៈੰ!*܊. ჹྣಔ control group )ߚӄೢྣៈੰ!*܊. ੰ܊ቫભ. Ԗៈೌמಔӝ,ྣ୍៝ܺ! )х֖ԾငᆶीฝငҺ*!. คៈೌמಔӝ! ӄଣៈΓኧ z ੰ܊ៈπਔ! z ձ! z ख़εੰޣΓኧ z. ӄଣៈΓኧ z ੰ܊ៈπਔ z ྣ୍៝ܺΓኧК z ձ! z ख़εੰޣΓኧ z. ៈྣៈ่݀ࡰ يᡏऊ״٣ҹ z Ӛ੮ᆅၡྖಥ z ຳॹԋ্ z ๏ᛰ౧ѨᕴΓԛ z. ᓸየ z Ҷլ z CPR Γԛ z ԝΫ z. !!კ 1Ǻࣴࢎزᄬკ. 27. !.
(37) ಃΒǵࣴزᡂϐᏹբࠠۓက! !. ҁࣴزύࣴزᡂϩࣁԾᡂǵ٩ᡂᆶڋᡂǴԾᡂύх֖ៈ. Γ܄ǵៈೌמషӝᆶੰΓ܄ΟᜪᡂኧǴੰΓྣៈ่݀ࣁ ٩ᡂǴԶᙴଣቫભၗࣁڋᡂǴӚᡂϐᏹբࠠۓကӵΠ߄܌ҢǴ х֖ӚࡰϷۓځကǵीໆЁࡋᅿᜪ٠ࡰϐीᆉБԄǶ! ߄ 2Ǻᏹբࠠۓက! ࡰ. ۓက. ीໆЁࡋ. ԾᡂǺៈΓ܄ǵៈೌמషӝᆶੰΓ܄ ៈΓ܄ ࣽៈ ၀ձύ၀ੰॄޑ܊ೢࣽៈৣΓኧǴࣽៈৣаᙴଣငҔЪςڗள КЁࡋ ৣΓኧ ࣽៈৣྣࣁޣϐǶ ៈৣΓ ၀ձύ၀ੰॄޑ܊ೢៈৣΓኧǴៈΓӵٿڀᅿаၗǴаᙴଣ КЁࡋ ኧ ငҔϐЬाவҞ༤ൔǶ ៈγΓኧ ၀ձύ၀ੰॄޑ܊ೢៈγΓኧǶ. КЁࡋ. ԾӚભៈᏢਠϐៈΓǴငΕᙴଣ၂Ҕය໔ૈՉੰ୷ҁྣៈ N+N1 Γ ޣǹуᖏπբᅈԃǴֹԋN1ᖏૈΚ૽ግЪ೯ၸN1ቩӝ КЁࡋ ኧ ޣǴૈՉੰ୷ҁྣៈޣΓኧǶ ៈπբ ੰ܊ύϐៈΓவ٣ៈπբϐԃၗǶ ԃၗ. КЁࡋ. ӧ၀ൂՏ ੰ܊ύϐៈΓӧ၀ൂՏவ٣ៈπբϐԃၗǶ πբԃၗ. КЁࡋ. ࢂցᏼҺ ੰ܊ύϐៈΓࢂցᏼҺՉࡹᙍǶ Չࡹᙍ. ӜҞЁࡋ. ௲ػำࡋ ᙍભ. ੰ܊ύៈΓϐ௲ػำࡋǺ1Ǻៈਠ 2Ǻࣽ 3ǺೌמᏢଣ 4ǺεᏢ 5Ǻᅺγ(֖)а. ӜҞЁࡋ. ੰ܊ύៈΓϐᙍભǺ1ǺN0 2ǺN1 3ǺN2 4ǺN3 5ǺN4. ӜҞЁࡋ. 28.
(38) ߄ 2Ǻᏹբࠠۓက)ុ*! ࡰ. ۓက. ीໆ Ёࡋ. ीᆉБԄ. ԾᡂǺៈΓ܄ǵៈೌמషӝᆶੰΓ܄ ៈೌמషӝ ࢂցࣁӄ 1Ǻࢂ ೢྣៈੰ 2Ǻց ܊. ӜҞ Ёࡋ. ྣܺΓ ၀ձύ၀ੰޑ܊ӄೢྣៈीฝငፎϐྣ୍៝ܺΓኧǶ ኧ. К Ёࡋ. دငྣܺ ၀ੰޑ܊၀ձύߚीฝငፎ(ৎឦدင୍ܺ៝ྣ)ޑΓኧǶ Γኧ. К Ёࡋ. ੰΓ܄ ၀ձύ၀ੰੰޑ܊ΓኧǶ. К Ёࡋ. ϣ/Ѧࣽ Ϸځд. 1Ǻϣࣽ. ӜҞ Ёࡋ. ࡚/ᄌ܄ ੰ. 1Ǻ࡚܄ 2Ǻᄌ܄. ੰΓኧ. 2ǺѦࣽ. 3Ǻځд. ӜҞ Ёࡋ. ੰԃស ၀ੰޑ܊၀ձύԃសຬၸ70ྃੰޑΓኧǶ ຬၸ 70 ྃ. К Ёࡋ. аख़εੰ ၀ੰޑ܊၀ձύаख़εੰՐଣੰޣΓΓኧǶ ՐଣޣΓኧ. К Ёࡋ. ٩ᡂǺੰΓྣៈ่݀ ܌Ԗભኧᓸ 1. ᐒᄬԾՉ،ۓДᅱෳޑВයǴДܭۓڰϺ࣬ӕձՉໆෳǶ የྣ܄࡚ޑ ᓸየวғ 2. ӧᅱෳϺǴ܌Ԗ࡚ྣ܄ៈੰΓᔈхࡴӧϣǴόፕੰΓԖೀ܈ӭೀ К ៈੰΓΓԛ ᓸየᔈӈΕीᆉǴջ٬࡚ྣ܄ៈੰΓӧՐଣϐ൩ςрޑᓸየǴЁࡋ ʏ࡚ྣ܄ៈ ੰΓΓԛ ҭѸीᆉǶ ×100. 1. ຳॹǺੰΓӢཀѦຳပԿӦय़ځ܈дѳय़Ƕ ࡚܄Տ 2. ԖइᒵޑຳॹǺࢂࡰ҅ԄइᒵੰܭΓੰᐕǵཀѦ٣ҹൔǵ॥ᓀᆅൔǵ ܭޣՐ ځ܈дಔᙃύ҅Ԅޑइᒵύޑຳॹ٣ҹǶ ଣය໔ว 3. ຳॹ٣ҹϩᜪǺ(1)ੰΓ଼நӢનǺຳॹࢂӢࣁੰΓ଼நکݩບᘐԶԋຳ ຳॹวғ ॹวғϐӒᓀ܄ቚଯǶ(2)ჹᛰނǵݯᕍ܈ഞᎈޑϸᔈǺຳॹޔௗࣁϣࣽ܈Ѧ К ғຳॹҹ ࣽޑᙴᕍೀ܌ЇଆǶ(3)ᕉნ্ǺຳॹࢂӢࣁᐒᄬύഢᕉნό܌ԋ Ёࡋ ኧʏՐଣ ޑǶ(4)ځдӢનǺຳॹࢂӢࣁځдচӢ܌ԋǶ ޣᕴΓ 4. ՐଣΓВǺᙴᕍᐒᄬӧВۓਔ໔ᗺीᆉӧ၀ᐒᄬϣௗڙՐଣྣៈϐੰΓ Вኧ ኧǶՉਔሡݙཀВਔ໔ᗺᔈۓڰǶՐଣΓВޑीᆉࣁДಃϺޑՐଣ ×100 ΓኧǴВуДϺޑՐଣΓኧǶ 29.
(39) ߄ 2Ǻᏹբࠠۓက)ុ*! ࡰ. ۓက. ीໆ Ёࡋ. ीᆉБԄ. ٩ᡂǺੰΓྣៈ่݀ 1. يᡏऊ״٣ҹǺൂԛޑज़ঁڋΓࢲԾҗي܈ᡏԾҗࡋޑ٣ҹǶ 2. ऊࣁ״ۓᙴᕍ୍ܺϐ೯ҔҞਔǴԜᜪϐऊ״όҔܭԜࡰǶٯ ӵЋೌය໔٬ҔۓڰаᆢੰΓۓϐ༈Ƕ 3. όᆅᙴᡗԛኧǴيᡏऊ״٣ҹаੰΓ໒ۈऊ״Կऊࣁ״่״ЗǴόፕ ऊ״ਔ໔ߏޑอǴᔈᆉࣁൂԛऊ״٣ҹǶ يᡏऊ ״4. ੰΓёૈӧ24 λਔϣᐕӭԛيޑᡏऊ״٣ҹǴࢂ܈ԛޑऊ״ਔ໔ К К ុ24 λਔߏ׳܈Ƕอኩޑஒऊ״ှନаߡᔠަᡏൻᕉǵՉӄᜢ Ёࡋ ࢲǵӵ൵ǵ१Ǵࣣόૈຎࣁऊ״٣ҹಖЗǶ၂ှନੰΓي. يᡏऊ״ ٣ҹኧʏ ՐଣΓВ ኧ×100. ᡏऊ״Ǵ܈Ӣ၂Ѩ௳Զख़ཥ٬Ҕऊ״ਔǴຎࣁऊុ״٬ҔǴԶߚी ᆉࣁќԛޑऊ״٣ҹǶ၂ှନऊ״ਔ໔ᔈόૈຬၸ60 ϩដǶ 5. يᡏऊࡰ״ѝज़ܭӝྣ܄࡚ޑៈੰǴόྣ܄࡚ߚܭៈੰǶ 6. ឯ٬ҔǵϯᏢ܄ऊ״ǵཥғٽόхࡴӧԜࡰϐीᆉύǶ ੮ᆅၡԾ ߚीฝܘ܄ᆅࡰيԖሷगᆅǵᏤֿᆅϷϪᆅϐකᆅੰӧߚᙴᕍी ܘϷྖಥΓ ߚीฝ ܄ฝϐΠǴӢੰΓځ܈дӢનᏤठᆅၡԾੰيֹӄಥрϐຝǴх֖Ծ К ԛ/Ӛᆅ ܘᆅ ܘᆶྖಥٿᅿݩǴȨԾܘȩࢂࡰකᆅੰаѦΚஒᆅၡܘᚆيᡏǴࣁΓ Ёࡋ ၡ੮ಕी ᕴΓԛ ჸޣޕǴӢځдӢનᆅၡவੰيᡏಥᚆϐຝᆀࣁȨྖಥȩǶ ×100%. ڋᡂǺᙴଣ܄ Ϧ/دҥ 1ǺϦҥ 2Ǻدҥ ᙴଣຑ᠘ 1Ǻᓬ ่݀. ӜҞ Ёࡋ 2Ǻᓬ. ӜҞ Ёࡋ. 3Ǻӝ. ࢂցࣁ௲ 1Ǻࢂ Ꮲᙴଣ 2Ǻց ੰኧ. ӜҞ Ёࡋ. ӄଣϐ࡚܄ੰϐᕴੰኧǶ. К Ёࡋ. ᙴ٣Γ ӄଣᙴৣΓኧǵៈৣΓኧǵៈγΓኧǶ ኧ. 30. К Ёࡋ.
(40) ಃΟǵࣴزीᆶࣴزᡯ! ǵʳࣴزी! ҁࣴزϐࣴزीЬाӃаੰ܊ൔ߄բࣁၗϩ٩ᏵǴԜൔ߄ Ϸࣴزύ٬Ҕϐ࣬ᜢୢڔǴࣣҗڑউ௲Ьϐӄೢྣៈीฝࣴزი ໗ࣴᔕǴҔаៈΓϷྣ୍៝ܺޑଛБԄǴᆶੰΓՐଣය໔ ౢғॄय़่݀໔ϐᜢ߯ǴੰΓ่݀ࣁࣴزύޑЬा٩ᡂǴΓଛ߾ ࣁԾᡂǴќѦӧϩၸำύǴڋӭᅿᙴଣ܄ᡂǴаफ़եځჹϩ ่݀ϐቹៜǴӢԜᙴଣࣁ܄ҁࣴزϐڋᡂǶ! ௗख़ᗺܫӧྣ୍៝ܺჹੰ่݀ޑቹៜϩǴ೭ҽаੰٯჹྣ ࣴ(ݤزcase-control study)ՉϩǴԾင܈ीฝငԖྣ୍៝ܺੰޑΓ ࣁࣴزಔ(case)ǴؒԖଛྣ୍៝ܺΨ൩ࢂؒԖௗڙៈೌמషӝੰޑ Γࣁჹྣಔ(control)ǴаԜՉϩКၨǶ! ϐࡕаៈΓൔ߄ύៈπਔҽǴаϷៈΓᅈཀࡋբࣁ ٩ᡂǴࢂցଛྣ୍៝ܺࣁԾᡂǴੰ܊ύуΕྣ୍៝ܺჹ ׯܭ๓ៈΓπբॄϐᔅշǶ! Βǵʳࣴزᡯ! ҁࣴز२Ӄᇆ٠ӣ៝୯ϣѦ࣬ᜢࣴزϐЎǴௗ໒ۈՉၗԏ Ǵၗӣԏ٠ࡌᔞࡕሡाዴᇡ܌ԏޑၗӧஒરҁᙯࣁႝηᔞޑၸ ำύԖคᒪᅅ܈ᇤǴ٠ዴᇡၗ༤ቪޣӧ༤เਔԖคౢғܴᡉϐᡄᒠ 31.
(41) ᙤᇤǴԶуаु҅Ƕ! ௗՉीϩᆶ่݀༼Ǵ٠ՉಃΒ໘ࢤޑЎӣ៝Ǵᆶ ่݀࣬ᜢϐЎύǴᆶҁࣴزϐ࣬՟Ϸ࣬౦ᗺǴനࡕՉൔޑኗቪᆶ යтፕЎޑዺኗቪǶ! ! ! !Ў !. ୢ. ၗ. ၗ. . ڔ. . . ӣ. . ԏ. ࡌ. ៝!. ी. !. ᔞ. !. ၗ ዴ ᇡ ค! ᇤ!. ी ϩ . ࣴ ز ่ ݀. ಃ Β ໘ ࢤ Ў ӣ ៝!. ኗ ቪ ൔ. !. !. !. კ 2Ǻࣴࢬزำკ!. ಃѤǵࣴزπڀᆶࣴزჹຝ! ǵʳࣴزπ!ڀ ҁࣴزϐࣴزπڀύǴੰ܊ϷៈΓൔ߄ࣁ໒ܫԄୢ่ߚ)ڔᄬ Ԅୢ*ڔǶୢڔϣԖϖҽǴϩձࣁǺ)*ᙴଣ܄ၗǹ)Β*ៈΓ ܄ၗǹ)Ο*ៈೌמಔӝၗǹ)Ѥ*ੰΓ܄ၗǹ)ϖ*ੰΓྣ ៈ่݀ǴᇥܴӵΠǺ! )* ᙴଣ܄ၗ! ᙴଣ܄ၗύх֖ᙴଣޑឦձǺϦҥد܈ҥǴϷᙴଣӜᆀǹځд. 32.
(42) ӵᙴଣຑ᠘ભǵࢂցࣁ௲Ꮲᙴଣǵ࡚܄ੰኧǴϷӄଣᙴ٣Γ ኧх֖ӄଣᙴৣǵࣽៈৣǵៈৣǵៈγΓኧǴ߾җፁғᙴ٣ᐒ ᄬ໒ฦၗǴϷፁғᙴଣຑ᠘ӝӜൂ၌ԶளǴॊၗЬा ࣁΑှӚᙴଣϐ୷ҁ܄Ƕ! )Β* ៈΓ܄ၗ! ៈΓ܄ၗх֖ੰ܊ύࣽៈৣΓኧǵៈৣΓኧǵៈγΓ ኧǵN+N1 ΓኧǴԜϩၗҗΓ༤ቪੰ܊ൔ߄ளޕǹќѦǴ܄ၗ ύᗋх֖ੰ܊ύៈΓϐៈπբԃၗǵӧ၀ൂՏπբԃၗǵࢂց ᏼҺՉࡹᙍǵៈΓ௲ػำࡋϷځᙍભǴԜϩၗٰԾៈΓᅈ ཀࡋୢڔύϐ୷ҁၗǴԜϩၗЬाҔаᢀჸៈΓΚଛǶ! )Ο* ៈೌמಔӝၗ! ៈೌמಔӝၗӅΟᚒǴаੰൂࣁ܊ՏǴፓх֖၀ੰࢂ܊ցࣁӄ ೢྣៈੰ܊ǵीฝငҺྣ୍៝ܺΓኧϷԾငྣ୍៝ܺΓኧǴԜҽ ࣁΑှៈೌמಔӝϐЬाၗǶ! )Ѥ* ੰΓ܄ၗ! ੰΓ܄ၗϩЬाᢀჸӚڙೖੰ܊ύੰΓኧǵ၀ੰࣽ܊ձǵੰ ԃសຬၸ 70 ྃΓኧϷаख़εੰՐଣޣΓኧǴҁၗЬाࢂाΑှੰ ҁيёૈቹៜྣៈ่݀࣬ޑᜢ܄Ƕ!. 33.
(43) )ϖ* ੰΓྣៈ่݀! ੰྣៈ่݀ύǴॄय़่݀ҽх֖Ԗᓸየǵຳॹԋ্ǵᆅၡྖ ಥǵҶլǵᎁၶ๏ᛰ౧ѨੰޑΓΓԛǹ҅य़่݀ҽҗੰΓϷৎឦᅈཀ ࡋևǴԜϩၗЬाҔܭᢀჸӧԾᡂׯᡂၸำύǴੰΓྣៈ่݀ ޑڙ܌ቹៜǶ! Βǵʳࣴزჹຝ! ҁࣴزኬҁޑᒧБԄǴࢂҗፁғϦ໒ܕǴளޑᙴଣԋࣁҁी ฝϐ၂ᒤᙴଣǴёܭ၀ଣϩੰ܊ଛीฝငፎϐྣ୍៝ܺǴҗܭ ৎᙴଣளޑᐒࣣ࣬ӕǴӢԜኬҁᒧኬБԄࣁᐒᒧኬύޑᒿᐒܜኬ (systemic sampling)ǴճҔៈΓԾךइᒵ[ݤ71]Ǵҗளޑϖৎᙴଣύ ϐ၂ᒤᆶߚ၂ᒤੰ܊ύៈΓڐշ༤ቪ 1~3 ӚД܊ੰޑൔ߄ǴВ ΟǴаੰൂࣁ܊ՏǴձϐៈΓ֡༤ቪၗǴԾ 2008 ԃ 3 ДԿ 2009 ԃ 12 ДӅԏள 1573 ၗǶϖৎᙴଣύǴӚϩѲӧѠчǵ ύǵࠄǵܿѤ(4 ৎϦҥᙴଣǵ1 ৎدҥᙴଣ)ǴځύԖ 3 ৎཥڋᙴଣຑ ᠘ᓬǵ1 ৎᓬǵ1 ৎӝǴ٠Ъځύ 3 ৎࣁ௲ᏢᙴଣǴӵΠ߄ϐᙴଣ Ӝൂ܌ҢǺ. 34.
(44) ߄ 3Ǻࣴزᒧڗϐᙴଣ܄ၗ ឦձ ᙴଣຑ᠘่ ࢂցࣁ௲ ੰ ᙴৣ ៈৣ ៈγ (Ϧ/دҥ) ݀(ᙑ)ڋ Ꮲᙴଣ ኧ Γኧ Γኧ Γኧ. ϩѲ Ӧ. ᙴଣӜᆀ. ч. भਪᙴଣ. Ϧҥ. ᓬ(ୱ). ࢂ. 230. 41. 176. 35. ύ. ᙦচᙴଣ. Ϧҥ. ᓬ(ୱ). ࢂ. 430. 116. 371. 36. ࠄ. Ԙηᙴଣ. Ϧҥ. ᓬ(Ӧ). ց. 70. 22. 74. 9. ܿ. ጪᙴଣ. Ϧҥ. ӝ(ୱ). ց. 149. 27. 93. 12. ܿ. ߐᒍᙴଣ. دҥ. ᓬ(ୱ). ࢂ. 300. 80. 382. 71. !. ಃϖǵၗԏၸำ! !. ҁࣴزၗЬाٰԾܭѠύៈࣽᏢਠڑউ௲Ьҗ 2008 ԃ. 3 ДԿ 12 Дǵ2009 ԃ 5 ДԿ 12 ДϐȨӄೢྣៈࡋڋਢीฝȩ ǴԜीฝ ЬाӄೢྣៈࡋڋΠǴӚቫભϐៈΓჹᖏྣៈ่݀ϐቹៜǶ ࣴزၗԏБԄЬाҗϖৎीฝ၂ᒤᙴଣύǴ၂ᒤᆶߚ၂ᒤੰ܊ϐ ៈΓڐշ༤ቪᜢܭៈΓǵྣ୍៝ܺଛᆶෳໆੰΓ่݀ ܊ੰޑൔ߄Ǵ٩ᏵӚ၂ᒤᙴଣϐૈΚᆶཀᜫϩձ༤ቪԿΟঁДޑൔ ߄Ǵൔ߄ύ٩ΟȐқǵڹǵλڹȑ༤ቪǹៈΓБय़Ψҗॶ ϐៈΓڐշ༤ቪᜢܭៈΓπਔᡂϐៈΓൔ߄Ƕ ᙴଣቫભၗ߾ЬाٰԾፁғᙴ٣ᐒᄬ໒ฦၗǴፁғᙴଣ ຑ᠘ӝӜൂǴϷੰ܊ൔ߄Ƕ! 35.
(45) ಃϤǵၗीᆶϩ! !. ӧၗޑीϩύǴҁࣴز२ӃՉൂᡂϩ(frequency. distribution)Ǵଞჹኬҁޑ܄բϩǹௗՉᚈᡂ܈Οᡂϩ ǴၸҬΰӈ߄(cross-tabulation)ϷӚᅿीᔠۓϩᡂ໔ϐ࣬ᜢ ܄ǹനࡕՉӭᡂϩǴаᡂ໔ޑӢ݀ᜢ߯Ƕ٬Ҕޑी೬ᡏ Ԗ EXCEL 2003ǵSPSS 13.0 Ϸ LIMPEP 8.0ǶϩᡯӵΠǺ ǵʳኬҁ܄ඔॊϩ! ԜҽࣁൂᡂϩǴଞჹኬҁ܄բϩǴΑှኬҁϩѲޑϷ ϩѲጄൎǵനεϷനλॶǴᆶѳ֡ॶǵྗৡǴаΑှኬҁᙴଣύៈ Γ܄ǵೌמಔӝำࡋǵੰΓ܄ϷੰΓྣៈ่݀Ƕ! Βǵʳ࣬ᜢᔠ!ۓ Αှኬҁޑ܄ϐࡕǴҁࣴزៈΓ܄ǵೌמಔӝำ ࡋǵੰΓ܄ᆶੰΓྣៈ่݀ϐ໔ޑᜢ߯ǴӢԜճҔᙁൂጕ܄ᘜǴΑ ှӚӢનჹੰΓྣៈ่݀ޑቹៜǶ! ΟǵʳӢ݀ϩ! ԜҽՉӢ݀ᜢ߯ޑǴճҔ EXCEL ՉϩीǴᡂ ໔ޑӢ݀࣬ᜢ܄ǴᙖीᆉӒᓀჹКॶ(Odds Ratio)Αှځᖏᆶीᡉ ǵӆीᆉቹៜޑᜐሞਏ݀Ϸ࣬ჹ॥ᓀ(Relative Risk)Ƕ. 36.
(46) Ѥǵʳᘜϩ ҁࣴྣޑزៈ่݀ၗࣁीԛ(ीኧ)ࠠၗǴճҔΝ݊ᘜኳ ࠠՉᘜϩǴՠΝ݊ኳࠠѸᅈىѳ֡ኧܭᡂ౦ኧޑज़ڋǴ೭ӧ ჴၗύόϼёૈၲԋǴԜኬҁόӝҔΝ݊ኳࠠՉϩ ਔǴᏢޣගрճҔॄΒԄኳࠠՉϩǴՠӕਔॺךѸԵቾၗࠠ ᄊޑୢᚒǴऩॄय़٣ҹวғᕴΓԛϩѲӧ႟ԛ܌ޑ՞КٯၸଯǴߡॺך คޔݤௗᢀჸၗϩѲևޑཀကǴΨคޔݤௗᙖԜၗΑှӚԾᡂ ჹੰΓྣៈ่݀ޑቹៜǴӧЎύೀၸӭ႟ޑၗ೯தᏢޣ٬Ҕ႟ ᑩኳࠠȐZero Inflated Modelȑٰჹ႟ޑԛኧՉঅ҅ǴӢࣁޑΝ݊ ኳࠠȐPoisson Modelȑ۳۳եၗᚆණޑำࡋǴॺך٬ҔΝ݊ኳ ࠠЪԖ҅ዴޑѳ֡ኧ่ᄬǴԶӕਔ႟ॶၸӭޑຝӸӧǵΨ൩ࢂၸࡋᚆ ණȐoverdispersionȑਔǴ೭ኬޑी่݀ஒલЮਏǴЪځྗৡӛ Πୃৡ[72]Ƕ ႟ᑩኳࠠࢂவڀ႟ኳࠠȐWith Zeros Modelȑۯ՜ԶٰǴڀ႟ኳࠠࢂ Mullahy ӧ 1986 ԃਔගр[73]Ǵଷ҆ဂᡏҗٿဂᡏಔԋǴҗ҂ୖޕኧ ij ߄ҢਔǴࢌΓӧဂᡏޑᐒࣁ ij ਔǴځӧဂᡏΒޑᐒࣁ 1-ijǴᖐٯ ԶقǴঁࣽᏢৎӢࣁځπբ܄፦ޑᜢ߯ǴΨдவόѺᆉว߄ፕЎǴ ӢԜόёૈԖፕЎว߄Ǵ߾дឦܭԛኧ҉ᇻࣁ 0 ޑဂᡏǴԶќࣽᏢ ৎޔ၂ว߄ՠۈಖ҂ԋфǴд߾ឦܭဂᡏΒǴ೭ٿဂᡏ໔Ӹӧ 37.
(47) ᅿόёᢀჸޑ౦፦܄Ȑheterogeneityȑ ǴϩਔऩόஒԜ౦፦܄ӈΕԵቾǴ ԶޔௗஒғౢΚόӕࣽޑᏢৎӝӧଆϩǴ߾ஒค҅ݤዴीᢀෳ ॶǴ٠ᏤठፕЎว߄ጇኧ೭ൂᡂޑԛኧϩଛၸࡋᚆණ[73]Ƕҁࣴزύ ޑኬҁΨࢂӵԜǴੰΓྣៈ่݀ύޑӚॄय़٣ҹԛኧǴԖԛኧ҉ᇻ ࣁ႟ޑဂᡏǴёૈࢂ၀ੰࣁ܊Ѧࣽੰ܊ǴӢԜӚӵᆅၡྖಥǵᓸየ ٣ҹวғޑԛኧ҉ᇻࣁ 0ǴдॺឦܭဂᡏǴќဂᡏࢂឦϣࣽޑᄌ ੰ܊ੰ܄ΓǴၨܰวғԜᜪ٣ҹՠۈಖ҂Ԗॄय़่݀ౢғǴԜࣁҁࣴز ύޑဂᡏΒǴௗΠٰॺך٬Ҕ႟ᑩኳٰࠠჹӚဂᡏύ ޑ0 Չঅ҅Ǵ႟ ᑩኳࠠᆶڀ႟ኳࠠޑৡձӧܭ႟ᑩኳࠠύǴij ёаᒿঁΓ፦ԶׯᡂǴ ൩ӵόӕဂᡏύ 0 ޑวғᐒԖ܌ৡ౦Ƕ ҁࣴزύϐੰΓྣៈࠔ፦ࢂаҁЎΒകѤύ܌ഋӈϐੰΓྣៈࠔ ፦ࡰՉෳໆǴஒᓸየǵຳॹǵيᡏऊ״ǵᆅၡྖಥǵҶլǵ๏ᛰ౧ ѨǵԝΫϷࡼՉCPRϐੰΓኧΖࡰϐวғԛኧуᕴࣁॄय़٣ҹวғ ᕴኧǴբࣁᔈᡂኧǴԶៈπਔǵीฝငҺྣ୍៝ܺᆶدငྣ୍៝ܺ Кǵख़εੰޣΓኧᆶ܌ԖޣК߾ࣁҁࣴزύቹៜ٣ҹวғӭჲ ޑԾᡂኧǶ٬ҔLIMDEP 8.0೬ᡏࢂҗځܭำԄᇟقၨSASభᡉܰᏢǴё ٬ኗቪਏၨ٬Ҕځд೬ᡏਔଯǴӢԜ٬ҔԜ೬ᡏՉीϩǶ. 38.
(48) ྣៈѨ௳ԛኧीᆉБԄǺ E ( y ). Pr( y ! 0) E ( y y ! 0). ៈѨᇤ යఈॶ!. P1. ln. ӧѝԖ 0 & 1 (Ӣࣁ dummy)!. x. bx חln. 0 ழΔln. x 1 ழΔln. p1 1 p1. P1 1 - P1. P1 1 - P1. 1. a bx. …odds. a. ab. § § p · p · ¨¨ ln 1 ¸¸ ¨¨ ln 1 ¸¸ © 1 p1 ¹ x 1 © 1 p1 ¹ x § p1 · ¨¨ ¸¸ © 1 p1 ¹ x ln § p1 · ¨¨ ¸¸ © 1 p1 ¹ x. NEGBIN. exp(bx) 1 exp(bx). Pr( y ! 0). p1 1 p1. Logit. …odds. b 0. b. 0. § p1 · ¨¨ ¸¸ © 1 p1 ¹ x ࠷ኙᑇΚ § p1 · ¨¨ ¸¸ © 1 p1 ¹ x. 1. exp(b). 0. OR (odds Ratio). ln E ( y y ! 0)
(49) a bx ln P x. 1. a b Px. ln P x. 0. a Px. 0. 1. exp(a b). exp(a ). 39. exp(b) >1 ਔǴж߄ ޣᐒεܭΠޣ.
(50) ࣬ჹ॥ᓀीᆉБԄǺ E ( y) x E ( y) x. 1 0. Pr( y ! 0) x Pr( y ! 0) X. RRT ᕴ॥ᓀ!. 1 Pr( y 0) x 1 Pr( y 0) x. 1 0. u. E ( y y ! 0) x. 1. E ( y y ! 0) x. 0. RR1 วғᐒ!. 1. Pr( y. 0. . RR2 วғԛኧ!. 0). exp(a bx) 1 exp(a bx). 1 Pr( y 0) x 1 Pr( y 0) x. 1 0. 1 1 exp(a b) 1 1 exp(a) 1 exp(a) 1 exp(a b) 1 exp(a) 1 exp(a) exp(b). 40.
(51) ಃѤകǵ่ࣴ݀ز ҁകύӅϩΟǴϩձࣁඔॊࣴزኬҁޑ܄ϐඔॊ܄ीϩǵᚈ ᡂϩᆶीБݤၨࣁፄᚇޑᘜϩǶ. ಃǵඔॊ܄ीϩ ҁаੰൂࣁ܊ՏǴᢀჸӚੰ܊໔Ӛ߄ޑ܄ǹ२ӃΑှӚੰ܊ ӧόӕձύϐៈΓ܄ϷៈೌמషӝำࡋǴௗᢀჸੰΓ ܄ǴനࡕࢂੰΓྣៈ่݀ޑևǴᙖԜॺךளаᢀჸၗޑᡏࠠᄊǴ ٠،ۓӵՖՉΠϩǶ ǵӚ߄܄ Ȑȑ97 ԃៈΓ܄ ϖύੰ ޑ܊93 ҽൔ߄ύևޑៈΓΚଛǴЬाύӧៈ γϷၨၗభៈγȐN+N1ȑǴៈৣଛΓኧѳ֡ѝԖ 0.80 ՏȐୖԵ ߕᒵǴߕ߄ 2ȑ Ǵϖчੰޑ܊ៈৣଛΓኧၨӭǴຬၸъኧޑਔ໔ੰ ܊ଛԖՏៈৣȐ59.14%ȑ Ǵѳ֡ଛԖ 0.87 ՏǴΟܿੰ܊ᆶ 5 ဦੰ ܊ៈΓΚଛၨкျ߾ޑឦៈγΓΚȐ59.14%Ǵ84.15%ȑ ǴΟܿੰ܊ѳ ֡Ԗ 0.85 ՏៈγǴ5 ဦੰ߾܊Ԗ 1.09 ՏǴԶ 3AB ᆶ 5AB ੰޑ܊Γ Κᓬ༈߾ୃӛៈৣǴΖԋаޑਔ໔ੰ܊ύࣣଛԖ 2 Կ 3 ՏៈৣǴ ᢀჸ 3AB ੰ 41.
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