醫院重大事件與急診醫療服務量相關性探討－以某區域醫院?例

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*,**** ** ** *** **** ***** 2000 SARS SARS 1999 2005 540±74 vs 445±73, 524±63 vs 409±43, p<0.05 p<0.05 p<0.05 p<0.01 SARS SARS

Case Report

* **** ** *** ***** 96 2 26 96 9 26 96 12 10 105 131

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[1] [2] [3] [4] SARS [5] SARS [6] 2003 SARS 2004 2002 [7] SARS 2005 15% [8] 2000 9 2001 2 2001 9 2003 4 SARS 2005 7

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SARS 2001 2 SPSS 12.0 10 SARS 2003 4 2003 9 SARS 3 6 12 Paired-t P 0.05 2/3 1/3 E N T 539±13 vs 452±31, 1079±34 vs 1026±37, p<0.05 540±74 vs 445±73, 98±18 vs 75±21, 1596±68 vs 1338±223, 78±15 vs 60±14, 522±54 vs 404±55, 441±56 vs 334±114, 1091±84 vs 914±102, p<0.01 319±29 vs 267±48, p<0.05 2001 2 p<0.01 427±14 vs 366±20, 755±47 vs 576±47, p<0.05

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ߒΙȈ ᎑ߖཱིᚂᏰϛЖԙҳᕊၼ ൐՝ȈؐТҁ֯Ρԩ ࠉࡣέএТШၶ ࠉࡣϲএТШၶ ࠉࡣΙԑ ࠉέএТ ࡣέএТ ̚ ࠉϲএТ ࡣϲএТ ̚ ࠉ এТ ࡣ এТ 3 ϱऋࡨຨ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋࡨຨ ɲ ɲ ɲ ɲ ɲ ɲ ϱऋ՞଱ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋ՞଱ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨᖂΡԩ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨΣ଱ᖂΡԩ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˵᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˶᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˷᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˸᜸ ɲ ɲ ɲ ɲ ɲ ɲ ॖΡ٘Ϸ ɲ ɲ ɲ ɲ ɲ ɲ ᄸҕ٘Ϸ ɲ ɲ ɲ ɲ ɲ ɲ ୊߳٘Ϸ ɲ ɲ ɲ ɲ ɲ ɲ ᆋ߳ ɲ ɲ ɲ ɲ ɲ ɲ

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ߒΠȈ ॖΡઽΣ୊߳๝п ൐՝ȈؐТҁ֯Ρԩ ࠉࡣέএТШၶ ࠉࡣϲএТШၶ ࠉࡣΙԑШၶ ࠉέএТ ࡣέএТ ̚ ࠉϲএТ ࡣϲএТ ̚ ࠉ এТ ࡣ এТ ̚ ϱऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ѴऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ϱऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨΣ଱ᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˵᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˶᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˷᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˸᜸ ɲ ɲ ɲ ɲ ɲ ɲ ॖΡ ɲ ɲ ɲ ɲ ɲ ɲ ᄸҕ ɲ ɲ ɲ ɲ ɲ ɲ ୊߳ ɲ ɲ ɲ ɲ ɲ ɲ ᆋ߳ ɲ ɲ ɲ ɲ ɲ ɲ

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ߒέȈ ઽೇॳخٱӇȞЫႫᐠڎཬᚽȃୄຨ Јȟ ൐՝ȈؐТҁ֯Ρԩ ࠉࡣέএТШၶ ࠉࡣϲএТШၶ ࠉࡣΙԑ ࠉέএТ ࡣέএТ ̚ ࠉϲএТ ࡣϲএТ ̚ ࠉ এТ ࡣ এТ 3 ϱऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ѴऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ϱऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨΣ଱ᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˵᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˶᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˷᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˸᜸ ɲ ɲ ɲ ɲ ɲ ɲ ॖΡ ɲ ɲ ɲ ɲ ɲ ɲ ᄸҕ ɲ ɲ ɲ ɲ ɲ ɲ ୊߳ ɲ ɲ ɲ ɲ ɲ ɲ ᆋ߳ ɲ ɲ ɲ ɲ ɲ ɲ

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SARS p<0.01 p<0.05 2001 2 [9] [10] [11] [12,13]

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ߒѲȈ ׽ڙ 6$56 ட೰ᚂ଱ȞୄХᚂᕛ݈୛Ȃࡌ଱јԑȟ ൐՝ȈؐТҁ֯Ρԩ ࠉࡣέএТШၶ ࠉࡣϲএТШၶ ࠉࡣΙԑШၶ ࠉέএТ ࡣέএТ ̚ ࠉϲএТҁ ࡣϲএТ ̚ ࠉ এТ ࡣ এТ ̚ ϱऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ѴऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ϱऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨΣ଱ᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˵᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˶᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˷᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˸᜸ ɲ ɲ ɲ ɲ ɲ ɲ ॖΡ ɲ ɲ ɲ ɲ ɲ ɲ ᄸҕ ɲ ɲ ɲ ɲ ɲ ɲ ୊߳ ɲ ɲ ɲ ɲ ɲ ɲ ᆋ߳ ɲ ɲ ɲ ɲ Ɏ ɲ ɲ

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ߒϤȈ ᄂࢊӫ౩ᙽຨڙ࡙ᄲ፡ᐌഋϷ॒ᐊ ൐՝ȈؐТҁ֯Ρԩ ࠉࡣέএТШၶ ࠉࡣϲএТШၶ ࠉࡣΙԑШၶ ࠉέএТ ࡣέএТ ̚ ࠉϲএТҁ ࡣϲএТ ̚ ࠉ এТ ࡣ এТ ̚ ϱऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ѴऋࡨຨΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ϱऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ Ѵऋ՞଱Ρኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ࡨຨΣ଱ᖂΡኵ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˵᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˶᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˷᜸ ɲ ɲ ɲ ɲ ɲ ɲ ᔮ༌಑˸᜸ ɲ ɲ ɲ ɲ ɲ ɲ ॖΡ ɲ ɲ ɲ ɲ ɲ ɲ ᄸҕ ɲ ɲ ɲ ɲ ɲ ɲ ୊߳ ɲ ɲ ɲ ɲ ɲ ɲ ᆋ߳ ɲ ɲ ɲ ɲ ɲ ɲ

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[11] 10 30%-90% [14] SARS SARS [15] SARS 2 3 % [16] SARS 18% 13% 17% [17] SARS 20% 30% [18,19] SARS [20] SARS 2002 2004 20%

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2005 7 [21] [22] 2005 15%[21] 2000 2005 1. 2. 3. SARS 4. 5. 6. SARS SARS

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ߒϲȈ࢚ୢ୿ᚂ଱ᐣԑپ१σٱӇᘈΙԑࠉࡣϞࡨຨᚂᕛ݈୛໔Шၶ ൐՝ȈؐТҁ֯Ρԩ ࣺᜰᡐ໶໔ १σٱӇ ϱऋࡨ ຨΡኵ Ѵऋࡨ ຨΡኵ ϱऋࡨ ຨ՞଱ Ѵऋࡨ ຨ՞଱ ࡨຨᖂ Ρኵ ᖂࡨຨ ՞଱ኵ ಑˵᜸ ੾௉ኵ ಑˶᜸ ੾௉ኵ ಑˷᜸ ੾௉ኵ ಑˸᜸ ੾௉ኵ ࡨຨॖ ΡΡኵ ࡨຨᄸ ҕΡኵ ࡨຨ୊ ߳Ρኵ ᎑ߖཱིᚂᏰϛ Жԙҳᕊၼ ɎɎ ɎɎ ɎɎ Ɏ ɎɎ ɎɎ ɎɎ ɎɎ ॖΡઽΣ୊߳ ๝п ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ɎɎ ઽೇॳخٱӇ ȞЫႫᐠڎཬᚽȃୄ ຨΪЈȃཬѶڍቇȟ ɎɎ ׽ڙ 6$56 ட ೰ᚂ଱Ȟࡌ଱ এТȟ ɎɎ ɎɎ ɎɎ ɎɎ Ɏ ɎɎ ɎɎ ɎɎ Ɏ ɎɎ ௰ଢ଼ӫ౩ᙽຨ ڙ࡙ᇄ፡ᐌҕಀ൷ᚂ ϞഋϷ॒ᐊ ɎɎ ɎɎ Ɏ Ɏ ɎɎ Ɏ ɎɎ Ɏ ̙ٷٱӇਢוܚԤᚂᕛ݈୛໔ࣱ֕౪ή६ޟᗍ༖ ̙ުҩޱȈή६Ґႀᡗ๿ಛॎ৯౴ Ɏ3 ȞࠉࡣΙԑޟ݈୛໔֕౪ಛॎ৯౴ȟ ɎɎ 3 ȞࠉࡣΙԑޟ݈୛໔֕౪ಛॎ৯౴ȟ

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SARS [23] [24] [25] [26] 6 SARS 2005 7 1. 2. 3. 4. 2001 2 5.

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Association of Hospital Major Events and Service

Volume of Emergency Department—Evidence of

One Regional Hospital

Sheng-Pyng Chen, Te-Fang Wang, Jenn-Shing Sher, Chung-Jen Su, Chun-Fang Chen, Ming-Chin Yang

Abstract

Objectives: In the face of major flooding and hospital changes in

becoming a SARS exclusive hospital after 2000, the hospital encountered difficulties in operation. Emergency service volume was also showing a trend of decline. Outside the SARS incident, the purpose of this study is to better understand what types of incidents are prone to influence the operation of emergency services, to provide administrators with a reference for analysis and decision making.

Methods: Statistical analysis and comparison of relevant variables on the

volume of various kinds of medical services based on pre and post variation of relevant variables of medical service volume (except for the month that incidents occurred) for the period between 1999 and 2005.

Results: Taking the hospital as an example, natural disasters do not

greatly impact emergency medical service volume (p>0.05). After further analysis, the increase of competitors in medical environment and the inclusion of soldiers in health insurance have a more significant impact on the service volume of surgical ER and emergency as well as critical cases (540±74 vs 445±73, 524±63 vs 409±43, p<0.05). Policy intervention and the change in health insurance payment system had a greater influence on medical ER and lighter medical cases (p<0.05). The number of soldiers who seek emergency treatments is the major decisive factor in emergency medical service volume Sheng-Pyng Chen, No.131, Jiankang Rd., Songshan District, Taipei City 105, Taiwan (R.O.C.) Received: February 26, 2007

Revised: September 26, 2007 Accepted: December 10, 2007

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(p<0.01). The SARS incident and adjustment of patient co-payment indeed was a major impact on emergency medical service volume. Nevertheless, amid major incidents, veteran emergency treatment volume showed the smallest change.

Conclusions: Preliminary results show no significant impact before and

after NARI Typhoon. However, after the establishment of nearby new medical centers, the inclusion of soldiers in the Health Insurance, hospital transformation to become a SARS exclusive hospital, and the increase of health insurance co-payment, some of variables relating to medical service volume showed significant statistical variance.

Key words: emergency medical service volume, major incidents, payment system, Severe Acute Respiratory Syndrome, SARS