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題名:探討以死亡率作為加護中心照護品質指標之合理性
書刊名:榮總護理
作者:徐曉雲陳雅玫周學智
作者(外文):Hsu, Hsia-yunChen, Ya-meiChou, Hsueh-chih
出版日期:2011
卷期:28:1
頁次:頁47-54
主題關鍵詞:死亡率加護中心照護品質平均存活時間MortalityIntensive care unitQuality of care indicatorsMean survival time
原始連結:連回原系統網址new window
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影響加護中心照護品質的因素,與加護中心、醫院特性及品質審查指標相關,其中死亡率為結果指標之一。本研究目的為了解樣本醫院94年1至9月六個成人加護中心病患住進至離開加護中心之死亡率及存活時間,比較各加護中心間存活時間差異情形。研究樣本數共2220人次,平均住院天數6.6天,平均年齡62.97歲,男性病患佔71.4%,女性佔28.6%。本研究採檔案分析,由資訊室協助,收集病患資料檔中性別、出生年月日、住入那個加護中心、入出該加護中心日期及死亡日期,採excel彙整資料,以SPSS 13.0統計軟體進行描述性統計、百分數、標準差及存活分析(Kaplan-meier)。研究結果:六個加護中心間平均存活時間未達顯著差異(p=.28),但比較死亡率卻達顯著差異(p=.003),死亡率以內科加護中心12.7%最高,較心臟外科(4.6%)高2.76倍。結論:因僅比較死亡率未考量六個加護中心間住院天數差異,導致某些加護中心死亡率偏高,可能造成該加護中心照護品質不良誤解,故建議在比較加護中心間照護品質時不宜僅採用死亡率,應將平均存活時間一併納入。
Mortality rate is one of the outcome indicators associated with quality of care. The purpose of this study was to compare the mortality rate, the survival rate and the difference in survival time of patients in 6 intensive care units. The sample size was 2220 patients. The mean length of ICU stay was 6.6 days. The average age was 62.97 years old. There were 71.4% of male patients and 28.6% of female patients in this study. The patient database were classified and coded. SPSS 13.0 statistical software was used for descriptive statistics and Kaplan-meier analysis. The result showed that the mean survival time was not significantly different. But the mortality rate was the highest and lowest in MICU and VICU (RR 2.76, p=.003). Comparing the mortality rate without considering the length of ICU stay will result in a misunderstanding of quality of care. It is better to replace mortality rate with mean survival time as an indicator of quality of care among ICUs.
期刊論文
1.陳玉枝(20030600)。加護病房醫療品質影響因素之探討。榮總護理,20(2),171-183。new window  延伸查詢new window
2.Laupland, K. B.、Kirkpatrick, A. W.、Kortbeek, J. B.、Zuege, D. J.(2006)。Long-term mortality outcome associated with prolonged admission to the ICU。Chest,129(4),954-959。  new window
3.唐高駿、薛貴霞、蔡建和、陳秀丹(20051200)。加護病房成本效益。中華民國急救加護醫學會雜誌,16(4),139-145。  延伸查詢new window
4.謝美妃、林秋菊、陳綉琴(20090900)。運用紐曼模式於一位頸椎損傷病患之護理經驗。長庚護理,20(3)=67,384-392。new window  延伸查詢new window
5.Diringer, M. N.、Edwards, D. F.(2001)。Admission to a neurological/neurosurgical intensive care unit is associated with reduced mortality rate after intracerebral hemorrhage。Clinical care Medicine,29(3),635-640。  new window
6.Donabedian, A.(1998)。The quality of care. How can it be assessed?。Journal of the American Medical Association,260(12),1743-1748。  new window
7.Douglas, S. L.、Daly, B. J.、O'Toole, E. E.、Kelley, C. G.、Montenegro, H.(2009)。Age differences in survival outcomes and resource use for chronically critically ill patients。Journal of Critical Care,24,302-310。  new window
8.El-Nabulsi, B. A.、Holy, M.、Al-Suleihat, A.、Smadi, S.(2005)。Appropriateness of admissions to intensive care unit。Journal of Research In Medical Sciences,12(2),6-9。  new window
9.Fowler, R. A.、Sabur, N.、Li, P.、Juurlink, D. N.、Pinto, R.、Hladunewich, M. A.(2007)。Sex-and age-based differences in the delivery and outcomes of critical care。Canadian Medical Association Journal,177(12),1513-1519。  new window
10.Japiassu, A. M.、Oliveira, B. A.、Gondim, C. R. N.、Kurtz, P.、Almeida, G. F.、Pinto, M.(2009)。Effect of type of admission on short-and long term outcome of nonagenarians admitted to an intensive care unit。Journal of the American Geriatrics Society,57(6),1128-1130。  new window
11.Kiekkas, P.、Sakellaropoulos, G. C.、Brokalaki, H.、Manolis, E.、Samios, A.、Skartsani, C.(2008)。Association between nursing workload and mortality of intensive care unit patients。Journal of Nursing Scholarship,40(4),385-390。  new window
12.Rimachi, R.、Vincent, J. L.、Brimioulle, S.(2007)。Survival and quality of life after prolonged intensive care unit stay。Anaesthesia and Intensive Care,35(1),62-67。  new window
13.Romo, H.、Amaral, A. C. K.(2004)。Effect of Pantient sex on intensive care unit survival。Archives Internal Medicine,164,61-65。  new window
14.Soares, M.、Carvalho, M. S.、Salluh, J. I. F.、Ferreira, C. G.、Luiz, R. R.、Rocco, J. R.(2006)。Effect of age on survival of critically ill patients with cancer。Clinical care Medicine,34(3),715-721。  new window
15.Wong, D. T.、Gomez, M.、McGuire, G. P.、Kavanagh, B.(1999)。Utilization of intensive care unit days in a Canadian medical-surgical intensive care unit。Clinical care Medicine,27(7),1319-1324。  new window
16.王雅玲、黃崇謙、楊啟賢(20061100)。頭部外傷原因與醫療資源耗用。北市醫學雜誌,3(11),1087-1098。  延伸查詢new window
其他
1.財團法人醫院評鑑暨醫療品質策進會(2010)。臺灣醫療品質指標計劃簡介及指標項目清單,http://www.tjcha.org.tw/SiteMap.asp。  延伸查詢new window
 
 
 
 
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