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題名:醫院對急性白血病人保護隔離之成本效益研究
書刊名:中華公共衛生雜誌
作者:星雙鈺金春華許惠媚 引用關係趙秀雄
作者(外文):Hsing, Nelson-hsingChin, Chuin-hwaShu, Hui-meiChao, Shiu-hsiung
出版日期:1996
卷期:15:1
頁次:頁80-90
主題關鍵詞:存活分析保護隔離成本效益醫務管理Survival analysisProtective precautionCost effectivenessHospital administration
原始連結:連回原系統網址new window
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     門診高度使用者之特性,本研究選取大溪鎮衛生所79年10月至80年 4月間的門診病人為對象,進行問卷訪視調查。本研究將月平均就診頻率為研究族群前5% 之病人定義為高度使用組,共313人;並且自其餘門診病人中隨機抽取246人作為對照, 稱之正常使用組。本研究以對數迴歸分析探討諸自變項對於高度使用門診的影響程度。研 究結果發現:(1)年齡愈高者使用門診的機會愈大,大於65歲者成為高度使用組的可能性 為小於40歲者的5.19倍;(2)在能力因素方面,有健康保險者成為高度使用組的可能性為沒 有健康保險者的3.82倍;(3)在需要因素方面,罹患慢性病與自覺健康不佳皆為高度使用門 診的原因,其勝算比分別為3.25與3.57;(4)社會支持功能不佳者成為高度使用組的可能性 為社會支持功能良好者的2.11倍。根據研究結果得知,「需要因素」為高度使用門診最重要 的因素;而健康保險所誘發的就診率增加,則有待進一步探討其適當性。 降低病患受到感染的機會。研究中部份的結果 顯示使用化學治療的劑量高低可能對受感染次數及感染天數有影響可為後續研究的建議。本 研究亦建議後續對平均感染的日數與病患死亡率間之關係做一研究,畢竟防止病患死亡是採 保護隔離措施的最終目的。
     This study was designed to examine the characteristics of frequent users at a group practice center (GPC). Patients who had visited Da-Xi GPC from May 1990 to March 1991 were chosen as the study population. Subjects were divided into two groups, the frequent user group and the control group. The frequent user group was comprised of 313 persons whose visiting frequency was in the top 5% among all registered patients. The control group consisted of 246 persons randomly sampled from the remainder. A questionnaire was employed for data collection and logistic regression was used for data analysis. The results show that: (1)The liklihood of becoming a frequent user for patients older than 65 years of age was 5.19 times that of patients youger than 40. (2)Insured patients were 3.82 times more likely to be frequent users. (3)Regarding need, chronic disease and poor health perception were both associated with frequent use with an odds ration of 3.25 and 3.57, respectively. (4)Those who were poorly socially supported were 2.11 times as likely to become frequent users as those who were wll socially supported. These results indicated the need factor is the most important causal factor in frequent health service utilization. The higher visiting frequency associated with insurance deserves further study. udy does not show what effect different chemotherapy dosages have on the chance of infection, we feel that future research may demonstrate a relationship. Whether delay of infection has an impact on patient mortality remains an interesting question and is suggested for further study.
期刊論文
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5.Bodey, G. P.、Keating, M. J.(1985)。Prospective random ized trial of antibiotic prophylaxis in acute leukemia。Am J Med,78,407-416。  new window
6.Estey, E. H.、Keating, M. J.(1982)。Causes of initial remission induction failure in acute myelogenous leukemia。Blood,60,309-315。  new window
7.Bodey, G. P.、Gehan, E. A.(1971)。Protective environment- prophylactic antibiotic program in the chemotherapy of acute leukemia。Am J Med Sci,252,138-151。  new window
8.Levine, A. S.、Siegel, S. E.(1973)。Protected environments and prophylactic antibiotics. A prospective controlled study of their utility in the therapy of acute leukemia。N Engl J Med,288,477-483。  new window
9.Schimpff, S. C.、Green, W. H.(1975)。infection prevention in acute nonlymphocytic leukemia: laminar air flow room reverse isolation with oral nonavbsorbable antibiotic prophylaxis。Ann Intern Med,82,351-358。  new window
10.Rodriguez, V.、Bodey, G. P.(1978)。Randomized trial of protected environment-prophylactic antibiotics in 145 adults with acute leukemia。Medicine,57,253-266。  new window
11.Agah, R.、Cherry, J. D.(1987)。Respiratory syncytial virus (RSV) infection rate in personnel caring for children with rsv infections。AJDC,141,695- 697。  new window
12.Goldman, D.(1991)。The role of barrier precautions in infection control。Journal Hospital Infection,18(suppl A),515-523。  new window
13.Klein, B. S.、Perloff, W. H.(1989)。Reduction of nosocomial infection during pediatric intensive care by protective isolation。N Engl J Med,320(26),1714-1721。  new window
14.Nauseef, W. M.、Maki, D. G.(1981)。A study of the value of simple protective isolation in patients with granulocytopenia。N Engf J Med,304(8),448-453。  new window
15.Ketchel, S. J.、Rodriguez, V.(1978)。Acute infections in cancer patients。Semin Oncol,5,167-179。  new window
16.Klastersky, J.、Weerts, D. t.(1973)。Fever of unexplained origin in patients with cancer。Eur J Cancer,9,69-76。  new window
17.Love, L. J.、Schimpff, S. C.(1980)。Randomized trial of empiric antibiotic therapy with ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer。Am J Med,66,643-648。  new window
18.Love, L. J.、Schimpff, S. C.(1980)。Improved prognosis for granulocytopenic patients with gram-negative bacteremia。Am J Med,68,643-648。  new window
19.Sickles, E. A.、Greene, W. H.(1975)。Clinical presentation of infection in granulocytopenic patients。Arch Intern Med,135,715-719。  new window
20.Singer, C.、Kaplan, M. H.、Armstrong, D.(1977)。Randomized trial of empiric antibiotic therapy with ticarcillin in combination with gentamicin, amikacin or netilmicin in febrile patients with granulocytopenia and cancer。American Journal of Medicine,62(5),731-742。  new window
 
 
 
 
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