| 摘要: | 衛生福利部中央健康保險署於1999年公告施行急診四級檢傷分類標準，後為使病患得到適切的治療，衛生福利部自2010年1月1日起全面實施急診五級檢傷分類標準，因其分類較詳細，且佐以電腦系統判讀，讓醫護人員可精確判別病患病情嚴重度，使危急之病人獲得優先處置。
全民健保自1995年開辦以來，其每年急診就醫平均人次為7,293,090人次、平均每日人次亦有19,672，每年的急診健保醫療費用平均也有179億點，顯示民眾對急診醫療需求日益劇增。本研究主要運用醫療資訊系統與資料探勘技術分析該院急診以健保身份就醫之急診病患資料，並以急診五級檢傷分類標準做為探討人口學結構（性別與年齡）、就醫情形 [來院方式、疾病分類與轉歸（離院）方式] 與醫療資源耗用（醫療費用與滯留時間）之關聯性。
本研究資料以台灣北部某區域教學醫院之急診病患為研究對象，資料採樣期間為2018年4月至同年6月於該院急診以健保身份就醫之病患，並運用SPSS 22.0 for Windows統計軟體為研究工具，其結果為急診五級檢傷分類與人口學結構（性別與年齡）未呈現顯著差異，而與就醫情形 [來院方式、疾病分類與轉歸（離院）方式] 與醫療資源耗用（醫療費用與滯留時間）有顯著相關性。
經過相關研究分析探討後建議：針對疾病較複雜之病患，且礙於院內設備及專科人力不足時，應先給予病患適當治療處置後再協助病患轉院，以避免延誤病情及無謂留觀造成醫療資源浪費；而醫師如能有更進一步之明確診斷，可做為未來醫院申請急重症急救責任醫院之參考。而相關數據之探討分析亦可做為醫院決策管理者參酌之用。但因本研究係採回溯性方式進行資料蒐集，需考量急診病患其檢傷分類級數高低、疾病嚴重度可能會受到季節、氣候、重大事故發生與否或不同醫院所在的區域別、層級別、權屬別……等因素影響，而使分類結果有所差異，建議嗣後之研究可針對不同季節、不同醫院所在的區域別、層級別、權屬別，再進行相關研究探討。
The Central Health Insurance Department of the Ministry of Health and Welfare announced in 1999 the implementation of the emergency four-level classification standard, and in order to provide appropriate treatment for patients, the Ministry of Health and Welfare has fully implemented the emergency five-level classification standard since January 1, 2010. Because of its detailed classification and computer system interpretation, medical staff can accurately determine the severity of the patients condition and give priority to critical patients.
Since the opening of the National Health Insurance in 1995, the average number of emergency medical treatments per year has been 7,293,090, and the average daily number has 19,672. The average annual emergency medical insurance costs are also 17.9 billion, indicating that the demand for emergency medical care is increasing rapidly. This study mainly uses medical information system and data exploration technology to analyze the emergency departments emergency medical information for emergency medical treatment, and uses the five-level classification standard for emergency diagnosis as a demographic structure (gender and age) and medical treatment. Hospital approach, disease classification and outcome (discharged)] and the relevance of medical resource consumption (medical expenses and staying time).
The data of this study were based on the emergency patients in a regional teaching hospital in northern Taiwan. The data sampling period was from April 2018 to June of the same year in the emergency department of the hospital for health care, and SPSS 22.0 for Windows statistical software was used. As a research tool, the results showed that there was no significant difference between the five-level classification of emergency department and the demographic structure (gender and age), and the situation of medical treatment [method of hospitalization, classification of disease and outcome (discharged)] and medical resources. There is a significant correlation between consumption (medical expenses and staying time).
After relevant research and analysis, it is suggested that: for patients with more complicated diseases, and if the equipment and specialists in the hospital are insufficient, they should be given appropriate treatment and treatment before the patients are transferred to the hospital to avoid delays and unnecessary observation. This will result in a waste of medical resources; and if the physician can have a further clear diagnosis, it can be used as a reference for future hospitals to apply for emergency care hospitals. The analysis and analysis of relevant data can also be used as a decision-making manager for hospitals. However, because the research department collects data in a retrospective manner, it is necessary to consider the level of the classification of the emergency patients, and the severity of the disease may be affected by the season, climate, major accidents or the regional or hierarchical level of different hospitals. Different factors, such as ownership, ownership, etc., make the classification results different. It is suggested that the subsequent research can be carried out for different seasons, different regions, different levels of the hospital, and ownership. |
