聚氯乙烯工人GST T1,GST M1及CYP2E1基因型與其肝功能之相關研究

黃 忠英, 鄭 尊仁, 黃 國良, 王 榮德, Ling-Ling Hsieh

研究成果: 期刊稿件文章同行評審

摘要

     本文目的是以統計模式之建立為出發點,對每天之平均及累積住院費用進行分析 ,探討腦中風病患由急性醫院「轉診」至長期照護機構之臨界日。在病患住院初期,進行大 部份的檢驗及急性治療,住院費用最高,待病情較穩定,不需要急性醫院的醫療設備後,費 用便會下降。因此,基於病情能反映於費用上的假設,對住院費用及住院天數進行兩段迴歸 分析,前後兩段之迴歸線斜率差異為最大、或前後兩段平均費用差距最大,便可視為轉診的 臨界日。除此之外亦可以累積住院費用達某百分比 (如 75%,80% 或 90%) 時作為切點討論 。 研究之樣本來自於臺灣北部某醫學中心, 共 1,357 人, 平均住院 22.9 天、住院費用 76.325 元。若以兩段迴歸法分析,則大部份可以在三至五天轉介: 若以總住院費之 75% 、 80% 或 90% 作為轉診臨界日, 則平均亦不過 12 至 13 天,比目前平均住院的 23 天仍短 很多。若能適時轉診,營運增長率可達 12% 至 34% 不等。因本研究僅以費用計算,並未參 考病人之病情徵狀,故建議後續之探討朝此方向進行,並結合「費用」與「病情」兩大項目 之分析結果綜合討論,以期能更有效運用有限之醫療資源。
     A few statistical models were constructed to investigate the most appropriate time to refer hospitalized CVA patients from a medical center to long term care institutes. Based on the assumption that patients' physical con- ditions can be reflected in their hospital fees, the cumulative charges were examined by a two-piece regression. It is perhaps most efficient, from hospital management's point of view, to transfer patients at the time where the dif- ference between the slopes of the regression lines before and after this point is maximized. Alternatively, one can also maximize the difference in average daily charges before and after such point, or when the cumulative charges reach, say, 75%, 80% or 90%. The studied sample consisted of 1357 CVA inpatients randomly drawn from a medical center in northern Taiwan. Their average length of stay (LOS) was 22.9 days, with a mean hospital fee of NT$76325. Results of the piecewise regression analysis show that most patients can be referred in 3 to 5 days. On the other hand, we also found that 75%-90% of the total fee was accumulated in the first 12-13 days. Should patients be transferred with-in the derived days, operating efficiency can increase by 12%-34%. Since only fees are used in the modeling process as the dependent variable, but physical conditions and outcomes of the patients have been largely ignored, results of this research can by no means be considered complete. Yet this still seems to be one of the pioneer projects investigating "referral date", instead of the reasonably well studied "length of stay". Therefore, it is suggested that further research be carried out from a more medical point of view, so that the combined results will be more comprehensive.
原文繁體中文
頁(從 - 到)499-512
期刊中華公共衛生雜誌
16
發行號6
出版狀態已出版 - 1997

Keywords

  • 氯乙烯
  • 細胞色素P450 2E1
  • 肝功能
  • 麩胺基硫轉移?

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