72-72 72 I
To Construct a Forecasting Model of Unscheduled Emergency Department Revist within72 Hours Student: Fei-Chen LAI Advisor: Prof. Chin-Yin Huang Department of Industrial Engineering and Enterprise Information Tunghai University ABSTRACT The emergency clinic patients,within 72 hours of unscheduled return, is a group of high -potential-risk patients in medical risks and medical disputes.although most hospitals use of information systems analysis to deal with the health care business, but they didn t do the further analysis for within 72 hours for unscheduled return of patients. Hope this study has been implemented for the hospital information system.this study use patient factors, hospital factors and disease factors to analysis of unscheduled return patients.analysis the factors of unscheduled patients, and to build their forecasting models. The results of the analysis found that "age", "consultation ", "After the movement of emergency", "triage level ", " division of Emergency " are the main factors of emergency anti-patient; the lower age of diagnosis occurred in a higher probability there are consultations incidence lower than the incidence of non-consultation in the "after the movement of emergency," "wait the bed" incidence was higher than other trends in the "triage level", Grade II and III occurred to a higher probability, especially in the third grade as the most in the "division of emergency", the "Infectious Diseases Obstetrics Gynecology ENT Ophthalmology," incidence was higher than other divisions. Keyword unscheduled, emergency, return care, forecasting models 2
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I 3 4 6 7 8 1.1 8 1.2 8 1.3 9 1.4 9 1.5 9 10 2.1 10 2.2 11 2.3 13 2.3.1 13 2.3.2 14 2.3.3 15 2.4 15 16 3.1 16 3.2 16 3.2.1 17 3.2.2 17 3.2.3 17 3.3 17 3.3.1 17 3.3.2 18 4
4.1 19 4.1.1 19 4.1.2 22 4.1.3 23 4.2 27 4.2.1 ogistic 27 4.2.2 Logistic 28 32 5.1 32 5.2 33 5.3 34 35 5
3-1 4-1 4-2 4-3 4-4 4-5 4-6 4-7 4-8 4-9 72 t- 72 72 72 72 72 72 72 4-10 72 4-11 72 4-12 72 4-13 4-14 Logistic 4-15 Logistic 4-16 4-17 6
1-1 3-1 7
1.1 2002 6,600,872 88 1995 42.05%( 2004) 72 72 1.2 72 72 1. 72 2. 72 8
1.3 1-1 1-1 1.4 1. 72 72 : = 72 2. 72 1.5 1775 130 9 9
2.1 (2005) 1. 2. 脇 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 10
1994 ( 2006) 1. 2. 24 3. 4. 5. 2.2 (2004) 1. 2. 11
( 2006) (Taiwan Quality Indicator Project, TQIP) ( 2004) 1. (1) 72 (2) 48 (3) 24 (4) 72 (5) 48 (6) 24 2. 3. X 4. X 5. X 6. 12
2.3 2004 1. 2. 3. 4. 5. 2.3.1 (1999) 0-4 65 45-64 (2000) (50.76%) (2002) 39 19 (48.7%) (2003) 13
(p<0.05) 2.3.2 62.1 14.2 23.7 (Hung, Chew, Kong, Hsiao&Liaw, 2004) 2000 (2003) Lerman Kobernick 48-72 32.5% Keith 7.8% ( 2006) ( 1999) (2004) (2002) Martin ( 2003) 14
2.3.3 Hung(2003) 62.1% (2004) 2000 (2000) (2004) 2003 (2000) 88.88% 7.64% 0.87% 2.4 3-1 V V V V V V V V V ICD9 V V V V V V V V V V V 15
3.1 3-l 1. 2. 3. 1. 3-1 3.2 16
ICD 3.2.1 1. 2. 3. 4. 5. 3.2.2 1. ICD9 ICD-9-CM 2. 3. 4. 3.2.3 1. 2. 3. 3.3 3.3.1 2008 9 1 9 30 7286 72 289 ICD 17
3.3.2 EXCEL SPSS 1. (Frequency Table) (Cross-tabulation) (count) (relative percentage) 2. Pearson p<0.05 3. Logistic Regression( ) Logistic Regression Logistic 18
4.1 (2008 9 1 9 30 7286 ) 4.1.1 1. 4-1 (4.2%) (3.7%) Pearson 4-1 α = 0.05 Pearsonχ 2 p 0.28 0.05 4-1 72 N 7286 p 4035 169 4.2% 3251 120 3.7% 0.280 2. t- 4-2 33.09 ( 26.933 ) 39.14 ( 29.993 ) α = 0.05 t- (p-value = 0.001) 19
4-2 t- N 7286 p 289 6997 33.09 39.14 26.933 29.993 0.001 3. 10 11-20 21-30 31-40 41-50 50 4-3 10 (3.3%) 11-20 (0.4%) 21-30 (0.2) 31-40 (0.1%) 50 (0.1%) 41-50 (0%) 7184 102 Pearson 4-3 α = 0.05 Pearsonχ 2 p 0.099 0.05 4-3 72 N 7184 p 10 5641 238 3.3% 11-20 819 26 0.4% 21-30 320 17 0.2% 31-40 178 7 0.1% 41-50 24 0 0% 50 202 2 0.1% 0.099 4. 20
4-4 (5.4%) (4.4%) (3.4%) (2.3%) (2.1%) 7056 230 Pearson 4-4 α = 0.05 Pearsonχ 2 p 0.006 0.05 4-4 72 N 7056 p 1068 25 2.3% 2943 130 4.4% 1801 61 3.4% 1182 64 5.4% 48 1 2.1% 11 0 0% 3 0 0% 0.006 5. 1 2 3 4 4-5 3 (4.3%) 2 (4.0%) 1 (2.9%) 4 (0.0%) Pearson 4-5 α = 0.05 Pearsonχ 2 p 0.054 0.05 21
4-5 72 N 7286 p 1 867 25 2.9% 2 2329 94 4.0% 3 3992 170 4.3% 4 98 0 0% 0.054 4.1.2 1. 4-6 (9.1%) (4.0%) (3.8%) Pearson 4-6 α = 0.05 Pearsonχ 2 p 0.659 0.05 4-6 72 N 7286 p 5917 236 4.0% 11 1 9.1% 1358 52 3.8% 0.659 2. 4-7 22
(5.0%) (3.9%) (3.5%)7178 108 Pearson 4-7 α = 0.05 Pearsonχ 2 p 0.053 0.05 4-7 72 N 7178 p 2512 87 3.5% 3133 122 3.9% 1533 80 5.0% 0.053 3. 4-8 (0.8%) (4.1%) Pearson 4-8 α = 0.05 Pearsonχ 2 p 0.008 0.05 4-8 72 N 7286 p 257 2 0.8% 7029 287 4.1% 0.008 4.1.3 1. 23
4-9 (100%) (7.7%) (5.8%) (3.8%) (2.1%) (1.2%) (0.4%) Pearson 4-9 α = 0.05 Pearsonχ 2 p 0.001 0.05 4-9 72 N 7286 p 3 3 100% 820 17 2.1% 85 1 1.2% 13 1 7.7% 255 1 0.4% 4484 171 3.8% 1626 95 5.8% 0.001 2. 4-10 (52.2%) (3.8%) (0.4%) (0.1%) (0.0%) (0.0%)7285 1 Pearson 4-10 α = 0.05 Pearsonχ 2 p 0.001 0.05 24
4-10 72 N 7285 p 3807 3 0.1% 1712 65 3.8% 414 216 52.2% 1312 5 0.4% 6 0 0% 34 0 0% 0.001 3. 4-11 (3.7%) (4.2%) Pearson 4-11 α = 0.05 Pearsonχ 2 p 0.361 0.05 4-11 72 N 7286 p 3469 130 3.7% 3817 159 4.2% 0.361 4. 4-12 (4.9%) (3.9%) Pearson 4-12 α = 0.05 Pearsonχ 2 p 0.219 0.05 25
4-12 72 N 7286 p 613 30 4.9% 6673 259 3.9% 0.219 26
4.2 4.2.1 logistic 4.1 (Pearson Chi-square) ( ) ( ) (,,,,, ) ( ) ( ) 4-13 4-13 N 7286 867 11.9% 2329 32.0% 3992 54.8% 98 1.3%,, 19 0.3%,,, 1157 15.9% 4484 61.5% 1626 22.3% 3807 52.3% 1712 23.5% 1312 18.0% 455 6.2% 27
4-13 N 7286 1068 1182 5036 14.7% 16.2% 69.1% 257 7029 3.5% 96.5% 4.2.2 Logistic Logistic (Forward Stepwise) (Backward Stepwise) 1. 2. 3. 4. 5. 4-14 Logistic =1 =0,, 28
4-15 4-15 Logistic Ward P- Level 4.214 0.916 21.144 0.001-0.019 0.004 18.832 0.001 0.981-1.424 0.768 3.433 0.064 0.241-7.654 0.602 161.644 0.001 0.000-3.299 0.168 384.905 0.001 0.037-5.367 0.462 135.071 0.001 0.005 0.182 0.278 0.430 0.512 1.200 0.763 0.271 7.945 0.005 2.145-13.278 4034.418 0.000 0.997 0.000 1. -4.191 0.927 20.439 0.001 0.015-3.900 0.897 18.882 0.001 0.020-3.907 0.909 18.479 0.001 0.020-0.019 2. -1.424 0.241 0.241 3. - 29
30-7.654 - -.001 0 4. - -3.299 - - 0.037-0.037 5. - -5.367 - - - 0.005-0.005 6. - 0.182 - - 1.200-1.200 7. - 0.763 - - 2.145-2.145 8. - -13.278 - - 0.000 0 9. -,,, -4.191 -,,, -,,, 0.015 -,,, 0.015 10. - -3.900 - -,,, 0.020 -,,, 0.020 11. - -3.907 - -,,, 0.020 -,,,
0.020 1.2 2.145 4-16 4-17 4-16 (%) 6997 0 100 289 0 0 96 4-17 (%) 6937 59 99.2 129 160 55.4 97.4 6,996 6,937 99.2% 289 160 55.4% 97.4% 96% 31
5.1 1. (1) (2) (3) (4) (5) 2. (1) (2) (3) 257 195 75.9 62 24.1 3. (1) (2) (3) (4) 4. 32
,,, 5.2 33
5.3 1. 2. 34
1 2004 2 3 84029441 1995 4-2000 5 72 105-110 2002 6 2004 7-2003 8 2006 9 1999 10 306-313 2004 11 2000 12 2004 13 2000 14 93-98 2003 35
1 CP Ng,CH Chung, 2003 An analysis of unscheduled return visits to the accident and emergencydepartment of a general public hospital, Hong Kong Journal of Emergency Medicine, 10 3 2 Hung SC, Chew G, Kong CT, et al, 2004 Unplanned emergency department revisits within 72 hours, Journal of Taiwan emerg Med, 6, 230-237 3 Lerman B, Kobernick MS, Return visits to the emergency department, Journal of Emerge Med, 5, 359-362, 1987 4 Keith, MD Bocka JJ, Kobernick MS, et al, 1989 Emergency department revisits, Ann Emerg Med, 18, 964-968 5 Martin-Gill, C. Reiser, R.C. 2004 Risk Factors for 72-Hour Admission to the ED, American Journal of Emergency Medicine, 22 6, 448-453 36