1,613 research outputs found
Detection of genetically modified soybeans in miso by polymerase chain reaction and nested polymerase chain reaction.
No full textDetection of genetically modified soybeans in Chou-Tou-Fu, Tou-Fu-Ju by means of polymerase chain reaction.
No full textSubstitution of Asp189 residue alters the activity and thermostability of Geobacillus sp NTU 03 lipase
No full textDevelopment and application of a nested polymerase chain reaction method for the detection of genetically modified soybean in Chinese traditional fermented soy food-sufu.
No full textClinical symptoms of TW-1 to TW-36 strain isolates.
No full textClinical symptoms of TW-1 to TW-36 strain isolates.</p
The Comparison of Medical Resources Utilization before and after Intervention of Tw-DRGs: An example of Orthopedics epartment of a Northern Regional Teaching Hospital
No full text前言
全民健康保險自民國84年開辦以來，至民國87年開始每年持續呈現虧損狀態，因此如何達到收支平衡，一直是學者研究的議題。於是全民健康保險署陸續推動各項支付制度，其目的都是為了藉由有效管理監控機制，確保總額支付制度的實施成效，進而降低醫療費用成長。美國於1983年正式採行疾病診斷關聯群支付方式（Diagnosis Related Groups，DRGs），其支付制度也被世界多國相繼採用。因此全民健保署決定於民國99年開始實施Tw-DRGs支付制度，以期能抑制醫療費用之成長。
目的
本研究其主要目的為探討Tw-DRGs實施前後兩年間骨科案例醫療資源耗用之比較。包括住院天數、總住院醫療費用與十七項住院醫療費用細項，同時也檢視申報差額等增減變化情形。希望能藉此了解在支付制度改變下是否會影響醫療資源耗用之情形。
方法
本研究進行地點為北區某區域教學醫院，資料樣本取自民國97年1月1日至民國100年12月31日止之健保住院申報檔資料，將從民國97年1月1日至民國12月31日止，即Tw-DRGs實施前兩年期間，骨科採取「論病例計酬」申報之案件，與從民國99年1月1日至民國100年12月31日止，實施Tw-DRGs後兩年期間，和「論病例計酬」所對應之組別予以選取，再將其醫療資源耗用情形予以分析統計。另再選取在Tw-DRGs實施前後均未納入「論病例計酬」或Tw-DRGs的案例，其ICD-9CM之診斷碼為720至724間，同時有施行脊椎手術案件當作對照組。
結果
在「全股關節置換術(20903)」的個案中，在年齡比較分析中即有明顯差異。
在「股骨幹、股骨頸閉鎖性骨折開放性復位術無主要合併症或併發症（21102）」的個案中，住院天數、診察費、病房費與藥事服務費均有明顯降低，申報差額則有明顯增加。在「肱骨、脛腓骨閉鎖性骨折開放性復位術無主要合併症或併發症（21904）」的個案中，住院天數與血液血漿費均有明顯降低，放射線診療費與申報差額則有有明顯增加。在「橈骨、尺骨閉鎖性骨折開放性復位術無主要合併症或併發症（22404）」的個案中，診察費、檢查費、放射線診療費、治療處置費、麻醉費、特殊材料費、藥費、藥事服務費、總住院醫療費用、申報差額有明顯增加外。在「跗骨、鏣骨、趾骨閉鎖性骨折開放性復位術無主要合併症或併發症（22504）」的個案中，除了放射線診療費有明顯增加外，其餘均無明顯差異。在「腕骨、掌骨、指骨閉鎖性骨折開放性復位術無主要合併症或併發症（22902）」的個案中，除了申報差額有明顯增加外，其餘均無明顯差異。而在Tw-DRGs實施前後均未納入論病例計酬或Tw-DRGs之脊椎手術案件，在實施前後所耗費的醫療資源上，均無明顯差異。
結論
根據研究結果得知，在Tw-DRGs實施前後均未納入論病例計酬或Tw-DRGs之案件，在實施前後的醫療資源耗用均無明顯差異；而在Tw-DRGs實施前屬於論病例計酬支付制度，實施後屬於Tw-DRGs之案件，所產生的醫療資源耗用情形均無明顯異常，若有異常則大部分因住院天數減少所導致之差異，也因此會使申報差額明顯增加。由此可知，透過監控機制，的確可將醫療成本有效降低Introduction
Since National Health Insurance of Taiwan was implemented in 1995, we were always finding the best solution to keep the finance balance. Although the Bureau of National Health Insurance implemented a lot of payment systems which purpose was to decrease the medical expenditures. In 1983, US government implemented the payment system of Diagnosis Related Groups （DRGs） which has been adopted by many countries in the world. So, the Bureau of National Health Insurance decided to implement Tw-DRGs payment system in 2010 to suppress the continuous growth of the medical expenditures.
Purpose
The purpose of this study is to compare the medical resources utilization of orthopedic department before and after intervention of Tw-DRGs. We want to understand whether the medical resource utilization changes after the implementation of Tw-DRGs payment system.
Materials and Methods
A northern regional teaching hospital was selected and the study was held in the orthopedic department. The admission claim data by "case payment" was collected from January 1, 2008 to December 31 2009 and the admission claim data by "Tw-DRGs" was collected from January 1, 2010 to December 31 2011. The medical resource utilization was analyzed including length of stay, medical detailed cost, and the discrepancy between actual medical cost and claim cost. The cases of spinal surgery （ICD-9CM Code: 720 to 724）which were neither in the case payment group nor in the Tw-DRGs group were also collected for control group.
Results
In almost all groups, the discrepancy between actual medical cost and claim cost increased with significant difference. The length of stay decreased with significant difference in two groups. The radiologic cost increased with significant difference in four groups. In the control group, the medical resource utilization was not significantly different before and after the implementation of Tw-DRGs.
Conclusions
The medical resource utilization in the orthopedic department was not significantly different in both groups. But the discrepancy between actual medical cost and claim cost increased in almost all the groups mainly due to decreasing of length of stay. So, the medical expenditure will decrease under the surveillance mechanism.目錄
誌謝 I
中文摘要 III
英文摘要（Abstract） V
目錄 VII
圖目錄 IX
表目錄 X
第一章 緒論 1
第一節 研究動機 1
第二節 研究目的 4
第二章 文獻查證 5
第一節 支付制度 5
第二節 論病例計酬支付制度 9
第三節 疾病診斷關聯群支付制度 11
第四節 各國實施疾病診斷關聯群支付制度 13
第五節 台灣版疾病診斷關聯群（Tw-DRGs） 17
第六節 實施Tw-DRGs對醫院的影響 21
第三章 研究方法 25
第一節 研究架構 25
第二節 研究假說 26
第三節 操作型定義 27
第四節 研究方法 29
第五節 資料處理與分析 30
第六節 倫理考量 31
第四章 研究結果 32
第一節 人口學特性 32
第二節 研究結果 38
第五章 討論 50
第一節 研究結果討論 50
第二節 研究限制 52
第六章 結論與建議 53
第一節 結論 53
第二節 建議 54
中文參考文獻 56
英文參考文獻 58
附錄 人體試驗委員會審核書 5
Relations between chest wall motion and diaphragmatic excursion in healthy adults in supine position.
No full textPhylogenetic tree based on the 56 kDa TSA gene ORF of TW-1 to TW-36.
No full textPhylogenetic tree based on the 56 kDa TSA gene ORF of TW-1 to TW-36.</p
Nadere verfijning DUROSTA-model: Toetsing H/Tw-parameter en aanpassing t.b.v. porositeitsverschillen en strandtransporten
No full textTeneinde het DUROSTA-model verder te verbeteren zijn de effecten modellering nader onderzocht en is de schaalgrootheid H/Tw nader bekeken.TAW/EN
Development of a rotor model for the numerical simulation of helicopter exterior flow-fields
No full textIncludes bibliographical references (leaves 84-85).A numerical methodology is developed to model the effect of a rotor on the surrounding flow-field. The model calculates the time-averaged aerodynamic forces exerted on the air by the fan blades within the blade-swept region, and permits the user to specify blade properties such as cross-sectional profile and orientation at a particular radial and azimuthal location. The calculated forces are included as source terms within the Reynolds-averaged Navier-Stokes equations for an incompressible fluid, which are solved by the commercial CFD solver, FLUENT. The effects of turbulence are incorporated through the use of Launder and Spalding's k-g turbulence model. This method is selected as being the most efficient use of the resources available, giving the economic advantages of a steady simulation, while allowing radial and azimuthal variations of rotor characteristics. In order to validate the accuracy of the numerical model for both aligned and non-aligned inflow conditions, results are compared with experimental data reported for an axial flow fan. Agreement between experimental and numerical results is excellent to good. Fan static pressure rise is closely predicted by the numerical solution, while fan power consumption and fan static efficiency are under and over-predicted respectively. This error may be attributed to frictional losses not accounted for in the numerical model. These include physical rotational instabilities, leading to increased mechanical losses, and tip effects due to the clearance between the fan blade tips and the fan casing. Trends are nevertheless consistently predicted by the numerical model for inflow angles up to 45°, and for the range of blade pitch settings used. The adverse effect of off-axis inflow on the fan static pressure rise is numerically predicted, while fan power consumption is found to remain independent of inflow angle, as had been experimentally observed. The rotor model is finally integrated with the fuselage of the CIRSTEL (Combined Infra-Red Suppression and Tail rotor Elimination) prototype in an analysis of the helicopter exterior flow-field. No experimental data for this configuration was available for validation purposes. However, the model is used in the simulation of several common helicopter flight conditions. Results are presented graphically, and generally indicate good agreement with physically observed phenomena
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