基本素養 Basic Literacy

人文素養
具備尊重生命及服務社會的團隊精神。
Humanity accomplishment
To form a team with a mind of respecting lives and serving societies
公民素養
具備多元文化認知及主動參與公共事務的精神。
Citizen accomplishment
With a spirit of recognition of multi-culture and active participation of public affairs
社會關懷
具備社會參與、關懷弱勢之精神,並具有健康不平等的敏感度和高度的社會關懷。
Social concern
With a spirit of social participation, care for socially deprived, and with a sense of social inequity and care
國際視野
具備深耕本土、放眼國際的全球衛生之視野。
International perspectives
With a vision of global health involving local insight and international perspective

核心能力 Competence

專業與跨領域能力
有能力運用流行病學證據與社會科學概念,進行跨領域的衛生政策與計畫分析。
Professional and cross-cutting capacity
With capability of using epidemiological evidence and social science concept in making multi-discipline analysis of health policy and planning
思考與判斷能力
有能力運用跨領域的視野檢視公共衛生政策議題與決策過程。
Ability of thinking and judgment
With capability of using multi-discipline vision in examining the public health issues and the process of decision making
良好的溝通能力
有能力將公共衛生專業知識運用於疾病預防與健康照護之實務工作。
Good communication skills
With capability of applying public health professional knowledge to disease prevention and health care practical work
創新與領導能力
有能力發掘健康相關之公共衛生議題,並具獨立探索解決問題的能力。
Innovation and leadership ability
With capability of independently exploring public health issues, and solving the problems

課程概述 Course Description

廿一世紀最重要的產業之一為醫療照護與保健事業,雖然可以從預防(如健康食品)、診治、復健及另類(包括中醫藥)等多方面來發展,但是它的瓶頸在於必須有適當的評估方法來証實其效果方能獲得人民的信任,也才能有國內外穩定的市場。健康服務效果的計量,必須同時考量生活品質的改變,及壽命的延長。我們發展新的研究方法,整合了一個跨領域的大團隊,從統計、臨床醫學、公共衛生、心理計量、經濟學、護理、職能與物理治療來作健康計量。一方面,在國際上領先寫出計量公式,並引入世界衛生組織生活品質問卷及歐盟的EQ-5D作評估工具;另一方面也把此方法實際用於對各種常見疾病進行診療效果評估:包括急性心肌梗塞、中風、各種癌症、愛滋病、癲癇、髖關節傷害、脊髓損傷、糖尿病、慢性阻塞性肺部疾病、地震、中草藥治療更年期與退化性膝關節炎等主題,使此法成為健康產業產品有效性與安全性評估之基本工具。藉著這些先進的評量工具,期望能提升醫療照護品質、促進全民健保的永續經營,同時又把台灣的健康產業各種產品帶入國際市場。全民健保自1995 年開始實施以後解決了就醫機會公平性的問題,但也使健保財務逐漸陷入困境。欲解決這樣的狀況,需一方面推動公共衛生疾病預防的工作使病人減少,另一方面需要提高健保給付的成本效果(cost-effectiveness),使健保的給付在最低成本下,達到人民健康最大量的效益。這是一個發展健康產業科技整合的新領域。需從經濟學預期效用理論(expected utility theory) 及心理計量學理(psychometric theory) 切入,來評估健康照護之效果。我們整合經濟評估、以研究各種醫療服務之成本效果,來算出一個「QALY」(quality-adjusted life year簡稱健康人年)。我們國家健保可以給付的成本價大概是多少,以便促進各種健保給付之醫療服務更合乎成本效果且能夠永續經營,同時也全面進行各種預防、診斷、治療、復健及另類醫療之效果評估,把這些方法與工具逐步推廣到臨床與保健產業上全面使用。 The quantification of global burden of diseases lead us to consider the impact of diseases from societal perspective. They have developed methods to approximately quantify years of life loss (YLL) and years living with disability (YLD) and quickly summarized the global burden for different diseases, which have drawn WHO’s attention to allocate more resources on preventing major diseases, especially for people living in the developing world. Their quantification methods of health impacts, however, have not considered quality of life (QOL) and financial costs for lack of data in most countries. Beginning in 2017, the Second Panel of Cost-effectiveness in Health and Medicine recommend to include a reference case of societal perspective for evaluation of consequences of different healthcare technology. They propose an impact inventory template, which includes not only impacts related to formal and informal healthcare sectors but also those of non-healthcare sectors. Typical impacts of non-healthcare sectors contain losses resulted from changes of productivity, consumption, social services, legal/criminal justices, education, housing, production of toxic waste or pollution by intervention, etc. These newly added demands cover the issue more comprehensively and health policy decision makers would be able to compare preventive, diagnostic & therapeutic, rehabilitative, and alternative medicines on the same metric. But it also produce big challenges to people on this field. My team have developed methods to quantify lifetime survival functions and compare them with age- and sex-matched referents simulated from national life tables to estimate LE (life expectancy) and EYLL (expected life expectancy) for different diseases. Then, the survival function can be multiplied with a second functions of the aforementioned items (QOL, costs, productivity, etc.), and integrate both to estimate quality-adjusted life expectancy, loss-of-QALE, lifetime costs, lifetime demand of care services, etc. With QOL multiplied with survival function, we are able to quantify the health benefits by quality-adjusted life year (QALY) unit for assessment of cost-effectiveness. Moreover, beginning in 2009, the FDA (Food and Drug Administration) of the U.S.A. has adopted PRO (patients reported outcome) as a primary outcome in evaluating health technology, and we shall try to measure QOL and PRO based on psychometry. Such measurements can also be applied in quantification of their dynamic changes along the course of diagnosis and treatment after repeated measurements and are very useful for long-term outcome evaluation. Choosing an appropriate measurement tool and analyzing these data through mixed effects models also provide us an efficient way for control of potential confounding on conducting cost-effectiveness evaluation.
The quantification of global burden of diseases lead us to consider the impact of diseases from societal perspective. They have developed methods to approximately quantify years of life loss (YLL) and years living with disability (YLD) and quickly summarized the global burden for different diseases, which have drawn WHO's attention to allocate more resources on preventing major diseases, especially for people living in the developing world. Their quantification methods of health impacts, however, have not considered quality of life (QOL) and financial costs for lack of data in most countries. Beginning in 2017, the Second Panel of Cost-effectiveness in Health and Medicine recommend to include a reference case of societal perspective for evaluation of consequences of different healthcare technology. They propose an impact inventory template, which includes not only impacts related to formal and informal healthcare sectors but also those of non-healthcare sectors. Typical impacts of non-healthcare sectors contain losses resulted from changes of productivity, consumption, social services, legal/criminal justices, education, housing, production of toxic waste or pollution by intervention, etc. These newly added demands cover the issue more comprehensively and health policy decision makers would be able to compare preventive, diagnostic & therapeutic, rehabilitative, and alternative medicines on the same metric. But it also produce big challenges to people on this field. My team have developed methods to quantify lifetime survival functions and compare them with age- and sex-matched referents simulated from national life tables to estimate LE (life expectancy) and EYLL (expected life expectancy) for different diseases. Then, the survival function can be multiplied with a second functions of the aforementioned items (QOL, costs, productivity, etc.), and integrate both to estimate quality-adjusted life expectancy, loss-of-QALE, lifetime costs, lifetime demand of care services, etc. With QOL multiplied with survival function, we are able to quantify the health benefits by quality-adjusted life year (QALY) unit for assessment of cost-effectiveness. Moreover, beginning in 2009, the FDA (Food and Drug Administration) of the U.S.A. has adopted PRO (patients reported outcome) as a primary outcome in evaluating health technology, and we shall try to measure QOL and PRO based on psychometry. Such measurements can also be applied in quantification of their dynamic changes along the course of diagnosis and treatment after repeated measurements and are very useful for long-term outcome evaluation. Choosing an appropriate measurement tool and analyzing these data through mixed effects models also provide us an efficient way for control of potential confounding on conducting cost-effectiveness evaluation.

課程學習目標 Course Objectives

  • Select a valid and reliable measurement tool for his/her study of QOL/PRO.
  • Conduct subject recruitment based on appropriate study design
  • Perform cross-sectional and/or repeated measurements with the QOL instruments
  • Design and analyze the QOL/PRO data with statistical model & control confounding
  • Make appropriate inference based on all the above actions and data analysis
  • Assess cost-effectiveness of healthcare technology, including prevention
  • Critically evaluate the validity and generalizability of a QOL/PRO study
  • 課程進度 Progress Description

    進度說明 Progress Description
    12/24 Integration of epidemiology and outcome research for health policy decision and cost-effectiveness of healthcare technology: Significance of QOL/PRO (Wang JD: No.461, FDAPRO)
    23/3 Develop and translate a quality of life/patient-reported outcome measure (Lin CY: 004, 007, 008, 084, 098, N050)
    33/10 Measuring patients reported outcomes: Development of WHOQOL-Taiwan version as an example (Wang JD: No.186, 462)
    43/17 Using classical test theory to examine quality of life/patient-reported outcome measures (Lin CY: 009, 098, 145)
    53/24 Using confirmatory factor analysis to examine quality of life/patient-reported outcome measures (Lin CY: 004, 007, 084)
    63/31 Using item response theory to examine quality of life/patient-reported outcome measures (Lin CY: 008, 022, 024, 033)
    74/7 Using quality of life/patient-reported outcome measures to answer research questions: examples from cross-sectional design (Lin CY: 029, 138, 147)
    84/14 Using quality of life/patient-reported outcome measures to answer research questions: examples from longitudinal design (Lin CY: 089, 122, 140, N034)
    94/21 Using quality of life/patient-reported outcome measures to answer research questions: examples from combination with objective measures (Lin CY: 002, 046, 079, 105, 108)
    104/28 Using quality of life/patient-reported outcome measures to answer research questions: examples from randomized controlled trials (Lin CY: 037, 042, 076, 110)
    115/5 Using QOL/PRO measures on special and/or disadvantaged populations (Lin CY: 022, 026, 144)
    125/12 Dynamic changes of quality of life: Examples of patients with morbid obesity receiving bariatric surgery and lung cancer patients receiving molecular target therapy (Wang JD: No.321, 327, 460, 478, 482)
    135/19 Estimation of lifetime medical cost, quality-adjusted life expectancy from claimed data under censoring (Wang JD: No. 453, 481)
    145/26 Estimation of health benefits from effective prevention of an illness: Methods and cancer screening as examples (Wang JD: No.470, 431, 409, 414)
    156/2 (1)Example of estimating the utility of a comatose patient.(2)Cost-effectiveness assessment for caring of patients under prolonged mechanical ventilation and its policy implication: (Wang JD: No.308, 374, 346)
    166/9 Integration of survival and functional disability to estimate lifetime duration of living with disability (Wang JD: No. 396, 398)
    176/16 Students’ report/project presentation (Lin CY, Wang JD)
    186/23 Students’ report/project presentation (Lin CY, Wang JD)
     以上每週進度教師可依上課情況做適度調整。The schedule may be subject to change.

    課程是否與永續發展目標相關調查
    Survey of the conntent relevant to SDGs

    本課程與SDGs相關項目如下:
    This course is relevant to these items of SDGs as following:
    • 健康與福祉 (Good health and Well Being)
    • 性別平等 (Gender Equality)
    • 就業與經濟成長 (Decent work and Economic growth)
    • 工業、創新與基礎建設 (Industry Innovation and infrastructure)
    • 減少不平衡 (Reduced Inequalities)
    • 永續城市與社區 (sustainable cities and communities)
    • 和平與正義制度 (Peace justice and strong institutions)
    • 全球夥伴 (partnerships for goals)

    有關課程其他調查 Other Surveys of Courses

    1.本課程是否規劃業界教師參與教學或演講? 否
    Is there any industry specialist invited in this course? How many times? No
    2.本課程是否規劃含校外實習(並非參訪)? 否
    Are there any internships involved in the course? How many hours? No
    3.本課程是否可歸認為學術倫理課程? 是,含學術倫理課程 2 小時
    Is this course recognized as an academic ethics course? In the course how many hours are regarding academic ethics topics? Yes, about 2 hours
    4.本課程是否屬進入社區實踐課程? 否
    Is this course recognized as a Community engagement and Service learning course? Which community will be engaged? No