請用此 Handle URI 來引用此文件:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72382
完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 鄭守夏(Shou-Hsia Cheng) | |
dc.contributor.author | Yen-Hua Chen | en |
dc.contributor.author | 陳彥華 | zh_TW |
dc.date.accessioned | 2021-06-17T06:39:02Z | - |
dc.date.available | 2025-10-19 | |
dc.date.copyright | 2021-02-23 | |
dc.date.issued | 2020 | |
dc.date.submitted | 2020-09-24 | |
dc.identifier.citation | Ben-jeng, W. (2014). 銀髮族醫療照護機構之流程再造. 福祉科技與服務管理學刊, 2(2). 中央健康保險局.(2019).全民健康保險家庭醫師整合性照護計畫. 中央健康保險署.(2013).全民健康保險論人計酬試辦計畫. 中央健康保險署.(2019).醫院以病人為中心門診整合照護計畫 中國民國內政部統計處.(2019).人口最新統計指標. 尹祚芊, 張念慈, 陳俞琪, 巫菲翎. (2000). 以病患結果為考量的照護模式-整合式健康照護系統. 護理雜誌, 47(2), 33-41. 余清祥, 王信忠, 許筱翎. (2019). 從全民健保研究資料庫評估高齡人口的醫療利用. 人口學刊, (58), 89-120. 林怡潔,陳啟禎,江宜珍, 鄭守夏.病患觀點之門診照護連續性與照護協調性的測量工具:臺灣版問卷發展與信效度分析.(2020)測驗學刊,67(1),1-30. 林詠蓉,周天給, 林恆慶.(2006).參與“家庭醫師整合性照護試辦計畫”民眾對計畫實施成效之觀感.台灣家庭醫學雜誌,16(4),260-273. 邱啟潤. (2015). 以行動研究建立高齡家庭照顧者之友善性社區照顧服務模式. 福祉科技與服務管理學刊, 3(1). 徐婕、李玉春(2017)。「家庭醫師整合性照護計畫」對民眾越級就醫之影響。台灣公共衛生雜誌,36(2),133-147。 徐嘉婕. (2017). 全民健康保險家庭醫師整合性照護計畫與照護連續性對照護結果之影響. 國家衛生研究院(2018)。醫療體系在高齡化社會的因應策略 張炳華, 張正權, 吳家津, 林川雄, 馮兆康. (2016). 從民眾角度看臺灣地區基層醫療體系之照護品質與其滿意度分析. 管理實務與理論研究, 10(2), 53-70. 張苙雲. (1998). [逛醫師] 的邏輯: 求醫歷程的分析. 臺灣社會學刊, (21), 59-87. 張婷, 郭年真. (2017). 初級照護品質與可避免急診之探討. 台灣公共衛生雜誌, 36(5), 473-486. 梁亞文,陳文意, 張曉鳳.(2016).照護連續性對高齡者急診與非緊急急診之影響探討.台灣公共衛生雜誌,35(2),152-163. 許佑任, 徐富坑, 李顯章, 陳端容, 林恆慶. (2006). 基層醫師對 [家庭醫師整合性照護試辦計畫] 成效評估. 台灣家庭醫學雜誌, 16(1), 13-26. 陳亮宇, 陳亮恭. (2016). 以人為本的整合居家醫療照護模式. 臨床醫學月刊, 78(6), 311-319. 陳亮恭. (2015). 高齡醫療服務的發展-由片斷走向整合. 護理雜誌, 62(5), 23-29. 陳俊宇.(2010).台灣中老年健康行為與可避免住院之相關因素探討.長榮大學醫務管理學研究所未出版碩士論文,1-90. 陳啟禎, 鄭守夏.(2013a).照護連續性之文獻回顧.臺灣公共衛生雜誌,32,116-128. 陳啟禎,陳麗光, 鄭守夏.(2017).照護連續性議題的省思與未來發展方向.臺灣公共衛生雜誌,36,324-336. 陳凱莉, 陳清惠. (2014). 台灣老人醫療自主權的省思. 護理雜誌, 61(5), 26-32. 陳綾穗, 郭彥宏, 陳惠貞. (2018). 運用 Andersen 醫療服務行為模式探討醫療資源豐富程度對跨區醫療利用行為之影響. 南臺灣醫學雜誌, 14(2), 72-81. 黃郁清,支伯生, 鄭守夏.(2010).照護連續性與醫療利用之相關性探討.台灣公共衛生雜誌,29(1),46-53. 臺北市政府衛生局(2009)。臺北衛生足跡40年 臺北市政府衛生局(2018)。107年度臺北市十二區健康服務中心社區個案管理成效服務計畫。 衛生福利部(2013)。開創全民均等健康照護計畫 衛生福利部國民健康署(2015)。中老年身心社會生活狀況長期追蹤調查成果報告。 衛生福利部國民健康署.(2018).民國一百零四年中老年身心社會生活狀況長期追蹤調查成果報告.Retrievedfrom衛生福利部國民健康署: 鄧雅蓮, 鄭秀容. (2015). 門診整合照護於多重慢性病人效益之統合分析與臨床應用. 榮總護理, 32(3), 295-303. 鄭守夏, 陳啓禎.(2014).健保制度下的醫療體系.台灣醫學,18(1),74-84. 謝佩倫, 陳靜敏. (2016). 護理人員引領社區老人慢性病照護管理模式—系統性文獻回顧探討. 護理雜誌, 63(4), 35-49. 蘇本華, 蔡雅芳, 張華蘋, 梁亞文. (2017). 照護連續性對住院醫療利用之影響. 健康科技期刊, 4(1), 44-64. 翁慧卿. (2006) 大高雄地區醫學中心門診病人預防保健行為利用概況與相關因素之研究.福爾摩莎醫務管理雜誌,2(1), 19-27. Almeida, P. F. D., Santos, A. M. D. (2016). Primary Health Care: care coordinator in regionalized networks?. Revista de saude publica,50, 80. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter?. Journal of health and social behavior, 1-10. Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical care, 46(7), 647-653. Annis, A. M., Harris, M., Robinson, C. H., Krein, S. L. (2016). Do patient-centered medical home access and care coordination measures reflect the contribution of all team members? A systematic review. Journal of nursing care quality, 31(4), 357-366. Babitsch, B., Gohl, D., Von Lengerke, T. (2012). Re-revisiting Andersen’s Behavioral Model of Health Services Use: a systematic review of studies from 1998–2011. GMS Psycho-Social-Medicine, 9. Bellon, J. E., Bilderback, A., Ahuja‐Yende, N. S., Wilson, C., Altieri Dunn, S. C., Brodine, D., Boninger, M. L. (2019). University of Pittsburgh Medical Center home transitions multidisciplinary care coordination reduces readmissions for older adults. Journal of the American Geriatrics Society, 67(1), 156-163. Brocklehurst, J. C., Dillane, J. B. (1966). Studies of the female bladder in old age. Gerontologia Clinica, 8(5), 285-305. Chen, L. M., Ayanian, J. Z. (2014). Care continuity and care coordination: what counts?. JAMA internal medicine, 174(5), 749-750. Devine, E. C., Cook, T. D. (1983). Effects of psycho-educational interventions on length of hospital stay: a meta-analytic review of 34 studies. In Evaluation studies review annual. Devine, E. C., Cook, T. D. (1986). Clinical and cost‐saving effects of psychoeducational interventions with surgical patients: A meta‐analysis. Research in Nursing Health, 9(2), 89-105. Fletcher, R. H., O'Malley, M. S., Fletcher, S. W., Earp, J. A. L., Alexander, J. P. (1984). Measuring the continuity and coordination of medical care in a system involving multiple providers. Medical care, 403-411. Flocke, S. A. (1997). Measuring Attributes of Primary Care: Development. J. Fam Pract, 4564, 74. Glouberman, S., Mintzberg, H. (2001). Managing the care of health and the cure of disease—Part I: Differentiation. Health care management review, 26(1), 56-69. Glouberman, S., Mintzberg, H. (2001). Managing the care of health and the cure of disease—Part II: Integration. Health care management review, 26(1), 70-84. Haggerty, J. L., Pineault, R., Beaulieu, M. D., Brunelle, Y., Gauthier, J., Goulet, F., Rodrigue, J. (2008). Practice features associated with patient-reported accessibility, continuity, and coordination of primary health care. The Annals of Family Medicine, 6(2), 116-123. Ham, D. (2020). Continuity of care in primary care and association with survival in older people. Hofmarcher, M. M., Oxley, H., Rusticelli, E. (2007). Improved health system performance through better care coordination. Kodner, D. L., Spreeuwenberg, C. (2002). Integrated care: meaning, logic, applications, and implications–a discussion paper. International journal of integrated care, 2. Kuo, T., Torres-Gil, F. M. (2001). Factors affecting utilization of health services and home-and community-based care programs by older Taiwanese in the United States.Research on Aging,23(1), 14-36. Leichsenring, K. (2004). Developing integrated health and social care services for older persons in Europe. International journal of integrated care, 4. Liaw, W., Jetty, A., Petterson, S., Bazemore, A., Green, L. (2018). Trends in the types of usual sources of care: a shift from people to places or nothing at all. Health services research, 53(4), 2346-2367. Liss, D. T., Chubak, J., Anderson, M. L., Saunders, K. W., Tuzzio, L., Reid, R. J. (2011). Patient-reported care coordination: associations with primary care continuity and specialty care use. The Annals of Family Medicine, 9(4), 323-329. Maarsingh, O. R., Henry, Y., van de Ven, P. M., Deeg, D. J. (2016). Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. British Journal of General Practice, 66(649), e531-e539. Matulich, E., Finn, D. W. (1989). Determinant criteria in patient satisfaction surveys. The Journal of Ambulatory Care Management, 12(3), 45-51. McDonald, K. M., Schultz, E., Albin, L., Pineda, N., Lonhart, J., Sundaram, V., ... Davies, S. (2014). Care Coordination Atlas Version 4 (AHRQ Publication No. 14-0037-EF). Rockville, MD: Agency for Healthcare Research and Quality. Ouwens, M., Wollersheim, H. U. B., Hermens, R., Hulscher, M., Grol, R. (2005). Integrated care programmes for chronically ill patients: a review of systematic reviews. International journal for quality in health care, 17(2), 141-146. Patrick, M. B. (1995). An Assessment of Patient Satisfaction at Kimbrough Army Community Hospital, Fort George G. Meade, Maryland. ACADEMY OF HEALTH SCIENCES (ARMY) FORT SAM HOUSTON TX HEALTH CARE ADMINISTRATI ON. Rogers, J., Curtis, P. (1980). The achievement of continuity of care in a primary care training program. American Journal of Public Health, 70(5), 528-530. Rogers, J., Curtis, P. (1980). The concept and measurement of continuity in primary care. American journal of public health, 70(2), 122-127. Schultz, E. M., McDonald, K. M. (2014). What is care coordination?. International Journal of Care Coordination, 17(1-2), 5-24. Schultz, E. M., Pineda, N., Lonhart, J., Davies, S. M., McDonald, K. M. (2013). A systematic review of the care coordination measurement landscape. BMC health services research, 13(1), 119. Turchi, R. M., Berhane, Z., Bethell, C., Pomponio, A., Antonelli, R., Minkovitz, C. S. (2009). Care coordination for CSHCN: associations with family-provider relations and family/child outcomes. Pediatrics, 124(Supplement 4), S428-S434. Uijen, A. A., Schers, H. J., Schellevis, F. G., van den Bosch, W. J. (2012). How unique is continuity of care? A review of continuity and related concepts. Family practice, 29(3), 264-271. Wang, M. C., Mosen, D., Shuster, E., Bellows, J. (2015). Association of patient-reported care coordination with patient satisfaction. The Journal of ambulatory care management, 38(1), 69-76. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/72382 | - |
dc.description.abstract | 研究背景:台灣民眾在全民健保制度下享有高度的就醫自由,而醫療體系的專科化發展,也造成門診醫療的片段化。衛生福利部與地方政府推行多年整合照護計畫,但無明確數據顯示計畫成效是否明確,亦無相關研究探討民眾對於照護協調的重要性與需求。
研究目的:以病患觀點探討門診照護協調性照護的重要性,以及其接受片段式醫療的經驗,並進一步探討民眾對於由專人協助整合其醫療照護之需求與相關影響因素。 研究方法:本研究在臺北市信義區健康服務中心進行,由單位指導老師指導實習內容,將以學生在健康服務中心參與社區民眾健康服務的經驗為基礎,分析「病人就醫經驗調查」之問卷資料,探討病患觀點對於照護協調之重要性與需求,研究對象為過去12個月內曾有西醫就醫經驗之60歲以上民眾(N=2144)。 研究結果: 民眾對照護協調性的重視程度高(平均17.01分,滿分20),曾接受過片段式照護的有37.79%,需要醫療人員協助整合醫療服務的有43.81%。多元線性迴歸與多元羅吉斯迴歸分析發現,年齡(70-79歲估計值=-0.46, P=0.0421)、80歲以上估計值=-1.31,P<0.0001)、家庭所得5萬以上(估計值=1.18,P=0.0306)與病患對於照護協調重要性有顯著相關,而需要醫療人員協助整合其照護服務與否,在個人因素中年齡(70-79歲Odds Ratio OR=0.67、P=0.0017)、教育程度(大專以上OR=1.50、P=0.0126)達統計上顯著相關。 結論:高齡長者較不重視照護協調性,而高所得者較需要醫護人員協助整合醫療照護,公衛護理師於社區服務時,可針對這些特質的民眾加強相關服務的提供,以減少片斷式醫療服務的發生。 | zh_TW |
dc.description.abstract | Background:Taiwanese people enjoy a high degree of freedom of choice when seeing a doctor. In the highly specialized health care system, fragmentation of care exists in ambulatory care settings. The Ministry of Health and Welfare and local governments have implemented integrated care plans for many years, yet, no evidence has shown the effectiveness of such plans. In addition, there has been no relevant research examining the perceived importance and needs for care coordination from patient perspectives.
Objectives:This study aims to explore patient perceived importance of care coordination, their experience in receiving fragmented care, and the needs of a care coordinator as well as associated factors. Methods:This research project was conducted at the Health Service Center in Xinyi District, Taipei City. Based on the students’ participation in the public services at the Health Service Center, the students were instructed to analyze the data of 'Patient Health Care Experience Survey,” which inquired the patients’ experience and opinion about care coordination. The subjects included in the survey were those who reached 60 years old or above and had at least one visit to the doctor in the past 12 months (N=2144). Results:The average score of the perceived importance of care coordination was 17.01 out of 20. About 37.79% of the respondents experienced fragmented care, and 43.81% of the respondents expressed the need for a care coordinator. Results from the multiple linear regression and multiple logistic regression respectively showed that, older people had lower scores of importance of care coordination (70-79 years old β= -0.46, p=0.0421 ; 80 years old or older β= -1.31, p<0.0001) and people with higher income showed higher scores (β=0.76, p=0.0184). Concerning the need for a care coordination, older people expressed lower need (70-79 years old OR=0.67, p=0.0017) yet people with higher education (college degree or above OR=1.50, p=0.0126) showed higher need for a care coordinator. Conclusion:This study showed that older people considered that care coordination to be less important and lower need for care coordination. On the other hand, people with higher income and higher education showed higher perceived importance and higher need for care coordination services. When serving in the community, public health nurses should pay attention to these personal characteristics and increase the needed services to reduce fragmented ambulatory care. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T06:39:02Z (GMT). No. of bitstreams: 1 U0001-1908202000555000.pdf: 2411271 bytes, checksum: 464ea4f51a2ff4ca07e1dcb843aa5917 (MD5) Previous issue date: 2020 | en |
dc.description.tableofcontents | 目 錄 致謝 I 中文摘要 II ABSTRACT IV 目 錄 VI 第一章、 緒論 1 第一節、 研究背景與動機 1 第二節、 研究目的 2 第三節、 實習單位簡介 2 第二章、 文獻探討 4 第一節、 以ANDERSEN模型探討醫療利用相關研究 4 第二節、 照護協調性 6 第三節、 臺灣醫療/民眾就醫現況 9 第四節、 國內外整合照護計畫 11 第三章、 研究方法 14 第一節、 研究設計 14 第二節、 研究假說 14 第三節、 研究架構 15 第四節、 資料來源與研究對象 16 第五節、 研究變項與操作型定義 17 第六節、 資料處理與分析方法 24 第四章、 研究結果 26 第一節、 描述性統計結果 26 第二節、 雙變項分析結果 30 第三節、 多變項分析結果 36 第五章、 研究討論 41 第一節、 研究方法討論 41 第二節、 研究結果討論 43 第三節、 研究限制 46 第六章、 結論與建議 47 第一節、 政策建議 47 第二節、 未來研究方向 48 附錄1 從照護連續性邁向協調性照護:全民健保雲端藥歷系統的影響評估面訪問卷 54 附錄2 過去台灣學界處理鄉鎮市區發展之分類 75 附錄表3- 1 病患觀點對於照護協調性的重視程度分數平均分配 78 附錄表3- 2 病患觀點對於照護協調性的重視程度多元線性迴歸(敏感度分析) 79 附錄表3- 3 病患觀點對於是否曾受過片段式醫療多元羅吉斯迴歸(敏感度分析) 80 附錄表3- 4 病患觀點對於是否需要一位醫療人員協助整合醫療服務多元羅吉斯迴歸(敏感度分析) 81 表目錄 表3- 1 病患就醫經驗與選擇操作型定義 22 表3- 2 環境因素操作型定義 23 表3- 3:個人因素操作型定義 24 表3- 4:能力因素操作型定義 26 表3- 5:需要因素操作型定義 27 表4- 1 描述性統計分析 32 表4- 2 描述性統計分析-病患就醫經驗與選擇 33 表4- 3對於照護協調性之重要性與研究變項特性之雙變項分析 36 表4- 4是否曾經接受過片段式醫療與研究對項特性之雙變項分析 37 表4- 5是否需要一位醫療人員協調整合所需各種照護與研究對之雙變項分析 38 表4- 6病患觀點對於照護協調性的重視程度多元線性回歸 41 表4- 7病患觀點是否接受過片斷式醫療多元羅吉斯迴歸分析 42 表4- 8病患觀點是否需要照護協調者多元羅吉斯迴歸分析 43 圖目錄 圖2- 1 ANDERSEN健康行為模型 9 圖2- 2 照護協調性環狀示意圖 12 圖3- 1 研究架構 20 | |
dc.language.iso | zh-TW | |
dc.title | 從病患觀點探討照護協調之重要性與需求 | zh_TW |
dc.title | Patient Perceived Importance and Need for Care Coordination | en |
dc.type | Thesis | |
dc.date.schoolyear | 109-1 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 周真貞(Chen-Chen Chou),徐慧娟(Hui-Chuan Hsu) | |
dc.subject.keyword | 病人觀點,照護協調性,片段式醫療,健康行為模式, | zh_TW |
dc.subject.keyword | Patient perspectives,Care coordination,Fragmentation of care,Health behavior model, | en |
dc.relation.page | 81 | |
dc.identifier.doi | 10.6342/NTU202004052 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2020-09-24 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 公共衛生碩士學位學程 | zh_TW |
顯示於系所單位: | 公共衛生碩士學位學程 |
文件中的檔案:
檔案 | 大小 | 格式 | |
---|---|---|---|
U0001-1908202000555000.pdf 目前未授權公開取用 | 2.35 MB | Adobe PDF |
系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。