類別:
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/18
2024-03-11T12:33:52Z高齡者臨終意象之探討
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/66301
標題: 高齡者臨終意象之探討; Elder's Image of the End-of-Life
作者: Tzu-Hui Wu; 吳梓卉
摘要: 台灣自1993年邁入高齡化社會,十大死因從早年的傳染性疾病轉變為慢性病及癌症,也因此近年來對於安寧療護、預立醫囑等觀念逐漸興起,期望能夠藉此讓人們在面對人生最後一段旅程能夠更有尊嚴,更希望醫療資源能夠得到最妥善之利用。綜觀台灣目前以臨終規劃、善終為主題之研究,大多針對醫護人員或是末期病患及其家屬進行研究,少見以高齡者為研究對象進行研究。本研究以滾雪球法蒐集受訪者進行質性研究,共訪談了34位受訪者,藉以了解高齡者對臨終意象為何?在他們的想像裡怎麼樣才符合心目中的善終?並了解高齡者對近年來興起之議題─安寧療護、安樂死與預立醫囑了解程度與態度。
本研究發現如下:
一、 對於臨終的態度,年紀越大者越不害怕面對,且臨終場所也由過去一定要回到家中嚥下最後一口氣,轉變為醫院或不造成親友負擔之場所皆可,與過去對於臨終之印象有很大的改變。
二、 受訪者大多已提前向配偶或子女表述臨終時處理之方式,與過往避諱不談此話題有很大的差異。
三、 與選擇安寧療護之相關因素包含:性別、出生地、職業以及家人死亡經驗;接受安樂死之相關因素包含:性別、臨終場所、宗教以及慢性病;會事先預立醫囑之相關因素則包含:性別、慢性病與教育程度。這些因素間的組合會對於是否選擇該方式有一定程度之影響。2012-01-01T00:00:00Z高齡急診病人之衰弱面向與其預後的關聯
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/90337
標題: 高齡急診病人之衰弱面向與其預後的關聯; Associations Between Frailty Dimensions and Outcomes in Older Emergency Department Patients
作者: 蔡于捷; YU-CHIEH TSAI
摘要: 研究背景和目的
老年族群是否衰弱之所以重要,是因為衰弱可做為健康預後的指標。目前全世界對於急診衰弱長者的相關研究其實相對缺乏,而對於老年族群的衰弱議題若不夠警覺,則可能讓因非典型症狀來急診的老年族群有較差的急診品質。
透過本研究,我們希望可以了解到使用急診醫療的老年族群中生理、心理、社會衰弱的比率,同時也能了解台灣老年族群急診就診前是否衰弱,對於預後的影響與關聯性。
研究方法
本研究為前瞻性之觀察性世代研究,針對2022/12/15~2023/03/02至新竹臺大分院生醫醫院竹北院區急診醫學部就診之病患進行收案,資料分析分為探討(1) 急診使用之老年族群是否生理、心理、社會衰弱(2)以及透過多變項羅吉斯迴歸,加入共變項探討生理、心理、社會衰弱,對一個月後追蹤是否再返急診、住院以及死亡有影響。共變項包括年齡、過去病史、一年內跌倒次數、性別、是否為機構住民、是否有多重用藥、當次就醫是否住院等。
研究結果
研究期間共收案207位民眾,其中有46.38%有生理衰弱,41.06%有心理衰弱, 48.79%有社會衰弱,可發現社會衰弱比率大於生理衰弱再大於心理衰弱。以羅吉斯迴歸分析生理衰弱、心理衰弱、社會衰弱對於一個月預後的影響,發現在調整共變項後,有生理衰弱的長者其一個月內再返急診的風險為沒有生理衰弱的長者的4.43倍(OR=4.43, p<0.01),有生理衰弱的長者其一個月內再住院的風險為沒有生理衰弱的長者的3.62倍(OR=3.62, p<0.05),有心理衰弱的長者其一個月內再返急診的風險為沒有心理衰弱的長者的2.23倍(OR=2.23, p<0.05)。另發現社會衰弱有較易一個月住院(OR=2.39, p=0.059)、一個月內死亡(OR=9.00, p=0.052)之傾向。
討論
本研究之生理衰弱、心理衰弱及社會衰弱比率是比過去研究社區取樣之比率來得高,推論為不同面向衰弱與急診醫療使用的需求有關。此外與過去社區研究不同的是社會衰弱比率高於生理心理衰弱比率,推測可能是因為社會衰弱長者因為社會網絡或支持較薄弱,較有急診醫療需求。以及未來若能針對社區之社會衰弱長者進行介入,或許有機會降低長者急診使用率。
本研究發現急診長者生理衰弱及心理衰弱與一個月再返急診之風險有關,前者也與一個月再住院風險有關,而社會衰弱的長者其一個月內再住院及一個月死亡的風險則有較高的傾向。若在急診就診時能篩檢出衰弱,則有機會針對此族群進行介入,像是轉介老年醫學科或是長期照顧管理中心等,可以提升照顧品質,也降低之後的醫療資源的使用。
結論
本研究是第一個在急診場域同時進行生理、心理、社會衰弱的三面向評估,也點出了急診場域與社區場域之衰弱比率差異,以及衰弱比率與急診一個月預後指標之關聯性,同時也推論社會衰弱與急診醫療使用的關聯性。; Introduction
The significance of frailty in the elderly lies in its role as an indicator of health outcomes. Research on the prevalence of frail elderly individuals presenting to the emergency department is lacking worldwide. The aim of this study is to find out the prevalence of frailty among elderly individuals who utilize emergency medical services, and to investigate the relationship between physical, psychological, and social frailties and health outcomes for these elderly individuals in Taiwan.
Method
This was a prospective observational cohort study that aimed to enroll patients who sought medical attention at the Emergency Medicine Department of National Taiwan University BioMedical Park Hospital Zhubei Branch, from December 15, 2022, to March 2, 2023. The data analysis was divided into two parts: (1) The assessment of physical, psychological, and social frailty among the study participants, and (2) Multivariable logistic regression analysis was conducted to investigate the impact of physical, mental, and social frailty on revisits to the emergency department, readmissions, and mortality within one month of follow-up. Covariates included age, medical history, number of falls within one year, gender, institutional residency, polypharmacy, index admission.
Result
A total of 207 participants were enrolled. Among them, 46.38% were identified as physical frailty, 41.06% as psychological frailty, and 48.79% as social frailty. Elderly individuals with physical frailty had a 4.43 times higher risk (OR=4.43, p<0.01) of revisit to the emergency department within one month compared to those without physical frailty; and a 3.62 times higher risk (OR=3.62, p<0.05) of readmission within one month compared to the other groups. Elderly individuals with psychological frailty had a 2.23 times higher risk (OR=2.23, p<0.05) of revisit at the emergency department within one month compared to those without psychological frailty. Social frailty was associated with a higher likelihood of readmission (OR=2.39, p=0.059) and mortality (OR=9.00, p=0.052) within one month.
Discussion
The rates of physical frailty, psychological frailty, and social frailty in this study were higher compared to rates obtained from community samples. This suggests a relationship between different dimensions of frailty and the need for emergency medical care. Furthermore, the rate of social frailty was higher than that of physical frailty, which suggested that older adults experiencing social frailty may have a greater need for emergency medical care due to a lack of social network or support. This higher rate of social frailty compared to psychological frailty highlights the importance of addressing social frailty in interventions targeting social frailty in the community, as it may help reduce the rate of emergency department utilization among older adults in the future.
This study found that the risk of revisiting the emergency department within one month among older adults was associated with physiological frailty and physical frailty. Moreover, the risk of readmission within one month was associated with physical frailty. Additionally, older adults experiencing social frailty have a higher tendency towards readmission within one month and higher risk of mortality within one month. Screening frailty during emergency department visits presents an opportunity for intervention and effective reduction of healthcare resources utilization in this population.
Conclusion
The findings of this study indicated that the prevalence of frailty among elderly individuals in the emergency department wa significantly higher than in the community. Additionally, the presence of physical frailty can assist in predicting the risk of revisit at the emergency department and readmission within one month for elderly patients seeking emergency care. Similarly, the presence of psychological frailty can help assess the risk of revisit at the emergency department within one month for elderly patients seeking emergency care. Most importantly, interventions aimed at reducing frailty in older adults after their discharge from the emergency room are crucial.2023-01-01T00:00:00Z高齡事業發展共創價值之可行性探討─經營模式、共創價值設計與顧客態度意向分析
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/51267
標題: 高齡事業發展共創價值之可行性探討─經營模式、共創價值設計與顧客態度意向分析; Feasibility Evaluation for Co-creation Value in Senior Enterprises: Analysis on Business Model, Co-creation Value Design and Customer Participation Attitudes
作者: Ya-Ting Yang; 楊雅婷
摘要: 人口快速邁向高齡化已成為全球趨勢,臺灣即將正式邁入高齡社會。高齡人口增加將帶來經濟活動與社會發展的全面性質變,各式需求帶動高齡產業發展。世界各國高齡議題探討蔚為風潮,但同時兼顧產業端與顧客端,以及探討其間互動共同創造價值之重要區塊研究卻付之闕如。在產業面向上,本研究檢視全臺立意取樣之33家高齡個案事業,採用個案研究與深度訪談之質性研究法,以經營模式與共創價值理論架構進行分析,探討個案機構經營模式於關鍵資源、關鍵活動及通路與顧客關係之推演,以及於價值主張中如何創造價值共創契機,並據以探討臺灣高齡事業經營模式與供需價值共創模式。在顧客面向上,本研究立意挑選進行共創價值設計之機構事業之顧客35名,採用質性研究法,進行共創活動滿意度深度訪談,並對全國隨機抽樣1,392位高齡族群進行問卷調查,採用量性研究法,探討臺灣高齡族群之價值共創態度意向,提供產業端掌握高齡族群對共創活動之意向,做為未來產業推動共創價值參考。
綜觀本研究之研究背景與動機,歸納本研究之主要研究目的如下:
一、探討高齡事業經營模式分析
二、探討高齡事業共創價值設計分析
三、探討高齡族群價值共創設計滿意度分析
四、探討高齡族群價值共創態度意向分析
本研究結果發現高齡事業經營模式與共創價值設計可分為四模式,包括實體機構群居照顧模式之實驗場域活動參與、居家社區服務輸送模式之田野蹲點觀察對話、社群電商實驗場域模式之體驗場域社群經營及可攜移動智能科技模式賦能學習聚眾行動。依據共創價值核心原則,經營模式共創設計四種型態包括實驗心態以擴大體驗空間,協助個人獲得價值新體驗、互動內容以擴大互動範疇,增加事業機構策略資本與營收、參與平臺以擴大參與平臺連結,降低供需雙方的成本與風險及網絡關係以擴大生態系統利益關係人聯繫,降低事業機構風險與成本,高齡事業經營模式及共創設計多朝四模式兼有服務類型,本體業態基礎主軸重心及各關鍵成功要素配置比例不同。
高齡族群多具良善互動特質、會將滿意服務回饋互動推薦分享給親朋好友家人,容忍包容方面對產品或服務較嚴謹要求,若對產品或服務提供不如預期時,容忍度相對較低,供需互動點實體服務著力全齡友善通用設計,跨業複合式促進生態系統互動,資通訊增進網絡科技人工智慧與健康資料加值,建構虛實整合一站式服務最佳完整解決方案以達成供需互動點達成創造增益與解決痛苦的配適最大值。
透過以上高齡事業經營模式和共創價值設計以及高齡族群共創價值設計滿意度和價值共創態度意向分析,深入瞭解臺灣高齡產業發展趨勢、高齡事業於供給與需求共創價值設計及結果,期待藉由探析過程,從中探掘產業商機與發展創新服務模式,為高齡族群生活帶來更好的品質。並將產業供給、顧客需求及價值共創過程方面之研究結果,提供欲發展高齡事業經營管理與尋求共創價值提高事業價值主張之事業體,以及投入高齡事業發展領域產官學研各界參考。; With the rapid development of global population ageing, the increase in elderly population and the change in population structure have great impacts on the senior industry. The speedy growth of the industry and the discovery of great business opportunities are driven by the various needs that the elderlies face in everyday living. Population ageing is a global issue that affects almost every country. Mostageing researches focused on demand side and studies related to supply side wererelatively scarce. Today’s development in Internet has made information spread much faster, allowing the elderlies and their caregivers to more easily access information, or even actively participate in value co-creation in the services provided.
This study’s analytic structure is based on the mixed research method with qualitative and quantitative research, aiming to investigate with the business patterns of middle-aged and elderly industry in Taiwan, and to analyze the business models and value co-creation platform design with 33 quality middle-aged and elderly enterprises. Furthurmore, to analyze the attitude intention with co-creation value for middle-aged and elderly People in Taiwan ane try to realize the value co-creation platform design with qualify middle-aged and elderly enterprises through viewpoints with 1,392 middle-aged and elderly people.
The purpose of this study is to help with the discovery of business opportunities and innovative service models and co-creation value design to improve the quality of life for the elderly population.As elderly needs and challenges are regarded asunprecedented experience, the relevant ministries and organizations are still learningand proposing new and innovative service models. We advocate societies which alloweverybody to understand the needs of the elderly sector, provide creative products andservice models, develop new market opportunities, and further replicate the successfulexperience in Taiwan to other regions.
This study divided the business models adopted by the sampled enterprises into four categories: residential care and co-residence model, home care and living in place model, community e-business experience model, and virtual and physical portable device model. We constructed a conceptual model that comprehensively describes essential aspects of value co-creation, and categorized the value co-creation designs into four types applying for different business models including interaction in experience spaces co-creation design, on-site interacting co-creation design, social networking platform co-creation design, and empowering customers’ co-creation design.
As most of the target customers were assembles of small markets, the successful enterprises often provided compound services, instead of only a single service. Depending on the core business of each enterprise, the proportions of models adopted differed. One feature of senior enterprises is that the services provided are elderly-centered. With business models intended for virtual and physical integrations, the industry offered total solutions for the elderlies and their caregivers. Through investigating successful cases of senior enterprises, this study intends to discover the opportunities for businesses and develop innovative service models, aiming to support the growth of the senior industry and provide better ageing environment and assistance. Through value co-creation platform design, the senior enterprises have converted the originally passive roles of the elderly and caregivers into active participants in the value co-creation process.
The new paradigm of co-creation presents huge opportunity for senior enterprises. Through value co-creation design, the senior enterprises have converted the originally passive roles of the elderly and caregivers into active ones, helped them become participants of the value co-creation process, and promoted innovative development during the interactive process in services. Value co-creation has led enterprises reveal customers’ experiences and met their needs, increases markets and profits, and also build a new paradigm to put customer experience at the center of the senior enterprises’ designs.2016-01-01T00:00:00Z高階影像健檢之服務品質與顧客滿意度、忠誠度關聯性研究
http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/45245
標題: 高階影像健檢之服務品質與顧客滿意度、忠誠度關聯性研究; The Relationship between Service Quality, Customer Satisfaction and Loyalty in Imaging Health Examination
作者: Cheng-Ping Chien; 錢政平
摘要: 研究目的:
近年來,由於生活型態改變、人口高齡化、疾病年輕化等因素,再加上教育水準及所得提升,民眾愈來愈注重自身的健康,同時健檢產業的競爭日益激烈,各類型的健檢機構如雨後春筍般的設立,高階影像健檢也是其中之一。
服務業對滿意度及忠誠度的研究相當多,但在醫療業則相對較少。本研究參考國外顧客滿意度模式,應用於高階影像健檢的消費者。經由相關文獻的探討之後,提出本研究的顧客滿意度及忠誠度假設,然後透過問卷調查的方式驗證,同時以統計數據,驗證模式中各變項間之相關性,以及顧客基本資料對於知覺價值、滿意度、忠誠度的影響。
研究方法:
本研究採橫斷面調查法,調查期間為2009年10月15號到11月30號,對象為台北市某一私人高階影像健檢中心的顧客,現場問卷共發放172份,有效回收問卷131份,有效回收率76.16%。本研究採用變異數分析及多元迴歸分析,來探討顧客基本資料、服務品質、產品品質與知覺價值、顧客滿意度、顧客忠誠度之間的相關性。
研究結果:
本研究重要結果:(一)50歲以下年輕受檢者的忠誠度顯著高於51歲以上的受檢者,(二)「自發性受檢者」在知覺價值、滿意度、忠誠度三方面,平均分數都顯著高於「非自發性受檢者」,(三)「曾經來過」的受檢者,知覺價值感受較高,(四)影響知覺價值的主要因素為服務品質,其中又以「體貼性」影響成份最高,產品品質的影響較小,且未達顯著水準,(五)影響滿意度的主要因素為服務品質及知覺價值,其中又以「醫療核心服務」影響成份最高,產品品質的影響較小,且未達顯著水準,(六)影響忠誠度的主要因素為滿意度,詳究其原因,以「醫療核心服務」影響成份最大,服務品質及產品品質對於忠誠度的直接影響較小,且未達顯著水準。
研究結論:
產品的品質(包括硬體設備、服務過程)對於知覺價值、滿意度、忠誠度而言,其影響的程度並不高,反而是服務品質的影響力較為顯著,此一結論可供各醫院或健檢中心的經營者參考,好的服務品質,對於受檢者的滿意度、忠誠度的正向影響是較為明顯的,而服務品質的各個構面中,又以醫療核心服務為其中最重要因素。高階影像健檢產業中,仍舊不能拋棄醫療業的本質,需以醫療業再加上服務業雙重性質,才能增加顧客的滿意度及忠誠度。; Background and purpose:
Due to the change of living style, aging population society, early onset of chronic disease, and higher level of education and income, people pay more attention on the issue of health. The health examination business boomed and expanded in recent years. Among them, imaging health examination is a unique and remarkable one.
There are many publications discussing the relationship between customer satisfaction and loyalty in many fields, except in medical entity. The study cites the popular customer satisfaction index from previous researches and applies on the imaging health examination industry.
Method:
The study is a cross-sectional survey, using questionnaire survey methodology, and took place from Oct 15, 2009 to Nov. 30, 2009. We got 131 complete and valid data from 172 customers. Analysis of variance and multiple regression modeling were the tools to interpret the relationship between perceived value, customer satisfaction, loyalty, service quality, product quality, and personal background.
Results:
The important findings are as follows: 1) The loyalty of younger population (less than 50-years-old) is higher than order people significantly. 2) The perceived value, customer satisfaction, and loyalty are higher in the spontaneous population. 3) Customer who had visited before has higher perceived value. 4) Service quality is the major factor influencing customer perceived value, and product quality has less effect. 5) Service quality and perceived value are the major factors influencing the customer satisfaction. Core medical service is the leading factor in service quality. 6) Customer satisfaction is the major contribution to loyalty. Again, core medical service has highest direct effect.
Conclusion:
The product quality (including hardware and service process) has relatively lighter impact on perceived value, customer satisfaction, and loyalty. In other words, the service quality has higher influence on these items. This conclusion reminds the managers of hospitals or health examination centers. Good service quality is the most essential factor to promote customer satisfaction and loyalty. Among the 5 dimensions of service quality, the core medical service is the leading cause. For imaging health examination industry, both entities (medicine and service industry) have equal importance.2010-01-01T00:00:00Z