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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 鄭守夏(Shou-Hsia Cheng) | |
| dc.contributor.author | Wen-Tzu Liao | en |
| dc.contributor.author | 廖文慈 | zh_TW |
| dc.date.accessioned | 2022-11-24T03:08:08Z | - |
| dc.date.available | 2022-02-15 | |
| dc.date.available | 2022-11-24T03:08:08Z | - |
| dc.date.copyright | 2022-02-15 | |
| dc.date.issued | 2021 | |
| dc.date.submitted | 2022-02-14 | |
| dc.identifier.citation | 李宜恬(2015)。病人住院經驗與忠誠度之相關性研究–以南部某區域醫院為例。未出版之碩士論文，高雄醫學大學醫務管理暨醫療資訊研究所。 何舜婷(2005)。不同滿意度模式與就醫選擇間的探討—以北部某一醫學中心為例。未出版之碩士論文，台灣大學公共衛生學院醫療機構管理研究所。 林汝潔(2020)。住院期間陪病者對住院病患就醫經驗與病患觀點出院狀態之影響。未出版之碩士論文，台灣大學公共衛生學院健康政策與管理研究所。 郭年真、鍾國彪、賴美淑(2015)。醫院品質報告卡之風險校正。台灣衛誌，34(6)，576-591。doi: 10.6288/TJPH201534104011 姚開屏、蕭宇佑、郭耿南、鄭守夏(2010)。病人報告之醫院品質：問卷發展與信效度分析。台灣衛誌，29(5)，440-451。http://dx.doi.org/10.6288/TJPH2010-29-05-07 陳信木、林佳瑩(1997)。調查資料之遺漏值的處置－以熱卡插補法為例。調查研究，3，75-106。doi:10.7014/TCYC.199704.0075 陳輝財(2008)。疾病嚴重程度與急診病患滿意度之探討–以北部某區域醫院為例。未出版之碩士論文，陽明大學醫務管理研究所。 溫福星、邱皓政(2009)。多層次模型方法論：階層線性模式的關鍵議題與試解。台大管理論叢，19(2)，263-293。doi:10.6226/NTURM2009.19.2.263. 鄭守夏、鍾國彪、董鈺琪、郭年真(2018)。住院病人就醫經驗調查運作模式之先驅研究。衛生福利部中央健康保險署委託研究計(編號：MOHW107-NHI-S-114-000008)，未出版。 鄭嘉惠、郭書麟、王拔群(2013)。病人住院經驗調查結果初探－以某醫學中心為例。醫療品質雜誌，7(6)，99-102。 Anderson, J. G., Rainey, M. R., Eysenbach, G. (2003) The impact of cyberhealthcare on the physician-patient relationship. Journal of Medical Systems, 27(1): 67-84. Andridge, R. R., Little, R. J. 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HIV Patients’ Experiences with Inpatient and Outpatient Care: Results of a National Survey. Medical Care, 40(12): 1149-1160. doi: 10.1097/00005650-200212000-00003 Young, G. J., Meterko, M., Desai, K. R. (2000). Patient satisfaction with hospital care – Effects of demographic and institutional characteristics. Medical Care, 38(3): 325-334. Zaslavsky, A. M. (2001) Statistical issues in reporting quality data: small samples and casemix variation. International Journal for Quality in Health Care, 13(6): 481-488. Zaslavsky, A. M., Zaborski, L. B., Ding, L., Shaul, J. A., Cioffi, M. J., Cleary, P. D. (2001). Adjusting Performance Measures to Ensure Equitable Plan Comparisons. Health Care Financing Review, 22 (3): 109-26 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/80506 | - |
| dc.description.abstract | "研究目的：國外有許多研究皆以詢問病患的醫療照護經驗(patient experience)，作為醫院品質概念之量測，並公開具可比較性的調查結果，供醫院、病人及保險人做決策參考依據，同時促進醫院品質之改善。然而，台灣雖已成功建構出適用於國內的病人經驗測量工具，卻受限於各醫院病人組成差異明顯，導致現階段的調查結果尚無法在醫院間進行公正評比。因此，本研究目的在於挑選出重要的病例組合校正因子(case-mix adjusters)，研擬適用於國內之校正模型，並將校正前與校正後的結果進行比對及分析。未來也可作為健保署評估醫院住院照護績效的評判項目之一，乃至公開調查結果，供醫院間績效評比及民眾就醫選擇之參考。 研究方法：研究為次級資料分析，使用住院病人經驗調查(patient experience of hospital care, PEHC)量表作為調查工具，收案院所為全台有健保合約之醫療機構，並採用年齡20歲以上的出院病患作為收案對象，最終將來自117間醫院，共8,630筆資料納入分析。本研究先採用多階層分析(multilevel analysis)，依照病人與醫院的巢狀(nested)結構，以評估「病例組合(case-mix)」對住院病人經驗調查的影響，並依PCV值(proportional changes in variance)選取最重要的校正因子放入最終分析模型。此外，為量化病例組合校正之影響，採用肯德爾相關係數(Kendall’s tau correlation coefficient)衡量醫院校正前後排名之不一致性。 研究結果：影響住院病人經驗調查最重要的校正因子為年齡、入院自評病情嚴重度、問卷填答者(是否代答)、入院原因(是否生產)以及調查方式。結果發現當調查問卷是由住院者本人/其他人員協助填寫、入院進行生產以及問卷是透過出院櫃檯發放者，會給予「較佳」的住院經驗評分，而年齡及入院自評病情嚴重度與評分則未發現一致的影響方向。此外，未校正排名與已校正排名的Kendall等級相關係數為0.95（Kendall 等於 1 代表完美一致性）；而校正後，任兩間醫院其排名的相對關係產生改變的機率為0.025，皆顯示校正前後的差異並不顯著。 結論：病例組合校正對於醫院評分及排名，無法達成顯著的影響效果，但實施校正可以更正少部分機構明顯被低估或高估的分數，並減少醫院間評比的偏差。" | zh_TW |
| dc.description.provenance | Made available in DSpace on 2022-11-24T03:08:08Z (GMT). No. of bitstreams: 1 U0001-1002202215120500.pdf: 3702129 bytes, checksum: 29d80814666d24e92109824bb803ba48 (MD5) Previous issue date: 2021 | en |
| dc.description.tableofcontents | "口試委員會審定書 ......................................................I 致謝................................................................II 中文摘要............................................................III 英文摘要..............................................................V 目錄 ...............................................................VII 圖目錄...............................................................IX 表目錄............................................................... X 第一章 緒論............................................................1 第一節 研究背景與動機....................................................1 第二節 研究目的.........................................................3 第二章 文獻回顧 ........................................................4 第一節 住院病人經驗評分校正之目的 .........................................4 第二節 影響醫院評分的病例組合校正因子.......................................8 第三節 病例組合校正之統計方法.............................................28 第三章 研究設計與方法 ...................................................36 第一節 研究設計 ........................................................36 第二節 研究架構與假說....................................................38 第三節 研究工具與變項操作型定義............................................40 第四節 資料處理 ........................................................46 第五節 統計分析 .........................................................49 第四章 研究結果 .........................................................54 第一節 描述性統計分析 ....................................................54 第二節 雙變量推論性統計分析................................................58 第三節 選取校正因子與病例組合校正分析........................................61 第四節 綜合醫院之校正評比..................................................84 第五章 討論..............................................................89 第一節 病例組合因子對住院經驗評分之影響.......................................89 第二節 病例組合校正之作用探討...............................................91 第三節 研究方法及工具之討論.................................................92 第四節 研究限制...........................................................94 第六章 結論與建議.........................................................95 第一節 研究結論...........................................................95 第二節 研究建議...........................................................96 參考文獻.................................................................98 附錄一 所有樣本(N=8,630)—住院經驗總分於各醫院校正前後的平均評分與排名............105 附錄二 比較不同篩選校正因子方法之校正後醫院排名................................109 附錄三 住院經驗調查問卷(PEHC) .............................................111 圖目錄 圖3-1本研究之研究架構........................................................38 圖3-2資料處理流程圖..........................................................46 表目錄 表2-1病例組合校正因子文獻回顧整理.............................................27 表3-1操作型定義—病例組合校正因子..............................................41 表3-2操作型定義—依變項......................................................43 表4-1病例組合變項之描述性分析.................................................55 表4-2住院經驗總分及各面向平均評分..............................................57 表4-3病例組合校正因子與住院經驗評分之雙變項分析..................................59 表4-4各項住院經驗評分之多階層分析..............................................65 表4-5所有醫院(55間)—住院經驗總分於校正前後的平均評分與排名........................78 表4-6排除生產個案醫院(55間) 住院經驗總分於校正前後的平均評分與排名..................80 表4-7所有醫院與未納入生產個案醫院比較 校正後的PEHC評分與排名.......................82 表4-8迴歸分析: 病例組合因子與住院經驗評分之複迴歸分析.............................86 表4-9綜合醫院(48間)—住院經驗總分於校正前後的平均評分與排名........................87" | |
| dc.language.iso | zh-TW | |
| dc.subject | 多階層分析 | zh_TW |
| dc.subject | 病例組合校正 | zh_TW |
| dc.subject | 病人經驗 | zh_TW |
| dc.subject | 住院病人經驗調查 | zh_TW |
| dc.subject | Patient Experience | en |
| dc.subject | Case-Mix Adjustment | en |
| dc.subject | Multilevel Analysis | en |
| dc.subject | Patient Experience of Hospital Care | en |
| dc.title | 住院病人經驗調查評分之病例組合校正 | zh_TW |
| dc.title | Case-Mix Adjustment of the Patient Experience of Hospital Care Survey | en |
| dc.date.schoolyear | 110-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽(Hui-Lin Lin),林寬佳(Hsien-Feng Lee) | |
| dc.subject.keyword | 病例組合校正,病人經驗,住院病人經驗調查,多階層分析, | zh_TW |
| dc.subject.keyword | Case-Mix Adjustment,Patient Experience,Patient Experience of Hospital Care,Multilevel Analysis, | en |
| dc.relation.page | 118 | |
| dc.identifier.doi | 10.6342/NTU202200531 | |
| dc.rights.note | 同意授權(限校園內公開) | |
| dc.date.accepted | 2022-02-14 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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|---|---|---|---|
| U0001-1002202215120500.pdf 授權僅限NTU校內IP使用（校園外請利用VPN校外連線服務） | 3.62 MB | Adobe PDF |
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