老人長期照護的醫療服務品質研究-以中部某醫院為例(I)

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Title:	老人長期照護的醫療服務品質研究-以中部某醫院為例(I)
Authors:	謝俊逸
Contributors:	資訊學院;資訊多媒體應用學系
Keywords:	老人長期照護;醫療服務品質;決策實驗室法;語意結構分析法;geriatric long-term care;medical service quality;DEMATEL;semantic structure analysis
Date:	2012
Issue Date:	2013-07-18 07:53:10 (UTC+0)
Abstract:	人口老化是目前全球各先進國家共同面臨的社會變遷經驗，台灣從1993 年開始老年人口數已經超過世界衛生組織所定義的高齡化社會之標準，隨著醫療技術的進步及生活品質的提升，使得人民平均壽命提高。台灣老人人口則預估在24 年間（1993 年～2017 年），將從7％爬升至13.50％，因此政府積極推動了老人長期照護機構式、社區式等多項老人長期照護服務方案。整個台灣醫療環境隨著整個社會經濟發展與政策影響，老人長期照護機構選擇性愈來愈多，因此台灣地區老人長期照護競爭愈來愈激烈，如何有限利用資源進行服務品質改善，為目前經營老人長期照護機構決策者所重視課題。因此本研究利用中部某區域教學醫院附屬老人長期照護機構，進行實證研究。首先以PZB 之SERVQUAL 量表架構建立之問卷，調查民眾對老人長期照護醫療服務品質期望與感受之間的落差，再採用重要-績效分析法分析找出優勢與劣勢；分別針對優勢與劣勢進行決策實驗室法(Decision making trial and evaluation laboratory, DEMATEL)問卷設計，透過DEMATEL 分析所得因果圖可以將複雜的因果關係簡化為易懂的結構，能深入瞭解問題以提供解決方向，此外藉由因果圖的協助，決策者可根據準則中導致類或影響類來規劃適合的決策，使醫院能以最小成本與時間有效地改善服務品質，增加競爭優勢與吸引更多顧客。進一步之研究將結合語意結構分析法(Semantic structure analysis, SSA)與Shapley value 進行老人長期照護醫療服務關鍵因素分析，透過順序態度圖觀察老人長期照護醫療機構競爭能力間之脈絡，可以驗證本評估模式之適用性。最後針對決策實驗室法與語意結構分析法結合Shapley value，進行相關結果差異比較，讓老人長期照護機構經營者在資源有限情形下，可更精確與可靠地透過因果圖將複雜的因果關係簡化為易懂的結構，能深入瞭解問題以提供解決方向，此外藉由因果圖的協助，決策者可根據準則中導致類或影響類來規劃適合的決策，進而擬定老人長期照護機構經營方向，以提昇整個老人長期照護機構服務品質。 The aging of population is an issue commonly seen in developing and developed countries. The number of the elderly people in Taiwan has already exceeded what World Health Organization defines since 1993. With the improvement of the progress of medical technology and quality of the life, people's average life span is improved. The percentage of the elderly people in Taiwan will rise to by 13.50% from 7% between the period 1993 and 2017, i.e. within 24 years, therefore the government in Taiwan actively promote a variety of the geriatric long-term care services including institutional care, community-based care, etc. The whole medical environment of Taiwan is influenced as the whole social economic development and policy, looking after more and more organization's alternatives for a geriatric long-term care, therefore the government looks after the competition for a geriatric long-term care. Under the limited resources, it is an important issue to find out the key factors to promote the medical service quality of the geriatric long-term care and market competitiveness. A case study of medical service quality of the geriatric long-term care was conducted in a hospital located in central region of Taiwan. Although hospitals in Taiwan carry on the satisfaction investigation to the patients regularly at present, the relations between the items in the questionnaire are not discussed for most of them. DEMATEL questionnaire can study the relations between the items. In this study, we will apply importance-performance analysis and DEMATEL method to evaluate the quality of medical services. First, collect the questionnaires which are based on PZB and try to find what are the major strengths and the major weaknesses by importance-performance analysis method. Then, we set up a DEMATEL questionnaire for the major strengths and the major weaknesses, respectively. Further research will combine semantic structure analysis method with the Shapley value to find out the key factors of geriatric long-term medical care service. DEMATEL and semantic structure analysis are two major methods to construct causal relationships graphs. The reliability of the method in our study can be verified by comparing these two methods of finding the factors of geriatric long-term medical care service. Finding out the key factors that resulted in failure, the policy-makers can improve significantly the medical service quality of geriatric long-term care with the least cost and time.
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