臺灣博碩士論文加值系統

台灣地區人口老化速度持續上升，失能人口亦逐年增加。因社會環境、家庭結構與功能變遷使居住於長期照護機構的老年人比率逐年提高，老年人口快速遞增也使照護機構的需求與數量逐年俱增，依衛生署統計，護理之家數量從1997年29家至2009年373家成長了11.86倍。護理之家的經營績效與照護品質廣為各界關切，緣此本研究針對護理之家進行實證研究，以探討護理之家經營績效與照護品質之相關模式。
以臺中縣內所有護理之家計23家做為研究對象：(1)設計結構式問卷收集投入項及產出項資料，以資料包絡分析法（Data Envelopment Analysis）之超效率模式進行經營績效評估；(2)委請專家學者親赴各機構依品質考核評分表進行實地評核，以無母數統計檢定（Mann-Whitney U test）進行結果分析。
研究發現： 1.經營績效部份：(1)平均技術效率為1.2644；(2)平均純技術效率為1.7885。(3)平均規模效率為0.8346。(4) 23家中僅2家屬於相對無效率：差額變數分析發現投入部份需增加照顧服務員時數及人事費；產出部份需增加總人日數、特別護理人數及年營運收入。(5)比較不同類型護理之家效率差異：公私立、獨立經營或醫院附設之效率皆無顯著差異，機構之床位規模則係70床以上較有經營效率。 2.照護品質部份：(1)機構類型為公立機構，於住民安全、服務內容、專業會診、照護計畫等項目，其分數均顯著高於私立機構；(2)經營型態為醫院附設型，在住民安全、急救設備、整體環境等項目，分數顯著高於獨立經營型態；(3)床數規模大小在各項目均無顯著差異。3.經營績效與照護品質之相關性：整體而言，二者均呈負相關，尤其公立護理之家經營績效與照護品質呈顯著負相關。
本研究並提出護理之家督導考核常見之缺失、改善建議方向及後續輔導訪查重點。研究之結果期做為政府研擬老人照護、長照保險、評鑑等相關政策及民間業者調整經營方向之重要參考。

In Taiwan, aging population as well as disabled population is rising in a constant pace. More and more senior citizens are arranged in the long term care facilities due to changes in social environment, family structures and family functions. Rapid increase of elderly population also causes the increase in need for long term care facilities. According to the statistics of the Department of Health, Executive Yuan, the numbers of nursing homes in Taiwan grew 11.86 times from 29 in 1997 to 373 in 2009. Therefore, the assessment of nursing home quality and management performance is becoming widely concerned. This study focuses on nursing homes to explore the related model between operating efficiency and quality of care by evidence based research.
Twenty-three institutions from Taichung County are selected as the study target. Our research making use of the evaluation results of the local health authority to analyze nursing home qualities and management performance. Data envelopment analysis (DEA) is used to evaluate the management performance of the target nursing homes and to compare the management efficiency among different categories of nursing homes. Based on the DEA model, five input and four output variables are selected and analyzed by super efficiency model analysis. The twenty-three institutions are categorized according to ownership, affiliation and scale to compare their quality by statistical Mann-whitney U test.
Our findings are summarized as follow. 1. In terms of performance efficiency: (1) Average technique efficiency is 1.2644. (2) Average pure technique efficiency is 1.7885. (3) Average scale efficiency is 0.8346. (4) Only 2 out of 23 DMUs are relatively inefficient. (5) There is no significant difference between public and private nursing homes, neither between hospital affiliated and independent institutions. With respect to scale, institutions with more than 70 beds are appeared to be more efficient. 2. In terms of quality of care: (1) For indexes such as residential safety, services provided, professional consultant and care plan, public nursing homes generally perform better than private owned institutes. (2) For indexes such as residential safety, emergency facilities and overall environment, hospital affiliated nursing homes generally have better rating than independent institutions. (3) There are no significant differences in all quality indexes among institutions of different scale. 3. In terms of the correlation between performance efficiency and quality of care: Public nursing homes appear to be significant negatively correlated.
Our results not only serve as an important basis for institutional managers to figure out their management problems, but also as basic principles to help manage their institutions efficiently. In addition, our study provides reference information for nursing home managers to redirect their future tasks and administration, as well as to examine whether their limited resources are used appropriately. Moreover, we hope that our study also provides as a valuable reference for the government to establish policies for elderly care.

目錄

中文摘要 Ⅰ
英文摘要 Ⅱ
致謝 Ⅲ
目錄 Ⅳ
圖目錄 Ⅵ
表目錄 Ⅶ
第一章 緒論 01
1.1 研究背景與動機 01
1.2 研究目的 04
1.3 研究問題 04
第二章 文獻探討 06
2.1 經營效率 06
2.1.1 效率 06
2.1.2 效率的分類 07
2.1.3 效率的評估方法 17
2.2 資料包絡分析法 13
2.3 DEA應用於護理之家或安療養機構之文獻 16
2.4機構品質的面向、指標與影響因素 22
2.4.1 結構指標 22
2.4.2 過程指標 23
2.4.3 結果指標 23
第三章 研究方法 28
3.1 研究對象 28
3.2 研究流程 28
3.3 資料收集工具 30
3.4 投入與產出變項之選取與操作性定義 30
3.5 分析方法 32
第四章 研究結果 33
4.1護理之家經營效率結果分析 33
4.1.1投入項與產出項權數 33
4.1.2投入項與產出項之描述性統計分析 33
4.1.3 投入項與產出項之關係分析 35
4.1.4 總體相關效率分析 36
4.1.5 差額變數分析 38
4.1.6 目標改善分析 38
4.1.7 參考群體分析 39
4.1.8 不同類型護理之家之效率差異分析 40
4.2 護理之家照護品質結果分析 41
4.3 護理之家經營效率與照護品質之相關分析 45
4.4護理之家督導考核常見缺失 47
4.5 護理之家督導考核建議改善方向 48
4.6 護理之家督導考核輔導訪查重點 48
4.7品質考核評分量表修訂重點分析 49
第五章 討論 52
5.1 護理之家經營效率 52
5.2 護理之家照護品質 55
5.3 護理之家經營效率與照護品質 57
第六章 結論 58
第七章 研究貢獻與建議 59
7.1 研究貢獻 59
7.2 研究限制 61
參考文獻 62
附件1、97年護理之家督導考核評分表 71
附件2、本研究研訂之護理之家督導考核評分表 77

圖目錄

圖2.1 研究流程圖 29
圖4.1 不同權屬別機構之效率與品質散佈圖 46
圖4.2 不同型態別機構之效率與品質散佈圖 46
圖4.3 不同規模別機構之效率與品質散佈圖 47
圖5.1 參考群體之效率與品質相關性散佈圖 54

表目錄

表2.1 醫療領域常用效率評估方法比較表 12
表3.1 投入/產出變項之操作性定義表 31
表4.1 投入項與產出項權數表 33
表4.2 敘述統計資料表 34
表4.3 投入與產出變數相關係數表 35
表4.4 總體相對效率值表 37
表4.5 無效率護理之家差額變數分析表 38
表4.6 無效率護理之家改善目標表 39
表4.7 護理之家參考群體表 40
表4.8 不同類型護理之家對比效率分析表 41
表4.9 機構屬性與各品質項目之差異分析表 42
表4.10 經營型態與各品質項目之差異分析表 43
表4.11 開放床數與各品質項目之差異分析表 44
表4.12 護理之家效率與品質（考核分數）之相關分析表 45

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