臺灣博碩士論文加值系統

中文摘要
已有研究顯示，醫院是否重視病人經驗，與其經營績效有相當程度之關聯性。改善病人經驗，不僅對於醫院提升財務表現有所助益，即透過醫療服務品質的一致性，提高客戶忠誠度，進而建立聲譽和品牌，並藉由病患親友的轉診來提升醫院服務的利用率。
為何強調病人經驗，從過往的醫療服務中發現病人接受的是片段的服務、以醫療提供者為中心的設計、以及病人被視為被動的參與者，這些都常常發生在以機構為主所提供的健康相關照護，現今的醫療服務強調提供連續性的照護、以病患為中心的服務、加強病人整體參與醫療決策的過程，以及電子化病歷的環境，可以進行更為創新的醫療服務傳遞方式，因此，在病患接受醫療服務的過程中，從你怎麼了轉變成你在乎什麼。
國內有關病人經驗調查工具尚無統一版本，目前僅鄭守夏等人於2010年參考國外病人經驗精神內涵所建構之「住院病人經驗調查問卷」，作為提供國內醫療院所發展其病人經驗調查問卷之參考。據此，本研究是以國內某區域醫院101至104年度住院病人滿意度調查及105年度住院病人經驗調查之次級資料為基礎，比較兩種不同監測工具之優勢與差異分析。
研究分析主要結果與結論如下：
一、就單一年度之比較，兩者監測工具與推薦意向之關聯性，病人經驗與推薦意向的關聯強度之解釋力較強。
二、病人滿意度與病人經驗之就診科別組間相關係數(ICC)差異，雖未能完全實證原先之假設，然整體而言，就診科別於病人經驗上相對於病人滿意度影響程度仍較大，且進一步發現病人滿意度之「病患權利與責任」構面內容較偏向屬於病人經驗。
三、病人滿意度與病人經驗於個人特徵之「填答者身分」及「年齡」呈現結果較為一致，即填答者身分為病人本人且年齡較大者，就醫感受較為正向，此發現可作為該院病人照護之參考。
四、整體上，就管理意涵而言，病人經驗有相對標準化及較少主觀意識的干擾與優勢，可提供不同構面之院內和全國數值之比較可能性，從管理面來看，有助於長期監測與內部改善對話機制之數據參考。

Abstract
Studies have shown that there is a considerable degree of correlation between the importance a hospital attaches to patient experience and its business performance. Improvement in patient experience has been shown to enhance both the financial performance and customer loyalty of a hospital. This in turn helps establish the hospital’s reputation and brand through consistency in medical service quality, and further upgrade the utilization rate of hospital services through patient referrals.
Why is it necessary to emphasize patient experience? It has been found in the past that the level of medical services received by patients was not comprehensive enough. Hospital services were typically more of a medical provider-centered design where patients were considered passive participants. However, today’s healthcare services emphasize the provision of continuous care and patient-centered services, with emphasis being placed on the patient’s overall participation in medical decision-making processes, and an electronic medical record environment that enables more innovative delivery of medical services. Therefore, while receiving medical care, patient care has been transformed from a process of “what’s the matter with you” to “what do you care about.”
Currently, there is still no unified set of investigative tools regarding patient experience in Taiwan. The only tool available is the “Inpatient Experience Questionnaire” established by Cheng Shou Hsia et al. after studying the comparative patient experience in foreign countries as a reference for domestic medical institutions to develop their own patient experience questionnaires. In view of this consideration, a comparison was made by this study to analyze the advantages and variances of two different monitoring tools based on the secondary data of the 2012 - 2015 inpatient satisfaction surveys and the 2016 inpatient experience survey from a particular domestic regional hospital.
The key analytical results and conclusions of the study are as follows:
1. Based on the single-year comparison on the correlation between monitoring tools and recommended intention, there is a stronger degree of interpretation on the correlation between patient experience and recommended intention.
2. Although the differences in Intraclass Correlation Coefficient (ICC) between patient satisfaction and patient experience among various medical departments cannot fully verify the original hypothesis, on the whole, the extent of impact on patient experience among the medical departments is still greater than that of patient satisfaction. Furthermore, in terms of the “patient rights and responsibilities” aspect, patient satisfaction is found to be closely related to patient experience.
3. There is consistency between patient satisfaction and patient experience in the results of “questionnaire responder identity” and “age” in the personal characteristics section. In other words, the medical treatment experience is more positive if the questionnaire responders are the patients themselves and are in a higher age range. This realization can serve as a reference for patient care in hospitals.
4. Generally, in terms of management implications, the interferences and advantages of patient experience are relatively standardized and low in subjective awareness. This can possibly provide different comparative aspects for hospitals as well as national standards. From a management point of view, this could be useful as a data reference for hospitals to help long-term monitoring and improvements in the internal dialogue mechanism.

目錄
中文摘要 I
Abstract III
目錄 V
圖目錄 VII
表目錄 VIII
第一章 緒論 1
第一節 研究背景與研究動機 1
第二節 研究重要性 3
第三節 研究目的 3
第二章 文獻探討 4
第一節 病人經驗監測工具之發展與應用 4
第二節 醫療服務品質、醫院經營與病人經驗之關係 6
第三節 醫療服務品質、醫院經營與病人滿意度之關係 7
第四節 病人經驗與滿意度之關係 7
第三章 研究設計與方法 10
第一節 研究架構 10
第二節 研究樣本 16
第三節 研究變項之操作型定義 17
第四節 統計分析方法 30
第四章 研究結果 33
第一節 描述性統計 33
第二節 單變項分析 60
第三節 多層次隨機截距模式比較 64
第四節 線性複迴歸分析 66
第五章 討論與建議 69
第一節 兩種不同住院病人就醫評價監測工具之優勢與差異分析 69
第二節 國際間即時性病人經驗調查趨勢比較 70
第三節 研究優點與限制 74
第四節 結論與建議 74
參考文獻 76
中文部分 76
英文部分 78
附錄 81
附錄一 文獻地圖之文獻列表 81

圖目錄
圖1 歷年病人經驗相關研究之趨勢 2
圖3-1 研究架構圖 14
圖3-2 病人滿意度之就診科別分群流程圖 15
圖3-3 病人經驗之就診科別分群流程圖 15
圖4 樣本醫院與全國7家醫院病人經驗表現之比較 59
圖5 NHS提出立即性監測之步驟 71
圖6 Press Ganey顧問公司立即性監測做法 73

表目錄
表2-1 鄭守夏等人(2010)住院病人經驗問卷建構之六大向度 5
表2-2 鄭守夏等人(2010)住院病人經驗問卷發展過程概述(以PDCA方法呈現) 5
表2-3 文獻地圖 9
表3-1 病人滿意度就診科別樣本數分配 19
表3-2 病人經驗就診科別樣本數分配 20
表3-3 病人滿意度自變項之操作型定義 21
表3-4 病人經驗自變項之操作型定義 23
表3-5 病人滿意度依變項之操作型定義 24
表3-6 病人經驗依變項之操作型定義 27
表4-1-1 101-104年度合併樣本住院病人滿意度之各研究變項描述 38
表4-1-2 105年度住院病人經驗之各研究變項描述 49
表4-1-3 樣本醫院各科別與全國7家醫院病人經驗表現之比較 59
表4-2-1 101-104年度合併樣本住院病人滿意度與推薦意向之單變項分析 62
表4-2-2 105年度住院病人經驗與推薦意向之單變項分析 62
表4-2-3 住院病人滿意及病人經驗與推薦意向之關聯性比較 63
表4-3-1 101-104年度合併樣本住院病人滿意度之多層次隨機截距模式 65
表4-3-2 105年度住院病人經驗之多層次隨機截距模式 65
表4-4-1 101-104年度合併樣本住院病人滿意度之線性複迴歸分析 67
表4-4-2 105年度住院病人經驗之線性複迴歸分析 68

參考文獻
中文部分
王嵩竑(2008)．醫療服務品質與病人滿意度之相關性．北市醫學雜誌，5(6)，582-592。
王嵩竑、林晉鋒(2012)．醫院門診病人「以病人為中心」感受對關係品質及病人忠誠度之影響．醫療品質雜誌，6(3)，48-58。
古慧仙、古慧嬋、張彩秀(2007)．影響門診病患就醫忠誠度之相關因素探討．澄清醫護管理雜誌，3(1)，36-45。
李文俊(2004)．國軍官兵門診醫療滿意度與忠誠度探討-某南部區域教學軍醫院為例(碩士論文)．高雄醫學大學，高雄市。
沈振榮(2016)．從民眾就醫滿意度探討新興醫院經營策略(碩士論文)．南臺科技大學，台南市。
林恆慶、陳楚杰(2003)．消費者使用品質報告卡之探討－以美國經驗為例．護理雜誌，50(4)，81-86。doi:10.6224/JN.50.4.81
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．臺灣公共衛生雜誌，29(5)，440-451。doi:10.6288/TJPH2010-29-05-07
洪淑真(2014)．醫療品質對病人滿意度之影響-以腫瘤個案管理服務為例(碩士論文)．元智大學，桃園市。
莊逸洲、黃崇哲(2000)．醫務管理學系列－組織經營，47-52．台北市：華杏出版機構。
許榮譽、溫源鳳、徐東寶(2008)．醫療品質、病患滿意度與病患後續醫療行為意圖－以國軍南部某醫院為例．危機管理學刊，5(2)，49-60。
陳玉萍、曾振淦、洪志宏、曾雁明(2011)．醫院服務品質與顧客價值對於癌患滿意度的關係探討．放射治療與腫瘤學，18(4)，287-297。doi:10.6316/TRO/201118(4)287
陳楚杰、林恆慶、楊銘欽(2004)．住院病人對醫院品質報告卡需求之初探．醫學教育，8(1)，62-67。
陳楚杰、楊銘欽、林恆慶(2004)．門診病人對醫院品質報告卡需求之初探．醫護科技學刊，6(1)，29-42。doi:10.6563/TJHS.2004.6(1).3
廖士程、李明濱、謝博生、李源德(2005)．醫病關係與醫療滿意度之全國性普查．醫學教育，9(2)，37-49。
衛生福利部健康服務品質政策辦公室(2015)．「住院病人經驗調查」操作手冊。
鄭嘉惠、莊禮如、王拔群、林隆煌(2009)．以病人滿意度探討醫院服務品質—以台北市某醫學中心小兒科為例．輔仁醫學期刊，7(2)，51-62。
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。
應立志、李福春、王萬琳(2012)．就醫者之醫療體驗對醫院滿意度之影響．若瑟醫護雜誌，6(1)，20-38。
魏文欽、扈克傑(2008)．醫療服務品質、病患滿意度與病患忠誠度關連性之實證研究-以高高屏地區區域教學醫院為例．中華理論結構模式LISREL學會，1(2)，25-49。
魏玉容、鍾國彪、鄭守夏(2005)．醫療品質評估的發展－從專業評鑑到報告卡系統．臺灣公共衛生雜誌，24(4)，275-283。doi:10.6288/TJPH2005-24-04-01

英文部分
A GE Healthcare Company. (2015). The Rising Importance of Patient Satisfaction in a Value-Based Environment. Retrieved from http://www.apihealthcare.com/white-papers
Campbell, J. L., Ramsay, J., & Green, J. (2001). Age, gender, socioeconmic, and ethnic differences in patients' assessments of primary health care. Quality in Health Care, 10, 90-95.
Carter, M., Davey, A., Wright, C., Elmore, N., Newbould, J., Roland, M., Campbel, J., & Burt, J. (2016). Capturing patient experience: a qualitative study of implementing real-time feedback in primary care. British Journal of General Practice, November 2016, 786-793.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, New Jersey: Eribaum.
David, B., Andreea, B. C., Maulesh, S., & Navneet, K. (2016). The value of patient experience: hospitals with better patient-reported experience perform better financially. Deloitte Center for Health Solutions. Retrieved from http://www.deloitte.com/us/hospitals-patient-experience.
Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open, 3:e001570. doi:10.1136/bmjopen-2012-001570
Edwards, K. J., Walker, K., & Duf, J. (2015). Instruments to measure the inpatient hospital experience: a literature review. Patient Experience Journal, Volume 2, Issue 2, 77-85.
Hargraves, J. L., Hays, R. D., & Cleary, P. D. (2003). Psychometric properties of the Consumer Assessment of Health Plans Study (CAHPS®) 2.0 adult core survey. Health Services Research, 38(6), Part I, 1509-1528.
Jenkinson, C., Coulter, A., Bruster, S., Richards, N., & Chandola, T. (2002). Patients' experiences and satisfaction with health care: results of a questionnaire study of specific aspects of care. Qual Saf Health Care, 11, 335-339.
Larsson, D. W., & Larsson, G. (2002). Development of a short form of the Quality from the Patient's Perspective (QPP) questionnaire. Journal of Clinical Nursing, 11, 681-687.
Luxford, K., & Suttn, S. (2014). How does patient experience fit into the overall healthcare picture? Patient Experience Journal, Volume 1, Issue 1, 20-27.
Merlo, J., Chaix, B., Ohlsson, H., Beckman, A., Johnell, K., Hjerpe, P., Råstam, L., & Larsen K. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health, 60, 290-297. doi: 10.1136/jech.2004.029454
Price, R. A., Elliott, M. N., Zaslavsky, A. M., Hays, R. D., Lehrman, W. G., Rybowski, L., Edgman-Levitan, S., & Cleary, P. D. (2014). Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev, 71(5), 522-554. doi:10.1177/1077558714541480.
Roland, M., Elliott, M., Lyratzopoulos, G., Barbiere, J., Parker, R. A, Smith, P., Bower, P., & Campbell, J. (2009). Reliability of patient responses in pay for performance schemes: analysis of national General Practitioner Patient Survey data in England. BMJ, 339, b3851. doi:10.1136/bmj.b3851.
Rubin, H. R., Ware, J. E., Nelson, E. C., & Meterko, M. (1990). The Patient Judgments of Hospital Quality (PJHQ) Questionnaire. Patient Judgments of Hospital Quality, 28(9), 17-18.
Salisbury, C., Wallace, M., & Montgomery, A. A. (2010). Patients' experience and satisfaction in primary care: secondary analysis using multilevel modeling. BMJ, 341, c5004. doi:10.1136/bmj.c5004