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研究生:謝淑芬
研究生(外文):HSIEH, SHU-FEN
論文名稱:探討血液透析病患選擇治療機構之相關影響因素
論文名稱(外文):To Explore the Influencing Factors of End Stage Renal Disease Patients' Choice of Hemodialysis Institution
指導教授:李易蓁李易蓁引用關係
指導教授(外文):LEE, I-CHEN
口試委員:蘇永裕許弘毅
口試委員(外文):SU, YUNG-YUSHI, HON-YI
口試日期:2023-06-29
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士在職專班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2023
畢業學年度:111
語文別:中文
論文頁數:139
中文關鍵詞:血液透析病患醫療服務品質病患滿意度就醫忠誠度
外文關鍵詞:hemodialysis patientsmedical service qualitypatient satisfactionmedical loyalty
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研究背景及目的
本研究以醫療服務品質、病患滿意度,及就醫忠誠度為研究主軸,以瞭解血液透析病患選擇治療機構之重要考量因素。本研究共擬定四個研究目的:(1) 瞭解血液透析病患,對選擇血液透析治療機構之醫療服務品質、病患滿意度,以及就醫忠誠度等因素,應包含哪些重要因素?;(2) 探討不同診所之血液透析病患,對選擇血液透析治療機構之醫療服務品質、病患滿意度,以及就醫忠誠度等因素之看法是否有差異?;(3) 瞭解血液透析病患對醫療服務品質、病患滿意度,以及就醫忠誠度等因素之看法是否會受到個人因素、罹病因素、透析現況,以及外在環境因素之影響?;(4) 瞭解影響血液透析病患就醫忠誠度之重要影響因素。

研究方法
本研究採橫斷性研究設計,採用立意抽樣方式,運用自擬式結構問卷,以高雄市四家血液透析診所病人為研究母全體進行匿名調查,本研究共發放500份問卷,回收300份問卷(回收率60%),其中有效問卷為 294 份。本研究使用SPSS 27.0 版統計分析軟體作為分析工具,應用建構信度與效度分析進行問卷檢測工作,以獨立樣本T檢定、單因子變異數分析,以及直線迴歸等方法進行資料分析與驗證假說工作。

研究結果
本研究擬定之研究工具,經建構信度與效度驗證後得知,可用來驗證本研究所提出之研究假設。資料分析與驗證假說工作,發現:(1)不同診所之血液透析病患,對於選擇血液透析治療機構之醫療服務品質、病患滿意度,以及就醫忠誠度等因素確實有不同感受。(2)罹患高血壓之血液透析患者與家庭支配所得這兩個因素,會顯著影響研究樣本對醫療服務品質、病患滿意度,以及就醫忠誠度之看法。(3)迴歸分析結果發現,血液透析病患之就醫忠誠度,會顯著受到醫療服務品質與病患滿意度之影響。

結論與建議
本研究發現提升血液透析醫療服務品質,不僅能增進血液透析診所之經營效率,同時亦能因滿足血液透析病患之醫療需求,進而建立高滿意度之服務口碑,創造血液透析病患之就醫忠誠度。本研究建議後續研究可進行跨縣市比較,不僅可擴大樣本數,同時亦可驗證本研究之結果是否具有外推性。

Background and Purpose
This study takes medical service quality, patient satisfaction, and medical loyalty as the main research axis to understand the important consideration factors for hemodialysis patients to choose hemodialysis institutions. This study proposes four research purposes: (1) To understand what are the important factors about selection of hemodialysis institutions from the three axes of medical service quality, patient satisfaction, and medical loyalty for the hemodialysis patients?; (2) To understand the difference of these factors between the patients in different hemodialysis institutions?;(3)Will questionnaire results be affected by personal factors, disease factors, dialysis status, and external environmental factors?; (4) To Understand the important factors that affect the loyalty of hemodialysis patients.

Method
This study adopts a cross-sectional research design, adopts the intentional sampling method, uses self-made structural questionnaires, and conducts an anonymous survey with patients from four hemodialysis clinics in Kaohsiung City as the research population. A total of 500 questionnaires were sent out in this study, and 300 questionnaires were recovered (recovery rate 60%). Finally, there are 294 valid questionnaires. This study uses statistical analysis software of SPSS version 27.0, construct reliability and validity analysis for questionnaire testing, independent sample T test, single factor analysis of variance, and linear regression for data analysis and hypothesis verification.

Results
The research tools can be used to verify the research hypotheses after construction reliability and validity verification. After data analysis and hypothesis verification, we find that: (1) Patients in different hemodialysis clinics have different feelings about the quality of medical services, patient satisfaction, and medical loyalty when choosing a hemodialysis institution. (2) The two factors of hemodialysis patients suffering from hypertension and family disposable income will significantly affect the results of the quality of medical services, patient satisfaction, and medical loyalty. (3) The results of regression analysis found that the loyalty of hemodialysis patients will be significantly affected by the quality of medical services and patient satisfaction.

Conclusions
This study showes that to improve the quality of hemodialysis medical services can not only improve the operating efficiency of hemodialysis clinics, but also meet the medical needs of hemodialysis patients, thereby establish a high-satisfaction service reputation and creat medical loyalty for hemodialysis patients. This study suggests that follow-up studies can conduct cross-county comparisons, not only to expand the sample size, but also to verify the extrapolation.

致謝 I
摘要 II
ABSTRACT IV
目錄 VI
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 4
第三節 研究流程 5
第二章 文獻探討 6
第一節 簡介血液透析與場域實務運作 6
第二節 病患選擇治療機構之相關影響因素 10
第三節 血液透析之醫療服務品質 16
第四節 血液透析之病患滿意度 20
第五節 血液透析病患對機構之忠誠度 26
第三章 研究方法 32
第一節 研究架構 32
第二節 研究假說 33
第三節 研究樣本與資料收集 35
第四節 收案診所之概況 36
第五節 研究工具 38
第六節 研究變項定義 43
第七節 資料處理與統計分析 47
第八節 倫理考量 49
第四章 研究結果 50
第一節 研究樣本之個人因素、罹病因素、透析現況及外在環境因素描述性統計 50
第二節 問卷建構信度分析 65
第三節 問卷建構效度分析 68
第四節 問卷內容之相關分析 71
第五節 差異性分析 76
第六節 單因子變異數分析 86
第七節 迴歸分析 90
第五章 討論 95
第一節 血液透析病患選擇治療機構之相關影響因素討論 95
第二節 不同診所之血液透析病患選擇治療機構之看法差異討論 98
第三節 血液透析病患選擇治療機構之相關影響因素是否會受到個人因素、罹病因素、透析現況,及外在環境因素之影響討論 104
第四節 血液透析就醫忠誠度之影響因素討論 108
第六章 結論與建議 109
第一節 結論 109
第二節 研究限制與建議 112
英文文獻 113
中文文獻 119
網路參考資料 120
附錄 121
附錄一: 人體試驗研究新案審查委員會同意證明書 121
附錄二: 探討血液透析病患選擇治療機構之相關影響因素問卷 122


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網路參考資料
糖尿病、消化系統和腎臟疾病國家研究所https://www.niddk.nih.gov/

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