影響護理之家評鑑結果之因素研究：以2009年台灣首次全國護理之家評鑑為例

Factors Associated with the Outcome of Accreditation of Nursing Homes: Results from the 2009 Taiwan Nursing Home Accreditation Survey

10.6288/TJPH2012-31-02-03

蔡淑鳳(Shwu-Feng Tsay)；林育秀(Yu-Hsiu Lin)；梁亞文(Yia-Wun Liang)

長期照護 ； 護理之家 ； 評鑑 ； Long-term care ； nursing home ； appraisal

台灣公共衛生雜誌

31卷2期（2012 / 04 / 01）

119 - 132

繁體中文

目標：本研究旨在瞭解台灣一般護理之家評鑑結果，並探討通過評鑑之影響因素，作為護理之家經營者及評鑑制度未來修正參考。方法：本研究為一橫斷性研究，以2009年「台灣護理之家評鑑資訊網資料庫」之351家一般護理之家為研究對象，進行次級資料分析；本研究將評鑑結果「特優」、「優」及「甲」者定義為「評鑑通過」，再以邏輯斯迴歸探討影響評鑑通過之因素。結果：受評鑑的護理之家中有169家（48.15%）通過評鑑，182家（51.85%）未通過評鑑；邏輯斯迴歸分析發現，設立區域、經營所有權、規模、負責人教育程度、負責人角色、競爭程度及占床率顯著影響護理之家是否通過評鑑。結論：主管機關應加強輔導護理之家，提升健康照護、人員管理、經營管理及安全環境四面向；提供機構管理者完整務實的繼續教育，提升機構經營成效。護理之家負責人除積極提昇本身經營管理知能外，也應重新思考護理之家本身的市場定位及發展方向，審慎評估護理之家組織特質之適當性。

Objectives: This study examined the results of the Taiwan Nursing Home Accreditation Survey and analyzed the factors related to qualifications for accreditation. Methods: This was a cross-sectional study using data from the 2009 Taiwan Nursing Home Accreditation Survey Dataset. A total of 351 nursing homes were analyzed. Passing accreditation was defined as obtaining a rating of ”especially excellent”, ”first-rate”, or ”A-grade”. Multivariate logistic regression analysis was performed to identify factors associated with passing accreditation. Results: Among the 351 nursing homes appraised, 169 (48.15%) passed and 182 (51.85%) did not. Significant factors associated with passing were: region, ownership, scale, owner's educational background, owner's role, competition, and occupancy rate. Conclusions: Policymakers should help nursing homeadministrators improve their performance in the provision of care, treatment services, human resources, management, and environment of care, and provide comprehensive continuing education to assist administrators in improving operational efficiency. Nursing home administrators should develop their management skills and reconsider their market position, development, and structural appropriateness.

1. 梁亞文、王素美、李卓倫、林育秀、鄭瑛琳(2008)。出院準備服務病患入住機構式長期照護之相關因素探討。醫護科技學刊，10，1-14。
   連結：
2. 盧瑞芬、謝啟瑞(2003)。台灣醫院產業的市場結構與發展趨勢分析。經濟論文叢刊，31，107-53。
   連結：
3. 行政院經濟建設委員會：中華民國台灣97年至145年人口推計。台北：行政院經濟建設委員會，2008。Council for Economic Planning and Development, Executive Yuan. R.O.C.(Taiwan). Population Projections in Taiwan from 2008 to 2056. Taipei: Council for Economic Planning and Development, Executive Yuan. R.O.C.(Taiwan), 2008. [In Chinese]。
4. JCAHO. Joint commission nursing facilities achieve better outcomes brochure. Available at: http://www.jointCommission.org/Joint_Commission_Nursing_Facilities_Achieve_Better_Outcomes_Brochure/. Accessed April 2, 2011
5. 內政部社會司：慢性醫院、護理之家與老人福利機構功能比較表。http://sowf.moi.gov.tw/04/new04.asp。引用2010/12/01。Department of Social Affairs, Ministry of the Interior, R.O.C. (Taiwan). A comparison of the functions of chronic-disease service hospitals, nursing homes, and welfare institutions. Accessed December 1, 2010 [In Chinese]
6. 行政院衛生署：98年度「一般護理之家評鑑計畫」評鑑手冊。台北：行政院衛生署，2009。Department of Health. Executive Yuan. R.O.C.(Taiwan). An Operational Manual for the "General Nursing Home Accreditation Program"-2009. Taipei: Department of Health. Executive Yuan. R.O.C.(Taiwan), 2009. [In Chinese]。
7. 王順民：台灣老化速度世界第一。http://www.npf.org.tw/post/1/3021。引用2010/04/28。Wang SM. The rate of growth in the number of the aged in Taiwan is ranked first in the world. Avialable at http://www.npf.org.tw/post/1/3021. Accessed April 28, 2010. [In Chinese]
8. 行政院衛生署：醫療機構現況及醫院醫療服務量統計。台北：行政院衛生署，2011。Department of Health. Executive Yuan. R.O.C.(Taiwan). The Current Status of Medical Institutions and Statistics Regarding Hospital Medical Service Loading. Taipei: Department of Health. Executive Yuan. R.O.C.(Taiwan), 2009. [In Chinese]
9. Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Facts about long term care accreditation. Available at: http://www.jointCommission.org/facts_about_long_term_care_accreditation/. Accessed April 2, 2011
10. Banaszak-Holl, J.,Zinn, J. S.,Mor, V.(1996).The impact of market and organizational characteristics on nursing care facility service innovation: a resource dependency perspective.HSR,31,97-117.
11. Barter, M.,McLaughlin, F. E.,Thomas, S. A.(1997).Registered nurse role changes and satisfaction with unlicensed assistive personnel.J Nurs Adm,27,29-38.
12. Grant, R. M.(1991).The resource-based theory of competitive advantage: implications for strategy formulation.Calif Manag Rev,33,14-35.
13. Huang, P.,Hsu, Y. H.,Tan, K. Y.,Hsueh, Y. S.(2000).Can European external peer review technique be introduced and adopted into Taiwan's hospital accreditation system?.Int J Qual Health Care,12,251-4.
14. McLaughlin, F. E.,Barter, M.,Thomas, S. A.,Rix, G.,Coulter, M.,Chadderton, H.(2000).Perceptions of registered nurses working with assistive personnel in the United Kingdom and the United States.Int J Nurs Pract,6,46-57.
15. Noether, M.(1988).Competition among hospitals.J Health Econ,7,259-84.
16. 王雲東(2009)。行政院經濟建設委員會委託研究計畫行政院經濟建設委員會委託研究計畫,台北=Taipei:行政院經濟建設委員會=Council for Economic Planning and Development, Executive Yuan. R.O.C.。
17. 行政院經濟建設委員會人力規劃處(2009)。我國長期照護需求推估及服務供給現況。台灣經濟論衡，7，54-71。
18. 林淑綿、邱聖豪、程瑞婷、鍾翰其(2009)。2007年至2008年新治醫院評鑑「平均水準參考表」分析初探。醫療品質雜誌，3，59-64。
19. 林麗蟬、吳婉翎、翟文英(2010)。住民照顧衝擊：長期照護機構評鑑決策模式發展基礎。長期照護雜誌，14，125-35。
20. 胡月娟、郭淑珍、林豐裕(2007)。護理之家機構特性與訪查結果關聯性之探討。澄清醫護管理雜誌，3，19-28。
21. 范淑玲(2004)。台北=Taipei，國立陽明大學研究所=Institute of Community Health Nursing. National Yang-Ming University。
22. 許世凱(2004)。台北=Taipei，國立台灣大學國家發展研究所=Graduate Institute of Nationa Development, National Taiwan University。
23. 廖峰偉(2000)。台北=Taipei，國立台灣大學衛生政策與管理研究所=Department of Health Policy and Management, National Taiwan University。
24. 廖素娟(2007)。醫院評鑑制度對健康照護體系之影響。醫療品質雜誌，1，12-4。
25. 鄭讚源(2000)。社會需求、市場理念與非營利組織：小型養護機構經營管理的迷思與困惑。兩岸非營利組織與公共事務學術研討會，高雄=Kaohsiung:

1. 許碧峰(2020)。台灣住宿型長照機構之市場結構與品質誘因。商略學報，12(4)，269-283。