醫學科學進步與照護品質提升產生「高齡化社會」問題；而資訊技術與照護服務結合，更進一步發展出遠距照護服務。Roger（1995）創新擴散理論與Attewell（1992）均提出新技術導入機構時需克服知識障礙問題，以使新技術成為常規化運作。本研究目的旨於（1）瞭解我國長期照顧機構採用遠距照護服務之現況；（2）探討長期照護機構採用遠距照護的知識障礙為何；（3）探討知識障礙對於長期照顧機構採用遠距照護服務的影響。本研究使用衛福部公告之長照機構名冊，以地區別分層比例抽樣500家機構作為研究樣本，以郵寄問卷方式進行調查，有效回收251份問卷，有效回收率為50.2%。以SPSS19.0進行信效度、描述性統計分析、獨立樣本t檢定、單因子變異數分析；Smart PLS2.0進行模式檢測與假說驗證。研究結果得知，高達七成二之長照機構對於採用遠距照護暫無意願，僅1.3%的長照機構目前有採用遠距照護。長照機構採用遠距照護時遇到最大的知識障礙為「法令規章」、「財務障礙」與「資訊安全」等。將知識障礙構面與控制變數同時納入PLS結構模型，得知整體模型解釋力為51.2%，表示本研究模型解釋力良好。而知識障礙中，影響遠距照護採用最大者為專案知識障礙中的管理效益，其次為組織知識障礙中的品質改善與流程整合，最後為專案知識障礙中的法令規章。上述障礙均對長照機構採用遠距照護具負向影響。本研究建議長期照顧機構高層主管能優先支持機構推動遠距照護，並且由機構共同組成遠距照護推動小組，以因應機構採用遠距照護時能及時掌握知識障礙問題。遠距照護技術廠商亦可針對長照機構採用遠距照護前後進行相關研究計畫，讓長照機構能更清楚採用前後之品質改善差異，以提升其採用意願。機構依循漸進採用遠距照護，並定期進行檢討作業，即時掌握長照機構對遠距照護採用後的流程知識缺乏問題，降低其障礙以提升採用意願。最後在法令規章的部分，政府應妥善規劃周全的遠距照護相關法令規章，並與即將施行的長期照顧服務法做結合，更甚可將長照機構採用遠距照護服務納入尚在研擬之長期照顧保險中，得以使長照機構採用遠距照護時減低機構負擔。 The advancement of medical science and the improvement of the quality of care for the elderly have caused "advanced age society", and it is combined with the information technology and care services to further develop telecare services. Roger’s Innovation diffusion theory (1995) and Attewell (1992) proposed a new technology introduction mechanism to overcome the barriers of knowledge, so as to make the new technology become a routine operation. The purpose of this study aims to : (1)understand the status quo of telecare in Taiwan’s long-term care institutions. (2)discuss the knowledge barriers of telecare adoption in long-term care institutions. (3)how the knowledge barriers influence telecare adoption in long-term care institutions.The study uses stratified proportional sampling and selected 500 long term care institutions as the research sample, and conducted a survey by mailing questionnaires 251 questionnaires responded , with effective response rate of 50.2%. SPSS19.0 is used to do descriptive statistical analysis, independent sample t-test, factor analysis. Besides Smart PLS2.0 is used to build the model and test hypothese.Results show that 70% of the two long-term care institation haveno intentions to adopt telecare, only 1.3% of the long-term care have been adopting telecare. The largest barriers are "laws and regulations", "financial barriers" and "information security". R2 of the partial least square (PLS) model is 51.2%, showing good explanatory power of the model. The largest barriers influencing the telecare adoption are management efficiency of project knowledge barrers, and then the quality improvement and process integration of organizational knowledge barriers, following laws and regulations of project knowledge barriers. The knowledge barriers have negative inpact on telecare adoption are on long distance as gear mechanism.The study suggests that long-term care institutions executives can give priority to support organizations to promote telecare by builging ad hoc group for organizations. Manufacturers of telecare technology should conduct market research to realize the need of long-term care institutions to improve the quality of telecare and increase their willingness of adoption. The progressive telecare should be reviewed and knowledge the barriers should be solved in real time. The government should properly planned comprehensive telecare related laws and regulations, and combined with the Long-Term Care Service act to support telecare adoptions lastly long-term care insurance should be developed in the future so as to reduce the finamcial burden of telecare.
