| 摘要: | 背景：機構式服務不僅照護時間長，照護內容複雜，照護需求由「治療」轉為「治療與照護並重」，照護品質日益受到重視。台灣醫療照護品質指標系列THIS與台灣臨床成效指標系統TCPI對於醫療品質改善皆有顯著貢獻，並涵蓋長期照護指標，屬全國機構皆可參與的全國性品質指標監測系統。然而全國性的品質指標監測系統在一般護理之家之間尚未普及。
目的：1.調查我國一般護理之家採用全國性的品質指標監測系統之現況。2.探討一般護理之家採用全國性的品質指標監測系統的知識障礙為何。3.探討知識障礙如何影響一般護理之家對全國性的品質指標監測系統的採用意願。方法：對全台514家一般護理之家進行問卷調查，共回收125份有效問卷，有效回收率為25%。透過迴歸模型分析各變數對機構採用全國性的品質指標監測系統意願之影響。
結果：「財務知識障礙」、「組織知識障礙」及「行為知識障礙」對全國性的品質指標監測採用意願有顯著負向影響，影響依序為「組織知識障礙」、「行為知識障礙」、「財務知識障礙」。表示財務的籌劃、機構內部工作流程的調整與人力規劃，以及人員的心理調適是影響全國性的品質指標監測系統成功導入機構的關鍵因素。
結論：本研究結果顯示一般護理之家採用全國性的品質指標監測系統僅為20%，採用現況尚未普及。首先財務知識障礙問題，機構方與醫策會或醫務管理學會需共同訂定符合一般護理之家的收費標準。組織知識障礙問題，由高階主管帶領，組成推動全國性的品質指標監測系統小組，定期開會將工作流程及人力配置整合到最佳。最後，行為知識障礙問題，讓人員認識到需要改變，並進行培訓提高人員的技能。
Background：Institutional services not only take long time, but also complicated. The demand for care changes from “treatment” to “pay equal attention to treatment and care”. The quality of care is increasingly valued. Taiwan Healthcare Indicator Series, THIS and Taiwan Clinical Performance Indicator, TCPI significant contribute to medical quality improvement, and cover long-term care indicators. They are a nationwide quality indicator monitoring system that can be participated by all agencies. However, the national quality index monitoring system has not been widely used among general nursing homes.
Objective：1. Investigate the status of general nursing home using a national quality indicator monitoring system. 2. To discuss the knowledge barriers of the adoption of a national quality indicator monitoring system in general nursing homes. 3. Exploring how knowledge barriers affect the willingness of nursing homes to adopt a nationwide quality indicator monitoring system.
Methods：A questionnaire survey was conducted and 514 questionnaires were issued to general nursing homes in Taiwan, 125 valid questionnaires were returned, and the effective return rate was 25%. The model was tested by multiple regression analysis.Result：Economics
barriers, organizational barriers, behavior barriershave a significant negative effect on the willingness to monitor national quality indicators, in the order of organizational barriers, behavior barriers, economics barriers. Financial planning, internal work flow adjustment and manpower planning, and the psychological adjustment of personnel is the key factor affecting the successful introduction of the national quality index monitoring system into the organization.
Conclusions：The general nursing home uses a national quality indicator monitoring system accounted for 20%, revealing that the adoption is not yet popular. Economics barriers, the institution and the medical policy association or the medical management society must jointly set the fees for the nursing home. Organizational barriers, led by a senior executive and fully authorized, forming a group that promotes a nationwide quality indicator monitoring system, regular meetings to integrate workflow and manpower allocation to the best. Behavior barriers, let people realize that they need to change, and training to improve the skills of personnel. |
