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博碩士論文 etd-0706116-175948 詳細資訊
Title page for etd-0706116-175948
論文名稱
Title
基層醫療院所滿意度分析之研究-以骨外科病人為例
A Study of Patient-Reported Satisfaction Toward the Services of Primary Clinics-Using Orthopedic Patients as Examples
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
73
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2016-05-10
繳交日期
Date of Submission
2016-08-07
關鍵字
Keywords
病人滿意度、醫療服務、醫療品質、基層診所、骨外科診所
Quality of care, Patient-reported satisfaction, Orthopedic Clinics, Primary clinics, medical service
統計
Statistics
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中文摘要
本研究主要探討基層醫療院所滿意度分析,以個案骨外科診所門診及復健病患為抽樣問卷對象,進行問卷調查,並透過比較各種就醫滿意度因素,來得知個案診所病患滿意度因素,並進一步將不同屬性病患與就醫滿意度加以比較,可提供基層醫療院所(含個案骨外科診所)作為經營策略上之參考。病人滿意度在近幾年已發展為多面向的結構;這意謂著病患可能對某一構面有相當高度的滿意度,但對其他的的構面則未必,甚至可能是很低的滿意度(Susan & Robert,1999)。對醫療產業而言,病患滿意度可視為衡量醫療品質的重要評估指標(Donabedian, 1996)。而現今醫院所採用的醫療服務品質衡量構面大多都是以Donabedian(1988)所提的『結構-過程-結果』三構面來衡量醫療服務品質。
本研究透過個案骨科診所進行問卷調查,對病患就醫滿意度因素進行研究,以平均值排序及成對樣本T檢定得出以下結果:依診所結構面而言,病患滿意度前五名依序為診療器具、醫師醫術、環境清潔、復健儀器、和復健師復健技術;滿意度最低的兩名為外觀和認識診所的人。依過程面而言,病患滿意度前五名依序為醫師仔細解說病症、 可以與醫師相互談論病情,醫師都會專注聆聽、醫師會提供所有可能的醫療檢查或檢測,以及醫師和復健師很清楚的解釋治療與用藥、復健的目的;滿意度最低的兩名為復健等候時間合宜和門診等候時間合宜。依結果面而言,病患滿意度前五名依序為復健後疼痛已有明顯改善、看病後病情已有明顯改善、復健後對於肌力已有明顯改善、復健後對於肢體關節活動已有明顯改善,以及就醫及諮詢方便性佳;滿意度最低的兩名為醫療費用和復健費用。
本研究進一步依病患人口統計變項及就醫背景,使用獨立樣本T檢定及變異數分析,探討就醫滿意度因素,依診所就醫滿意度結構面而言,在性別、年齡、婚姻狀況、教育程度和家庭年收入有部份問項有顯著差異;在就醫背景方面,則初複診、就醫來源、交通工具和交通時間有部份問項有顯著差異。依診所就醫滿意度過程面而言,在年齡、婚姻狀況、教育程度、職業和家庭年收入有部份問項有顯著差異;在就醫背景方面,交通工具、交通時間有部份問項有顯著差異。依診所就醫滿意度結果面而言,在職業有部份問項有顯著差異;在就醫背景方面,在交通工具有部份問項有顯著差異。
Abstract
For medical industry purposes, patient satisfaction can patient-reported satisfaction toward the services of primary clinics, with special focus on orthopedic patients. Questionnaire are issued to orthopedic patients of a target orthopedic clinic. Through comparison of various physician satisfaction factors, we hope to identify the critical clinic patient satisfaction factors. The results are expected to provide primary health care institutions with directions for their business strategy planning.
Patient satisfaction in recent years has developed into a multifaceted structure. For medical service quality evaluation and research methods, we follow the satisfaction model proposed by Donabedian (1988) and focus on three facets, namely process, structure, and outcome.
We report the result of orthopedic medical care satisfaction factors by employing average values and paired sample T test. In the structure facet, the top five factors of patient satisfaction are medical equipment, medicine physician, clean environment, rehabilitation equipment, and rehabilitation division rehabilitation technology, whereas clinic appearance and acquaintance of clinics people are among the lowest patient satisfaction. In the process facet, the top five factors of patient satisfaction are the detailed explanation of patients’ condition, well interaction with the physician on the discussion of patients’ disease, physician’s attention on patients, supply of all possible medical examinations or tests, and detailed explanation of treatment, medication, and rehabilitation purposes, while rehabilitation waiting time and outpatient waiting time top the list of dissatisfaction factors. In the outcome facet, the top five satisfaction factors are pain relief after rehabilitation, symptom reduction after treatment, muscle strength improvement after rehabilitation, limb and joint activities improvement after rehabilitation, and convenience of medical care and counseling, with medical expenses and rehabilitation costs being the two lowest satisfaction factors.
This research also conduct independent sample T test and analysis of variance to compare the dependence between demographic variables/background of patients and medical care satisfaction factors. We find that in the structure facet, gender, age, marital status, education level, household income, first or second visit, medical sources, transportation, and travel time have significant differences. In the process facet, age, marital status, education level, occupation, household income, transportation, travel time, these questionnaire items have significant differences. Finally, in the outcome facet, occupation, background, and transportation have significant differences.
目次 Table of Contents
論文審定書 i
誌 謝 ii
中文摘要 iii
英文摘要 iv
目 錄 v
圖 次 vi
表 次 vii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 研究流程 3
第四節 研究架構 5
第二章 文獻探討 6
第一節 醫療服務業方面 6
第二節 醫療滿意度相關文獻 8
第三章 研究設計 12
第一節 研究架構 12
第二節 變數之操作性定義與衡量 12
第三節 問卷設計 14
第四節 抽樣設計 15
第五節 資料分析方法 15
第四章 實證結果分析 17
第一節 樣本資料分析 17
第二節 診所各構面因素之萃取與信度分析 22
第三節 就醫滿意度各構面差異分析 25
第四節 病患特性於診所就醫滿意度各構面之差異分析 32
第五章 結論與建議 56
第一節 研究結論 56
第二節 研究限制與建議 57
參考文獻 58
附錄 62
參考文獻 References
一、 中文部份
李旻貞,1996,全民健康保險基層醫療服務品質之研究-以病人滿意度為評估方法,陽明大學衛生福利研究所碩士論文。
李宏滿、趙明玲,2009,骨科門診病人之滿意度及其相關因素探討,新生學報,第五期,頁21-36。
吳萬益 林清河,「企業研究方法」,華泰書局出版,2000年。
林恆慶、陳楚杰,2003,管理式醫療用來控制醫療品質的方法介紹,醫院雜誌,第三十六卷第一期,頁1-10。
林進財、周瑛琪、郭亭玉,2001,一般民眾對醫院行銷公關認知之研究,醫護科技學刊,3(4),頁350-357。
張嫚娜、張志明、蕭娜足,2006,某醫院門診病患滿意度分析,醫院,第三十九卷第六期,頁34-45。
洪陵鎧,2007,影響病人忠誠度之研究,國立東華大學企業管理研究所碩士論文。
張換禎 張秉庠,「醫療行銷管理學」,華杏出版股份有限公司,2005年1月出版。
陳楚杰,「醫院組織與管理」,宏翰文化,2003年9月出版。
陳順宇,「多變量分析」,華泰書局,1998年。
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,第十八卷第四期,頁287-297。
黃琡珺、王琪雅,2009,門診醫療服務品質量表之建構,行銷評論,第六卷第二期,頁221-248。
詹定宇、詹麗珠,2005,等待者特性對等待品質評價之影響-以醫院中之等待線為例, 管理評論,第二十四卷第一期,頁83-108。
蔡文正、龔佩珍,2003,民眾對基層診所評價與就醫選擇影響因素,台灣公共衛生雜誌,第二十二卷第三期,頁181-193。
劉美玉、許輔宸、郭素娥、張肅婷,2008,門診病患滿意度之分析探討,Chung Shan Medical Journal,第十九卷,頁209-220。
謝淑敏,2010,區域醫院骨科住院服務品質滿意度之研究─以中部某區域醫院為例,國立彰化師範大學企業管理學系國際企業經營管理研究所碩士論文。
謝溫國,2001,利用品質機能展開法解析醫院的服務品質要素與其系統化之研究─以中部某區域醫院為個案, 醫務管理期刊,第二卷第四期,頁86-107。

二、英文部份
Brewster, A. C. and Bradbury, R. C. (1988). “Hospital quality control: A key to competitive health plans. ” In P. Boland (ed.), The New Healthcare Market pp.106-115.
Brook R. H. and Lohr K. N. (1987), ”Monitoring quality of care in the Medicare program,” Journal of American Association,” Vol 258 No21 Dec,pp.3138-3141.
Churchill,G.A. (1979).”A Paradigm for Developing Better Measures of Marketing Constructs.”Journal of Marketing Research,16:pp.64-73.
Donabedian, Avedis (1978), “The Quality of Medical Care,” Science, Vol. 200, 26 (May).
Donabedian A. (1980)”The definition of quality and approaches to its management.Explorations in quality assessment and monitoring”. Ann Arbor, Mich, Health Administration press, Vol 1.
Donabedian, A. (1988)" The Quality of Care : How Can It Be Assessed? " The Journal of the American Medical Association , Vol.260, No. 12, pp. 1743-1748.
Donabedian, A. (1996),”Evaluating the Quality of Medical Care”, Milbank Memorial Fund Quarterly, 16(6), pp.206-216.
Ford, Robert C., Bach, Susan A. & Fotterler, Myron D, (1997), "Methods of Measuring Patient Satisfaction in Health Care Organizations", Health Care Manage Rev., 22(2),Aspen Publishers, Inc pp.74-89.
Hair J F., Anderson, R. E., Tatham, R. L. and Black, W. C.2006.”Multivariate Data Analysis with Reading 6rd”Printice Hall.
Handelsman, Sharon Faith (1991), “An Investigation of Determinants that Influence Consumer Satisfaction with Inpatient Health Care Encounters (Patient Satisfaction) “, Unpublished Dissertation, Rush University.
Hulka, B. S., & Cassel, J. C. (1973), “The AAFP-UNC Study of the Organization Utilization and Assessment of Primary Medical Care”, American of Public Health, 63(6),pp. 494-501.
Hyde, P. C. (1986), “Setting Standards In Health Care”, Quality Assurance, 12(2), pp.57-59.
Jones, T. O. & W. E. Sasser (1995), "Why Satisfied Customers Defect," Harvard Business Review, 73 (6), pp.88-99.
Juran, J. M. (1986), “Universal Approach to Managing for Quality”, Quality Propress, 19, pp. 10-24.
Kaiser, H. (1958), “The Varimax Criterion for Analytic Rotation in Factor Analysis,”Psychometrika, Vol. 2, pp.187-200.
Kotler, P., 2003, Marketing Management, 11th (Ed.), Upper Saddle River, NJ:Prentice- Hall.
Lehtinen, U., & Lehtinen, J. R. (1982), “Service Quality: A study Quality Dimensions”,Unpublished Working Paper Helsinld. Finland OY: Service Management Institute.
MacStravic, R. S. (1987) Loyalty of Hospital Patients:A Vital Marketing Objective, 107 Health Care Management Review, 12(2) : pp.23-30.
Mechanic, D.1978 Medical Sociology, 2nd ed. New York: Free Press
Oliver, R. L. and Bearden, W. O., 1985, Disconfirmation Process Consumer Valuations in Product Usage, Journal of Business Research, 13(3), pp.235-246.
Robinson, J. P. and P. R. Shaver (1973), Measures of Psychological Attitudes, Ann Arbor,MII: Survey Research Center Institute for Social Research, University of Michigan..
Robinson, J. P., P. R. Shaver, and L. S. Wrightsman (1991), “Criteria for Scale Selection and Evaluation,” in Measures of Personality and Social Psychological Attitudes, J. P.
Robinson, P. R. Shaver, and L. S. Wrightsman (eds.). San Diego, Calif.: Academic Press.
Stratmann, W . C.,(1975),”A Study of Consumer Attitude about Health Care”:The Delivery of Ambulatory Services,Medical Care,13(7),pp.537-548.
Susan E Roush & Robert J Sonstroem,(1999)”Development of the physical therapy outpatient satisfaction survey”. Physical Therapy, 79(2), pp.159-170 .
Vuori H,(1987)”Patient satisfaction-an attribute or indicator of the quality of car?” QRB, March pp.106-108.
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