| 摘要: | 摘要 研究目的:本研究主要想藉由一個由理論衍生出的研究架構去檢測醫院增設居家照護單位之影響因素。 研究樣本：1998-2001年間評鑑合格之各級醫院，去除掉精神專科醫院、長期照護醫院、離島地區之醫院、有申請急性病床但未使用的醫院、以及在研究期間關閉的醫院一共438家。 研究設計：本研究屬於橫斷面(cross-sectional)之研究，以個別醫院為研究之單位。本研究設計希望定義出有可能會影響醫院增設居家照護單位之醫院特質以及外部環境之相關變項。 統計方法：本研究使用邏輯斯(logistic regression)回歸之統計方法來檢測影響醫院增設居家照護單位之相關醫院特質以及環境因素等變項。醫院特質變項包括：醫院評鑑等級、教學狀態、地區、醫院屬性、醫院急性病床數、專科數、住院天日、離院人次、手術人次、醫師數、護士數。環境因素變項包括：獨立型居家照護機構數、每千人醫師數、每千人護士數、家戶收入、家戶工作人數、老人人口比例、地方政府枝健康花費。 研究結果：研究結果發現醫院特質變項中僅教學狀態、醫院屬性、專科數、住院天日、離院人次與醫院增設居家照護單位有關。本研究中所有的環境因素變項都沒有統計上的顯著意義。 結論：醫院具有教學功能、擁有較多的專科數、屬於公立醫院、擁有較多的離院人次以及較少住院天日的醫院比較有可能去增設居家照護單位。; Abstract Objective. This study was aimed to test a theoretical model of the predictors of the establishment of hospital-based home care units in Taiwan. Sample. Four hundred and thirty-eight hospitals were identified from the Taiwan National Hospital Accreditation List (1998-2001) as studied hospital sample, excluding the psychiatric hospitals, chronic hospitals, hospitals located in the off-shore, hospitals without active acute beds, and hospitals closed in the study period. Study Design. This was a cross-sectional study using individual hospitals as unit of analysis. This study was designed to identify the factors that may influence hospital strategy, that is, the establishment of hospital-based home care unit. It was expected that relationships exist between hospital characteristics, and environmental factors, and hospital strategy. Methods. Logistic regression analysis was used to examine the effects of accreditation status, teaching status, location, ownership, hospital size, specialty complexity, inpatient days, discharge volume, surgery volume, physician availability, nurse availability, and the market-level factors such as home care facility concentration, physician concentration, nurse concentration, per capita income, employment, senior population, and county or city expenditure on the establishment of hospital-based home care units in Taiwan. Principal Finding. A hospital tending to establish its own home care unit was related to teaching status, ownership, specialty complexity, inpatient days, and discharge volume of the hospital characteristics in this study. None of the environmental factors showed statistically significant in this study. Conclusion. Hospitals with teaching function, more service lines, public owned, higher inpatients discharged, and less inpatient days were more likely to make strategy for establishment of hospital—based home care units. |
