| 摘要: | 本計畫為「國科會優秀年輕學者研究計畫」
從2003 年因SARS 事件下，健保局所啟動的家庭醫師整合性試辦計畫所成立的社 區醫療群嘗試提供民眾整體性的初級醫療與預防保健服務。然過去的研究仍缺乏從民 眾健康角度著眼來了解社區醫療群介入的成效評估。因此，以台灣家庭醫師整合性試 辦計畫之社區醫療群為例，本研究擬提出為期四年的研究計畫，擬以「社區、社會、 組織與健康」為研究架構，期望完成以下研究目的： 1. 以社區、社會與健康模式，了解會員民眾與非會員民眾的健康差異與 其相關影響因素； 2. 以社區、社會、組織與健康模式，了解各社區醫療群整體會員健康差 異與其相關影響因素； 3. 以社區、社會、組織與健康模式，分類社區醫療群運作型態，並提出 各類社區醫療群的策略管理建議； 4. 探討會員與非會員民眾對基層醫療服務就醫途徑選擇決策因素。 本研究結果可以了解家庭醫師整合性試辦計畫介入及各醫療群運作之成效、提出各 醫療群整合互動之特定改善策略方案；以及了解民眾在基層醫療選擇就醫決策模式之有 效及適當政策介入模式或方案。 本研究計畫擬針對家庭醫師整合性試辦計畫下之中區96 群社區醫療群為研究對 象，擬以自行發展之結構式問卷涵蓋社區環境、社會資本，以及民眾健康等構面進行 會員民眾與非會員民眾問卷調查(共51,800 位)；並以自行發展的結構式問卷涵蓋社區 醫療群夥伴組織運作構面來進行機構夥伴問卷調查(計581 家診所及32 家合作醫院)。 另外，相關社區環境資源、社區醫療群組織特性等二級資料亦將同時由本研究蒐集後 進行資料佐證與匯集。本研究將採用多層次結構方程式、結構方程式、群集分析、觀 念地圖等研究分析工具，分析軟體包括微軟辦公室軟體、SPSS、Mplus 與AMOS 等統 計軟體。
The SARS epidemic challenged Taiwan public health and the healthcare system in Spring 2003 and Primary Community Care Networks (PCCNs) were the product of primary care health reform in Taiwan. Few studies have been devoted to evaluating the effectiveness of PCCNs from the human health perspective. Under the PCCN intervened nationwide as a demonstration project, this study will aim to explore four major themes with a community-society-organization-health as conceptual framework: 1. to explore the health differentiations between the member and non-member patients and the determinants within the PCCNs, using the community, society, and health perspectives; 2. to explore the health differentiations of member patients and the determinants across the different PCCNs, using the community, society, organization and health perspectives; 3. to categorize the modes of PCCNs from the community, society, organization and health perspectives and propose the strategies for their future performance; and 4. to explore the psychological decision making pathways of primary care visits for member and non-member patients. The findings will beneficial to understand the determinants of people health, the effectiveness of PCCNs, the strategic actions of PCCNs for improvement, and people psychological decision making pathways of primary care visits for policy interventions in the future. Ninety-six PCCNs in the middle Taiwan will be included in this study. Developed, structured, and validated questionnaires covering the constructs of community environment, human social capital, and health outcomes will be released to 51,800 member and non-member patients. Also, developed, structured, and validated questionnaires covering the constructs of organizational integration and characteristics will be released to 581 PCCN clinics and 32 PCCN hospitals. Secondary data about the communities and organizations will be collected to validate and merge with the primary data in this study. Multi-level structural equation modeling, structural equation modeling, cluster analysis, concept mapping analysis will be performed by the relevant statistical and office software including SPSS, Mplus, and AMOS. |
