台灣長期照顧管理中心運作現況與相關因素探討：以 Donabedian 模式為例
Operation of Long Term Care Management in Taiwan : Using Donabedian Model
中文摘要
論文摘要
論文名稱：台灣長期照顧管理中心運作現況與相關因素探討：以 Donabedian 模式為例
研究所名稱：臺北醫學大學護理學研究所 研究生姓名：曾慧姬
畢業時間：九十七學年度第一學期
指導教授：陳靜敏 臺北醫學大學護理學院教授
本研究以 Donabedian 模式分析台灣長期照顧管理中心運作現況與相關因素，研究目的是以照 顧管理專員的觀點，瞭解我國長期照顧管理中心在結構、過程及結果層面之執行現況，並探討相 關因素之影響。採橫斷式相關性研究設計，以台灣 25 縣市長期照顧管理中心的照管專員，排除 無訪視經驗者為收案對象。共寄出 253 份問卷，實際回收有效問卷 196 份（回收率 77.47％）。 研究工具乃為自擬結構式問卷，具良好專家內容效度（專家內容效度值為 .82 以上）及可接受 信度（Cronbach’s Alpha 值介於.55-.93 之間），研究結果以 SPSS15.0 套裝軟體進行分析。
研究對象平均年齡為 32.13 歲；性別以女性佔 94.4％居多；婚姻狀況則以未婚佔 52.6％；將 25 縣市區分為北區、中區、南區及東區，其中以南區 39.8％居多。在人員素質中，教育程度 以大學佔 85.7％、實務經驗平均為 6.61 年、專業背景以護理佔 79.6％、在目前所服務的長期 照顧管理中心的平均年資為 17.39 個月、薪資來源以衛生署 80.6％為多、主要負責業務是照顧 管理佔 95.9％、職缺以臨時人員佔 66.3％為多。以 Donabedian 模式測試運作現況，以結構、
過程與結果面的相關性及照顧管理專員不同的背景資料對於長期照顧管理中心在結構、過程及結 果面的影響，以 t 檢定、單因子變數分析、卡方檢定、皮爾森積差相關及邏輯式迴歸來分析，結 果說明如下：整體結構面與工作困擾感受有呈現顯著正相關（r＝ .48, p< .01）；結構面的組 織架構（r＝ .49, p< .01）、設備（r＝ .20, p< .01）、資源種類（r＝ .33, p< .01）與工 作困擾感受均呈現顯著正相關。整體過程面運作現況與工作困擾有呈現顯著正相關（r＝ .23, p< .01）；過程面的個案管理過程（r＝ .18, p< .05）、組織運作（r＝ .18, p< .05）、運用 媒體傳銷（r＝ .22, p< .01）與工作困擾均呈現顯著正相關。顯示在結構面的組織架構中人員 編制是足夠的、組織章程是明確清楚，在設備的部份是充足及資訊化是完善的，加上資源種類多 元且充足，即會使照管專員在感受工作困擾程度較低。以留任意願與結構、過程及結果面相關因 素之邏輯式迴歸分析，顯示留任意願與整體結構面（β＝ .58, p< .009）是有相關的。故長期 照顧管理中心在結構、過程與結果面向三者皆呈現相關性，與本研究之研究假設相符，且能符合 Donabedian 模式之預測。
研究發現照管專員感受的工作困擾以資源與政策的平均得分較低，可能是長期照護十年計劃才剛 開始推動，人員對於政策的部份並不清楚，此次只是對於長期照顧管理中心運作現況的初步探 討，且有許多照顧管理專員是新加入長期照顧管理中心，其服務的年資很短，建議在推展一段時 間之後，人員能了解整個政策時，針對工作困擾再做更深入的探討，並且能與此次研究結果做比
較。
關鍵詞：照顧管理專員、Donabedian 模式、工作困擾
英文摘要
Title of Thesis: Operation of Long-Term Care Management Centers in Taiwan: Using Donabedian Model
Institution: Graduate Institute of Nursing, Taipei Medical University Author: Tseng, Huei- Chi
Thesis directed by: Chen, Ching-Min, RN, DNS, Professor
This paper analyzed the long-term care management center current operation in Taiwan and the correlation factors with Donabedian model. The purpose of the study would like to understand the long-term care management center’s operational situation in the structure, the process and the outcome from care manager’s viewpoint, and discussed the effects of correlation factors. The cross-sectional, correlation research design was used. Target population of this study was all care managers in the long-term care management center of 25 cities in Taiwan which excluded no practical experience of members. A total of 253 questionnaires were posted, however, 196 valid returned(response rate:77.47%). The research
instruments were self developed with acceptable content validity for good experts (CVI > .82) and internal consistency ( Cronbach’s Alpha= .55~ .93). The outcomes were analyzed by SPSS15.0 software.
The object of study average age is 32.13 years old; the sex was 94.4% majorities for the female; the unmarried was 52.6%; divided four areas by 25 cities, east, south, west and north area, among others south area 39.4% majorities. In the personnel quality, the education level 85.7% was graduated from university; the average age of practical experience was 6.61 years; the specialized background was 79.6% as nurses; in the long-term care management center average period of service which present serves as 17.39 months, the salary 80.6% came from the Department of Health, the principal service was concerned the care management 95.9%, unofficial staff was 66.3%. By Donabedian model tested current operation situation for the structure, the process and the outcome which the correlation
between different background staff and effects in the long-term care management center, by the t-test, one-way ANOVA, Chi-square, Pearson correlation and logistic regression analyzes. The result was as follows: The overall structural aspect and the work puzzle feeling had the positive correlation (r= .48, p< .01); the structural aspect organization construction (r= .49, p< .01), the equipment (r= .20, p< .01), the resources type (r= .33, p< .01) and the work puzzle feeling has the positive correlation. The overall process aspect of operation result and the whole work puzzle had the positive correlation (r= .23, p< .01); the process
aspect''s case management (r= .19, p< .05), the organization
operation (r= .18, p< .05), using the media marketing and the work puzzle had the positive correlation (r= .22, p< .01). Showing the staff of structural organization was enough; the organization regulation was clearly, the equipment was sufficient and the information was perfect, in addition resources type was diversiform and sufficient, that would make care managers the lower in work puzzle. The willing of continued service and the structure, the process and logical equation of regression analyzed the outcome and its correlation factors, showing the willing of continued service and the structure (β= .58, p< .009) had related. Therefore, the long-term care manage center in the structure, the process and the outcome presented the correlation that matched with this research, and can conform to forecast of the Donabedian model.
This study discovered care managers’ work puzzle from the lake of resources and the policy unclear which average score was low, maybe it just now start to promote ten-year-long-term care management, the staff was unclear about the policy, this only regarding the long-term care management center current operation discussed preliminary and many care managers joined that who a period of service was short-term, we suggested that the staff understand the entire policy after
promotion a period of time, making a more thorough discussion again in view of the work puzzle and compared with this outcome.
Keywords: care management , work puzzle, Donabedian model
