利用Rasch測量分析2004年臺灣老人福利機構評鑑指標之研究

asch Analysis of Accrediation for Taiwan's Elderly Welfare Institutes in 2004

老人福利法第13 條規定í 主管機關對老人福利機構應予輔導、監督及 評鑑。」醫院評鑑規範有醫院應加強與社區內其他醫療機構或長期照謹醫療 機構、社會福利機構等問之合作。 為增進對長期照謹醫療機構的瞭解，也為對改革中的醫院評鑑制度提供 改善意見，本研究利用Rasch （1960） 測量客觀等距的特性，分析2004 年內政 部所屬老人福利所複評131 家機構的評鑑資料，將三類受評機構的評分表，合 併成為統一的評分標準，進行（1）評鑑指標的單一向度檢測； （2） 排名各機 構的能力水準； （3） 各層級機構在各評鑑指標上的反應情形； （4） 對個別受 評機構異常指標的評鑑報表呈現。 結果擷示118 個指標中，醫療距離之指標得分皆相同而不予列計外，刪 除收容個案符合機構服務能力水準及外展服務努力及貢獻的二個指標不合 Rasch 模式（ infit超出0.6 及1. 4 範固） ，而符合單一向度指標共有115 個，信度 達0.91 0 小型機構在設備添購及參與社區上呈現困難，安養機構在個案研討 與失禁如廁二指標上呈現達成不易，養謹機構在SARS 測量體溫上表現優異， 安養機構在廚師表現與寢室人數二指標表現傑出。整體上以小型機構表現最 佳，養謹及安養機構間沒有統計顯著上的差異。 Rasch 分析評鑑資料，可以提供更多的訊息。不單只是關心受評機構間的 排名，或是受試者樣本間的差異，也關心受試者對試題指標間的反應情形， 更是關切各受評者在不同能力水準下的「應表現好而未表現好、或未預期表現好卻是表現好」的地勵功拔。也更能客觀對歷次評鑑分數上做縱斷面的長 期分析與比較。

Taiwan's elderly welfare law stipulated that authorities should be supervised and accredited periodically. Hospital accreditation standards also emphasized relevant long-term healthcare institutes on mutual communications and collaborations in communities. In order to pay more understanding on long-term healthcare institutes and improving hospital accreditation on the reform, Rasch measurement was used in this study to analyze data from a total of 131 institutes in 2004 and to combine separated scoring sheets into a single one attempting at (1) examining indications fitting a unidimensionality, (2) ranking institutes on ability strata, (3) responding changes across items on institute hierarchy, and (4) reporting unexpected strings for individual examinee institute. Results were shown that the indication of distance apart from hospitals was dropped owing to the score identically endorsed. Two indications of case treated appropriately and outside service rendering were deleted due to misfit Rasch model's expectation (infit statistics beyond the range of 0.6 and 1.4). The remaining 115 items were deemed to construct a unidimensionality. Persons reliability (similar to Cronbach's ) was reached to 0.91. Small institutes suffered difficulties in equipment acquirement and community participation which diffientated those of elder care institutes in case study and Urinary Incontinence treatment. Body temperature examination in SARS period was excellantly performed by elder healthcare institutes.