以德菲法建立醫院內部評估社區健康服務成效之指標

Setting Up Effect Indictors for the Internal Evaluation of Community Health Service within Hospitals by the Delphi Method

目的：本研究希望建構醫院內部評估社區健康服務之成效指標，以利瞭解醫院提供社區相關健康服務後，可能產生之效益作有效之評估。希望建構之評估指標包括社區健康服務回診之成效指標、社區健康服務個案回診滿意度之問卷指標，和社區健康服務個案未回診調查之問卷指標。方法：利用修正式德菲法(Delphi)，採二次專家問卷調查回覆後修正，建構社區服務成果評量指標。結果與建議：研究結果發現「社區健康回診成效指標」中，其中以參與社區健康服務總人數之回診比例與滿意度調查為專家認同最可行之評估社區成效之指標。「社區健康服務個案回診滿意度之問卷指標」，專家一致認同提供服務之第一線社區工作人員泰之服務態度為問卷指標中極具代表之重要構面，另自社區轉診醫院間之院內志工與轉診服務人員服務滿意度亦是民眾回診滿意度關鍵因素。「社區健康服務轉介個案未回診調查之問卷指標」，則以瞭解民眾未至醫院就醫之項目重要性最高。本研究建議社區服務指標之建構，應考量醫療環境政策以及醫院經營方向進行調整，視需求修正成效評估指標，另於轉介個案回診時，醫院提供細心接待與安排服務，可正面加深民眾對醫院印象，更可使民眾感動溫暖，對醫院產生信賴感，提升其整體醫療服務滿意度。

Purpose: In order to evaluate the effect on communities that results when health services are provided by hospitals, effect indicators for the internal evaluation of the Community Health Service were set up within hospitals. Effect indicators in the form of questionnaires were used. One was given to measure an individual’s satisfaction to the follow-up visits at the Community Health Service, and a questionnaire was also given to individuals who did not return for follow-up visits at the Community Health Service. Methodology: The Modified Delphi method and revision of the result through two professional questionnaires were used to evaluate the effect indicators of the Community Health Service. Conclusion and Suggestions: This study showed that the number of satisfied people returning for follow-up visits is the most feasible indicator to evaluate the effect of the Community Health Service. There was unanimous agreement from those who answered the questionnaire that the attitude of the community health center staff is the most important factor that contributes to an individual's satisfaction in regard to the follow-up visits to the Community Health Service. Also, the attitude of hospital volunteers and staff responsible for referrals from clinics to hospitals also plays an important role in the satisfaction that is felt by patients about follow-up visits. The questionnaire is given to individuals who do not return for the follow-up visits to the Community Health Service so that an understanding may be acquired of why patients tend not to go to hospitals when needed. The study results suggest that when establishing indicators of community service, the policies which govern the medical environment and daily hospital management should be taken into consideration when designing the effect evaluation indicator. Furthermore, when the referred patients return for follow-up visits, the hospitals should provide careful treatment and arrangements to the patients to give them a positive impression and convey a strong sense of competence and reliability, so as to increase their satisfaction with the overall medical services.