護理之家機構特性與照護品質相關性研究

The Relationship between Facility Characteristics and the Quality of Care in Nursing Homes

本研究目的在探討護理之家機構性性（經營型態、規模、佔床率、護理人員護理時數、病患服務員照護時後）與照護品質（壓瘡率、跌倒率、轉／住至急性照護機構率、感染率、使用身體的束率）的相關性。參考Donabedian品質管理理論模式，採描述相關性設計，以隨機分層抽樣方式，自全台123家立案護理之家抽取39家，以郵寄結構式問卷方式共進行3個月的資料收集，計32家護理之家全程參與。以組織層級分析單位，採描述性統計及邏輯迴歸進行資料分析。結果顯示經控制民特性後，獨立型態護理之家比醫院附設型態護理之家傾向有低跌倒率與低感染率，且機構床位數大於45床者傾向有較高跌倒率。本研究結論是護理之家機構的經營型態及機構規模與機構所提供的照護品質（跌倒率及感染率）有關。討論與建議在文內有詳細描述。

The purpose of this study was to examine the relationship between the facility characteristics (ownership, size, occupancy rate, registered-nurse hours per patient day, nursingassistant hours per patient day) and the quality of care (pressure ulcer rate, falls rate, rate of transfer/discharge to inpatient acute care, infection rate, rate of use of physical restraint) in nursing homes. Based on Donabedian's quality management framework, a descriptive correlational design was used. Stratified random sampling was adopted to select 39 homes from 123 licensed nursing homes. Thirty-two nursing homes returned the structured questionnaires by mail over a three-month period. Data were analyzed using descriptive statistics and logistic regression at the organizational level. The results of this study revealed that after controlling for characteristics of residents, independent nursing homes had lower falls and infection rates than hospital-affiliated homes. Facilities with over 45 beds had higher falls rates. The study concludes that the ownership and size were associated with the quality of care (falls and infection rates) in nursing homes. Discussion and suggestions are described.