個案管理與醫院滿意度之關係探討——以台北某醫院為例

Exploring the relationship between case management and hospital patient satisfaction: an example of certain hospital in Taipei

目的： 本研究目的為探討個案管理介入後，個案管理民眾對醫院的滿意度及其影響因素。方法： 本研究自 101 年 3 月 1 日起至 101 年 10 月 30 日止。本研究個案同意接受個案管理並至少參與一場次運動與防跌、減重、戒菸或用藥安全課程，總共 350 人參與本研究。於介入 8 個月後，以問卷詢問對於本院之就醫忠誠度，藉此評估個案管理之成效。以「美國顧客滿意度指標」（ American CSI）模型為基礎發展自陳式結構性量表。問卷內容分為四大部分，分別為：本院的服務品質共 10 題，顧客的自覺價值共 4 題，顧客忠誠度共 4 題。本研究之資料分析方法包括描述性統計分析與結構方程模式進行驗證性分析。結果： 經本研究之個案管理介入後，社區民眾對醫院的滿意度及其影響因素。其主要發現為：接受個案管理個案之「顧客期望」與「顧客自覺價值」對於「服務滿意度」是有顯著影響。「顧客期望」對於「顧客自覺價值」亦有顯著影響。但是「顧客自覺價值」並不是「顧客期望」影響「服務滿意度」的關鍵因素。討論： 「顧客期望」與「顧客自覺價值」是醫院品質提升的重要指標，醫療知識突飛猛進，病人及家屬對醫療照護也有表達意見的權力，提昇病人對照護滿意度及節省醫療成本，個案管理照護模式值得積極推廣及建立。結論： 本研究所提出的研究模型與實證資料檢測後，應具有相當的信效度，顯示本研究所發展之研究模型應可接受，未來可應用於以醫院為基礎之服務滿意度檢測之參考。

Objective: The research investigated factors affecting hospital patient satisfaction after case management intervention. Methods: The research was conducted between March 1 and Oct 30, 2012. Participants agreed to receive case management services and attend at least one of the educational sessions on exercise and fall prevention, weight management, smoking cessation and drug safety. Three hundred and fifty people participated in the research. After an 8- month-long intervention, a questionnaire survey about hospital patient satisfaction was carried out to understand the effects of case management. The self-report questionnaire based on American Customer Satisfaction Index (ACSI) was conducted. The structural equation modeling was applied to perform confirmatory analysis. Discussion: Customer expectations and perceived value are also important quality indicators. While patients and families become more educated and conscious, they no longer stay at the passive end but would like to have their opinions respected. In brief, case management is a practice that contributes to patient satisfaction and cost containment. Results: Key findings suggested that after the intervention of case management, customer expectations and perceived value showed a significant effect on customer satisfaction; customer expectations had a significant effect on perceived value. However, perceived value was not a key factor affecting the relationship between customer expectations and customer satisfaction. Conclusions: The research model proposed in this study was found to be acceptable with adequate reliability and validity. Future research can benefit from the model in the examination of hospital patient satisfaction.