隨著高齡化社會的來臨，慢性病及長期照護已成為主要的醫療型態，無線科技的進步，為居家照護個人提供一個新的服務與商業模式。本研究目的在分析遠距居家照護產業的產業結構以及產業環境，針對國外目前已實行的遠距居家照護計畫及個案作探討、比較，以了解遠距居家照護產業的發展現況，並找出此產業的競爭模式及發展趨勢之策略。研究的資料來源包括期刊、論文、專書，以及網路資料，利用文獻分析之次級資料分析法，以輔助遠距居家照護產業分析。研究採用Michael Porter的產業結構分析作為理論依據。分析結果發現遠距居家照護產業客戶的議價力高，同業競爭尚不激烈，供應商的議價力高，新進者的威脅中高，替代品的威脅中高。遠距居家照護新興產業特性包含技術、策略及政策上的不確定性，成本及經費補助上面臨困難，早期發展的限制與風險，尚未標準化的產品和技術等。遠距居家照護市場需求及產業規模大，有相當大的成長空間。目前台灣遠距居家照護產業有很好的發展機會及優勢，但也遭遇相當多困難包括產業發展起步晚、產品及技術吸引力不足等。因應策略包括降低客戶及供應商的議價力以提高產業進入障礙，採取低成本領導策略，尋求產品及服務內容差異化提高競爭優勢。政府應積極鼓勵遠距居家照護產業發展並儘早設立認證制度，以保障照護服務品質。本研究結果可供產業競爭策略及發展之參考。 / As the elderly population increased in the 21 century, chronic diseases and home health care have become the focus of medical care. With the rapid advancement in information technologies (IT) in Taiwan, home telecare provides a new service and business model for the care of patients at home. The purpose of this study was to analyze the developmental trends of home telecare industry and its competitive strategies. The structure of the industry, industry environment, and competitive strategies were analyzed. The home telecare project and business model of the industry was also compared. Data collected from literature including journal, theses, books and internet were used for secondary data analysis. Michael Porter’s conceptual model was used as a framework to analyze the home telecare industry. The analysis showed that there were high bargaining power of buyers and suppliers, moderately high threat of new entrants and substitute products or services, and low rivalry among existing firms. Characteristics of the emerging home telecare industry included high uncertainty of the technology, strategy and policy, financial difficulties in cost and funding support, limitation and risk in early development stage, non-standardized products and technique, etc. There were high needs, industry scale, and space of growth in the industry, as well as good advantages and opportunities for the development of the home telecare industry in Taiwan. Difficulties encountered included delayed development of the industry in Taiwan, inadequate attraction of product and technique etc. Competitive strategies involved decreasing bargaining power in clients and suppliers, lowering cost strategies, differentiation in product and service content to increase competitive advantage. Government should actively involved in the development of home telecare industry and set up legal regulations to insure service quality. The findings of this study can be used as a reference for the competitive strategy and development of home telecare industry.

This thesis addresses the hypothesis that a single, waist-mounted triaxial accelerometer (TA) can be used to monitor human movement patterns in unsupervised, freeliving subjects over extended periods, and that it can be used to quantitatively measure parameters that can provide clinical insight into the health status of the subject. A rigorous theoretical and experimental understanding of the signals obtained from a TA is developed. The effect of the placement of the TA device on the waist is explored and a model relating device position to TA signal is developed for a range of postures and activities. A classification framework for movement identification using the signals from a waist-mounted TA is presented. This framework is based on a hierarchical binary processing tree and is designed for real time use. An implementation of this framework for monitoring housebound patients is presented. Algorithms for detecting falls, distinguishing between activity and rest, classifiying transitions between different postural orientations, and for identifying periods of standing, sitting, lying and walking are developed. In evaluation studies performed in controlled laboratory conditions, every algorithm performed with better than 90% accuracy. Once movements are identified, movement-specific parameters sensitive to changes in functional status are extracted from the signal. A two stage methodology for employing the accelerometry system in monitoring free-living subjects is introduced. The first stage involved monitoring specific movements through a directed routine. The second stage involved monitoring of free movement. Signals obtained from the directed routine are used to extract clinically relevant, movement-specific parameters. Signals obtained from the period of free movement are monitored for falls and other abnormal events. General parameters of movement, including energy expenditure, are also measured. The system was evaluated in a series of field studies in laboratory and home environments, in supervised and unsupervised settings, using cohorts of healthy subjects. A pilot trial was conducted in which six healthy elderly subjects wore the TA device for a period of up to three months. The technical performance and useability of the system were evaluated. Clinically significant parameters were measured and the effects of age and health status on the measured parameters were evaluated.